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Wednesday, January 18, 2012

Translating Docspeak

My car was running a little funny the other day, so I took it to a local mechanic.

I know next to nothing about cars. This is not something I'm proud of, but it's the truth. So I'm completely at the mercy of the mechanic to fix my car, and because I know so little, my ability to assess the honesty and validity of the mechanic's diagnosis is severely limited. It's not a good spot to be in.

I took my car into the shop and left it for an evaluation. I got a call later in the evening from the mechanic.
This was our conversation (or my recollection of it at least)

Me: Hello
Mechanic: Hello. So I've taken a look at your car and I think I know what the problem is.
Me: Oh good! That was quick. I'm glad you got to the bottom of it. So what's the problem?
Mechanic: Well your computer said it's a P0300 problem which means that you're having a random misfire.
Me: Um. OK. I'm not sure what that means, but I trust you. So can you fix it?
Mechanic: Well, yes I can, but ya see, the spot I need to get to is behind the fuel injection block and it's buried deep behind the cylinders and I'd have to take off the whatcha-ma-call-it cap to get to the flux capacitor to remove the belt and then replace the spark plug with a widget.
Me: Oh I see. (I have no freakin' clue what that means) But can you fix it?
Mechanic: Yeah, but I gotta get behind that fuel injector...car part... widget...new flux capacitor.
Me: Fine. How much will it cost?
Mechanic: Hmm.. I think about $500. So do you want me to fix it?
Me: Go for it. I'll pick it up tomorrow.

So that was our conversation, as I remember it. I consider myself a pretty well versed guy, but at that moment I felt completely stupid. The mechanic was speaking English, but whatever he said to me sure sounded like some Greek mixed with some Chinese and some Back to the Future. How could I make an informed decision if I didn't understand the problem and my options? I had no choice but to trust the mechanic and to let him handle the problem as he saw fit.

When I got off the phone, I thought to myself, "Wow. That must be what patients feel like every day."

I've seen this scenario play out too often on the wards in dealing with a matter far more important than a car - peoples' health.

What does one say when a doctor says to you "you've had a myocardial infarction caused by years of atherosclerotic plaque deposition in your coronary arteries. We'll need to perform a CABG (cabbage) to bypass the stenotic vessels so that your myocardium can be perfused again"?

Or, "we're going to do an SI-joint nerve ablation first and then place a stimulator device rather than a PCA... does that sound good?"

Even simple words that medical folks use every day, like "biopsy" is not part of the lexicon of a great number of people. I remember on pediatrics we rounded on young teenage boy who had a large mass in his brain that had no diagnosis. We wanted to biopsy the mass but the surgeons were hesitant. The patient waited in the hospital for a week while we deliberated, and every morning during rounds we'd report to the mother of the boy that we wanted to do a biopsy on their son. She nodded but looked confused every time. Then I realized, she didn't know what biopsy meant. Finally, my attending realized this after a week and said, "We're going to go into your son's head surgically and take out a small piece of his brain to look at under the microscope."

This kind of translation from doctor-speak to everyday English is what is sorely lacking in so many medical interactions. In medicine, we get so used to using our own parlance that we forget that the rest of the world does not speak in our tongue.

Patients come to doctors to find out what the problem is and then to fix it. There is therapeutic value in getting a diagnosis. When doctors don't simplify their language so that the average patient can understand what the problem is, they do them a great disservice. 

My hospital goes through great pains to make sure that Spanish speaking patients have translators in every interaction so that they can be adequately informed of their medical status and care. This is the right thing to do. But perhaps we need English-to-Doctor-speak translators as well to ensure that the majority of patients actually know what their problems are too. That's actually a role I think medical students can play. Only a year ago, we were non-speakers of Docspeak, so we have all these new words in our lexicon but we still remember what it was like to speak without medical jargon. We can play the role of translator if we want.

But that doesn't solve the problem. Doctors need to make a greater effort to ensure that their patients have a basic comprehension of their problem. That might mean slowing down, or taking an extra second to rephrase what one wants to say.  Or even spending a few minutes doing a little teaching and patient education. I don't think that's asking too much. 

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