No Australian doctor is fluent in only one language, regardless of their cultural heritage. “Medical English” has been said to have a vocabulary the same size as some European languages and the latest edition of that famous medical dictionary, Dorland’s, runs to 2,175 pages (i), compared to the Macquarie’s 1,940 (ii). Medical English is a language all of its own that is exclusive and difficult to learn. Which is why so many freshly minted doctors look dismayed when they are told they can’t use their brand new language on people who don’t understand it.
Patients generally don’t speak Medical English and will look baffled at the sort of jargon, acronyms and technical terms with which doctors are quite comfortable. We learn to communicate efficiently and effectively in high pressure situations, where describing a patient as “an LOL in NAD after a FOOSH” quickly conveys the message that this particular little old lady is in no apparent distress after falling on her outstretched hand and so treatment can proceed accordingly. Such shorthand communication might be acceptable between members of the health care team but would not be understood by the LOL herself. And, sadly, the acronym “LOL” is now more likely to signify to current medical students that you are either “laughing out loud” or expressing “lots of love”, neither of which would be ideal in the situation.
A recent paper in The Medical Journal of Australia drew attention to the prevalence of jargon and acronyms in surgical consent forms in a public hospital in Adelaide. The authors (Mark Siddins, Elizabeth Klinken and Lee Vocale) found that only 18.5% of forms described the procedure in plain language, with 15.3% using just an acronym to describe a significant component. Admittedly, this was in a urology unit and terms such as TURP have become commonly used by the general population, even if their actual meaning is poorly understood. Simply explaining to a patient that their “turp” is actually a “transurethral resection of the prostate” adds little value, as would pointing out that “laser” actually means “light amplification by stimulated emission of radiation”. The procedure really needs to be explained in plain language with diagrams and time for questions.
The study design didn’t capture what the patients were told verbally, only what was recorded on the consent documentation. But as the authors comment: “... we believe that a consent process is not acceptable unless verbal discussion is augmented by relevant written information. Specific documentation provides patients and others an opportunity to reconsider key points privately, or share information with “significant others”. It also ensures consistent and transparent provision of information”. This is especially important when procedures carry a significant degree of risk – only 4.1% of consent forms in the study mentioned relevant risks.
The Adelaide authors state their belief that consent forms for elective procedures should include – at a minimum – a plain language description of the procedure along with its purpose and intended benefit, as well as information regarding material risks and established alternative treatment options. This aligns well with the NHMRC’s 2004 guidelines on providing information to patients (iv) which recommend that the whole communication process (not just the written part) convey:
- the possible or likely nature of the illness or disease;
- the proposed approach to investigation, diagnosis and treatment;
- the expected benefits;
- common side effects and material risks;
- whether the intervention is conventional or experimental;
- who will undertake the intervention;
- other options for investigation, diagnosis and treatment;
- the degree of uncertainty of any diagnosis arrived at;
- the degree of uncertainty about the therapeutic outcome;
- the likely consequences of not choosing the proposed diagnostic procedure or treatment, or of not having any procedure or treatment at all;
- any significant long term physical, emotional, mental, social, sexual, or other outcome which may be associated with a proposed intervention;
- the time involved; and
- the costs involved, including out of pocket costs.
Although this is a huge amount of information to be successfully conveyed, it is in line with community expectations as to how doctors will perform. Obviously, the completeness and depth of detail will vary depending on the individual case.
Dr Siddins and his colleagues make the valid point: “The primary purpose of consent is not to minimise the risk of subsequent litigation, but to formalise the process by which patients (or those responsible for their care) are empowered to make appropriate decisions regarding treatment options” (iii). Prudent proceduralists would do well to ensure that they are communicating with their patients in easily understood, jargon-free language backed up by printed materials that are similarly useful to the patient.
Author: Professor Stephen Trumble Chair, Editorial Board Specialist Management Services
i Dorland's illustrated medical dictionary. Philadelphia, PA : Elsevier Saunders, 31st ed. 2007
ii Macquarie dictionary. Sydney : Macquarie Dictionary Publishers, 5th ed. 2009
iii Siddins ST, Klinken EM, Vocale LR. Adequacy of consent documentation in a specialty surgical unit: time for community debate? MJA 2009; 191(5): 259-262
iv General Guidelines for medical practitioners on providing information to patients. Canberra: National Health and Medical Research Council, 2004