I was talking with a nurse educator about the uncertainty and difficulties nursing students can face as they learn the specialized language of medicine. She said,
“Because this is a different language. It’s very difficult for a student to come in and talk ‘urination.’ They’re used to saying ‘pee.’ And yet their patients aren’t going to say, ‘I urinated today.’ They’re going to say ‘I peed today.’ [So students wonder] how do I talk to you, how do I talk to you?”
One of the biggest trip hazards in health communication is the specialized language used in medicine. Medical information, terminology and forms can be intimidating for anyone who doesn’t deal with them regularly.
By now you know the benefits of clear and timely patient-centered communication.
As if the ‘clear’ part wasn’t tough enough, you usually are communicating under serious time constraints.
This article is to help you start to become aware of your own language—and your patients’—so you can make some progress on that question: How do I talk to you?
We make words do work
So let’s stop and think about things we tend to take for granted when we speak. It’s important to remember a few things about people’s use of language
We all use language every day in complex ways. We are often unaware of the sophisticated uses of language in our everyday lives, as they are habitual or unconscious.
The groups we’re a part of have an enormous impact on the words we use. They shape what counts for us as normal or common language. The way our words have been used by people in the past—and by whom–influences how we use them in the present.
Think of language as something in our human tool kit. It’s one of our most powerful tools, and we’re always using it to make things happen. We make our words do work.
Potty talk
The nurse educator and I continued to talk about the shift in purpose, thinking, and context involved in the shift in language from ‘pee’ to ‘urine.’
She added that there’s another potentially earlier step here. She pointed out that parents may teach children the term ‘pee-pee’ in the context of ‘potty training.’
Let’s think about pee-pee for a moment.
In a language sense, pee-pee does specific work. It gives a (onomatopoeic) label to a body function that, for the child, has been unnamed until now.
But now, this function needs a name! Because it’s an important topic in the household!
The child transitions from diapers to toilet use, through learning to be aware of and monitor this body function. And that monitoring, that awareness, is supported by talk. Namely, everyone’s intentional use of the term pee-pee.
The word does its job. The child is potty trained. Eventually, though, it outlives its usefulness, as the child learns that big kids don’t say pee-pee. When it ceases to be useful to the child, it’s dropped for the grownup version, pee.
Like pee-pee, pee works just fine. Unless you go into medicine.
It’s not that there’s anything wrong with the word pee.
And it’s not that non-medical professionals couldn’t understand the word urinate.
It’s more that we will use a term that does the work we need it to do, until we have a good reason for changing it.
Words working in the patient encounter
In 1977, Labov & Fanshel wrote Therapeutic Discourse. It’s an entire book dedicated to the analysis of 15 minutes of actual speech between a patient and her psychotherapist. This book drew major attention to the work done through the words people use in health-related interactions.
It was followed a few years later by Mishler’s The Discourse of Medicine, which underlined the significance of the ways people use language in health-related interactions:
“The point of departure for this research is to treat medical interviews as a form of discourse, that is, as meaningful talk between patients and physicians. Further, this discourse is viewed seriously; it is not ‘mere’ talk, but the work that doctor and patient do together as an essential and critical component of clinical practice.”
We all have been socialized into various ways of thinking about and talking about health, well-being, and health care.
It can be easy to take for granted that the people around us share our linguistic and cultural practices. In health care, the people you work with use the same kinds of language you use, for the same reasons you use it (more or less).
When it comes to your patients and their families, it can seem natural to compare their ways of talking, thinking about, and doing health with yours. Or maybe with the ‘average’ or ‘mainstream’ patient.
Don’t let that difference become an obstacle in your care relationship.
What you can do
It can be tempting to think of medical terminology as a different language. Where, if you put it into a translator app, it would come out in flawless patient vernacular.
Yet having that kind of app isn’t exactly a solution.
Sure, pee-pee, pee, and urine are different terms for the same thing, at least on a surface level.
But they do different work. They are used for different reasons, for which they are entirely adequate. One is not better than the other.
I want to return to what the nurse educator said when talking about her students concerns: how do I talk to you? how do I talk to you?
Here are three things to remember, and some phrases you might consider:
Your patient’s language
Approach your patient as someone who uses language in sophisticated ways in their everyday life. Speak to them with this assumption in mind. An important approach in patient communication is connecting the health information you hold, to what the community you are trying to reach already values. And that includes the language they already use.
Your language
In whatever language feels natural to you, mention that you’re aware medicine has some of the most unusual language out there, and that it took you years to learn it. Now you’re surrounded all day by people whose jobs require this specialized language use. This can be a drawback in conversations with people whose jobs don’t depend on speaking this same language. But you’re doing your best to be aware of when you’re using insider terms.
The work you’re doing together
Looking at patients’ knowledge and language use as a ‘gap’ between you, can imply that your position is the one to be reached. In this view, progress counts as how far patients can make it in your direction.
Mention that, as you talk together, you the practitioner are drawing on all your medical experience and education, and they the patient are drawing on a lifetime of experience with their body. You both have your areas of expertise. Assure them these are complementary—not competing–knowledge bases. Both of you are necessary for this to work.
The benefits to paying attention to your language are that you can make adjustments. So you can speak in a way patients will understand. The benefits of paying attention to your patients’ language includes learning what matters to them, and therefore, where you can start to build the bridge between you.
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