“Hmm, alright. So Mrs. A has a history of hyperlipidemia, hypertension and osteoporosis and is here today to follow up on her management of hypertension since we just prescribed her metoprolol two weeks ago. It seems like she told the nurse that she has a fever and has complaints of rhinorrhea so let’s not forget to ask her about that.” Jeff’s gaze shifted from the screen and towards me. “What questions do you have so far?”
Huh? Just like that, my confidence took a nosedive. Jeff could have spoken to me in Mandarin, and I would have been no better off in understanding what he had just said. Suddenly, I felt very small in my new white coat. Rhinorrhea sounded pretty severe. How dumb would I sound if I asked Jeff how long the patient had to live? I thought.
I reflected on orientation week two months earlier when our physician mentors discussed how learning medicine was like learning a new language, saturated with its own set of unique vocabulary. I didn’t fully comprehend how true this statement was until Jeff spoke, hitting me with a flurry of jargon that I made a mental note to Google later. I became aware of how large the gap was between our medical knowledge. Despite only being two years ahead of me in training, behind his eyes lay a reservoir of knowledge and vocabulary, passed down from ancient and modern civilizations alike, that was still foreign to me. A surge of excitement coursed through me as I realized that I would soon be in his shoes, fluent in the language of medicine, in just a couple of years.
Medical English is more than a cultural nod to the history of medicine. In my second year, I have become increasingly aware of how medical topics require a greater vocabulary to adequately describe and convey the granularity within medicine. For example, the public uses the term “heart failure” to describe a dysfunction in the heart, while medical providers may use the term “HFpEF” (heart failure with preserved ejection fraction) or “HFrEF” (heart failure with reduced ejection fraction) — terms nuanced by their differences in pathophysiology, clinical manifestation, prognosis and management.
Unfortunately, such medical language can be extremely difficult for patients to interpret. A landmark study in 2003 found that more than one-third of Americans have limited health literacy skills. These Americans lack the capabilities to understand healthcare information and adequately navigate through our increasingly complex medical system. Numerous studies demonstrate this link, finding that deficiencies in health literacy contribute to poor health outcomes and health disparities. Perhaps this link is most evident when we look at patient education materials — the average American reads at an 8th-grade level, yet more than 75% of patient education materials are written at a high school or college level.
Patients that are more knowledgeable of their conditions are more likely to adhere to their treatment plan and also have better overall outcomes. Therefore, it is our role as future and current medical providers to not only diagnose and treat but to also educate and empower. This role is becoming increasingly important for providers to consider as patients are gaining greater access to their medical records. For a patient, it can be difficult and even scary to translate the “med-speak” that they may encounter on their charts. It is imperative that providers be mindful of ensuring their patients are adequately informed.
That being said, this process is very individualized. Patients can lie on different areas of the spectrum regarding their biomedical knowledge and it is oftentimes difficult to assess where one lies on that spectrum. Patients are already in a very vulnerable position and it can be embarrassing for them to ask what they may perceive as “dumb questions.”
Contrarily, a provider that is overly eager to explain concepts to patients may come across as patronizing. This becomes even more complex and challenging when considering the limited time that providers already have with their patients due to administrative tasks. Adding even a couple extra minutes per patient can take up an entire day for an already overworked professional.
Medical students, on the other hand, do have this time and are in the perfect position to help fulfill this role. This provides an opportunity to reinforce our knowledge base and improve our patient communication skills, while also providing a beneficial service that our superiors may not have the time for. For patients, these interactions could drastically improve not only their medical literacy but trust in their care team as well.
Just recently, I called a patient that had visited the clinic to share lab results. She wanted to “get a second opinion” after being skeptical of a plan from her previous doctor. Mrs. B was a mother in her 30’s with a friendly but reserved personality who had few interactions with the medical system, outside of her OB/GYN, prior to the appointment.
On the call, I shared that her LDL cholesterol was “a little high,” but it wasn’t anything to be concerned about right now. I heard a short “uh-huh,” and as she thanked me for sharing these findings, I recalled how there were moments during her clinic visit when she revealed subtle hints of confusion, like when she was told her blood pressure. While “high cholesterol” is an often-heard phrase, I had a feeling that Mrs. B may not understand how to interpret it. I decided to ask, “What is your understanding of cholesterol, and what questions do you have about these results?” After a brief pause, she opened up and quietly responded, “Would you mind explaining what this all means?”
I felt a burst of delight at the opportunity to share what I’d been learning in medical school. As I enthusiastically affirmed and answered her questions, I sensed that I had built greater trust with Mrs. B. Her questions soon transitioned to other topics that she was uncertain of, including the merits of the COVID vaccine and how her medications worked. By the end of our call, I could hear greater comfort and confidence in her voice. While the call took a couple more minutes than I had originally expected, it had filled me with a sense of purpose and was the best part of my day.
As I’ve made progress in my medical journey, I think back on the excitement and apprehension of my early clinical experiences. I chuckle when I think about my reaction to Googling “rhinorrhea.” Now, when I hear the first-year students struggle to pronounce words like “erythematous” or “hydrochlorothiazide,” I’m reminded of how much I’ve learned in just the past year. However, observing third- and fourth-year medical students give oral presentations with a complete assessment and plan, I’m reminded of how much more still lies ahead. As I continue to learn the language we adopt, I hope to create more moments of understanding and trust that have made my medical journey all the more rewarding.