“Are we using technical terms that are not appropriate for any patient?”

“Are we using technical terms? That are not appropriate for any patient?”

This was a physician group administrator talking with me on the phone. This group had reached out to me, and I was asking about the problems they were facing. This was one of the first things the administrator said.

I hear versions of this question from many providers.

You know by now that high quality patient-provider communication is a key determinant of a patient’s health.  But we all – patients and providers–have been socialized into various ways of thinking about and talking about health, well-being, and health care. Part of your role as a health professional is to recognize every one of us has what we consider ‘normal’ or natural ways of talking about health.

This article will help you start to become aware of your own language—and your patients’—so you can be more effective in the ways you communicate with all patients.

First, don’t beat yourself up

It can be so tempting to think about communication as simply the transfer of information.

I have this thing–it’s information!–and I want to give it to you so you can have it, too.  So I’m going to communicate with you. I’ll talk to you, or give you something to read or look at. Et voila!

Kind of like sharing chocolate or digital photos of your pets. I have it, and I give it to you, and now you have it too.  Except ideas and information don’t travel between people as neatly as pocket snacks or funny animal pictures.

I’ve written before how one of the biggest trip hazards in health communication is the specialized language used in medicine. Like the physician group administrator indicated, this specialized language of technical terms isn’t appropriate for any patient – regardless of their social and cultural background.

But the communication difficulties aren’t all limited to those times providers are talking with patients.

Across–and within—groups of health professionals, the terminology is different. IPE (interprofessional education) is growing in importance, as teams learn how to communicate across specializations and roles. Consider IPE events, when you might have trouble understanding your colleagues in another specialty.

How about administrators, educators, and policy activists?  The topics are different. The knowledge, assumptions, and motivations are different.

In short, people’s ways of thinking, talking about, and ‘doing’ health, wellness, and health care are different. We are socialized into the ways we talk, think, act, and more. And over time we come to inhabit these ways as ‘normal.’

In health communication, we want people to understand something that we believe is important to their health and well-being. There are several steps to this process.

Being aware of your normal – and what you take for granted – is a massively important first step. So let’s take a look at what you’re taking for granted when it comes to some of the words you frequently use.

What does coffee mean to you?

It can be tricky to stand back and look at your own language, but that’s why I’m here. And I’m going to turn to one of my favorite sages, Jim Gee. Gee is very good at exposing some of what we take for granted when we communicate, read, watch, play video games, and more.

(If you’re hardcore into thinking about communication as a simple transfer of information, maybe don’t read this part.)

Let’s see Gee pull the curtain back on what we take for granted about something as seemingly simple as what words mean. 

“Meaning is not a thing that sits fixed in the mind (as a ‘concept’ with fixed boundaries, for example). It is not something that sits in dictionaries. Nor does it reside in the minds of experts and ‘well-educated’ people to the exclusion of others. Rather, meaning is primarily the result of social interaction, negotiations, contestations, and agreements among people. It is inherently variable and social.” (p.21)

For nearly a century, researchers concerned with language have known that “The meaning of words is always affected by context” (Gumperz). That means, among other things, that researchers  turned attention from the study of language in general toward language in use. So, rather than examining language in abstraction from its actual everyday use, researchers conducted detailed examination of real situations. Et voila, researchers began to find that the various contexts that surround us when we talk, read, listen, write are what gave language its meaning and significance.

To put another way, in order to understand the particular meaning and significance of a word or phrase, how it functions, and its practical uses, we would have to know the context in which it was used.

Our own experiences tell us that the same word or phrase, spoken in different situations, can have different meanings and significance. This is because meaning is locally made. Take coffee, for instance, again turning to Gee:

 “In fact, most words do not have fixed meanings. Take even so simple a word as ‘coffee’ (Clark 1989). If I say, ‘The coffee spilled, go get a mop.’ I am talking about a liquid. If I say, ‘The coffee spilled, go get a broom,’ I am talking about beans or gains. If I say, ‘The coffee spilled, stack it again,’ I am talking about tins or cans. If I say ‘Coffee growers exploit their workers,’ I am talking about coffee berries and the trees they grow on.”

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Being on autopilot

The funny this is, we know all this. We just don’t often have to stop and think about it. Like I said, we are socialized into the ways we talk, think, act, and more. And we tend to work with, hang out with, or otherwise be surrounded by folks who talk, think and act in ways similar to us.

Much of what we do with language escapes our conscious awareness. We rely on assumptions, and ways of talking, acting, and being, that we use almost automatically.

That’s not to say we’re doomed to life-on-autopilot, or that the meaning of everything is totally up for grabs (though sometimes both of those things feel true).

It might help to think of words and phrases in everyday use as carrying general meanings around with them.  The many possible meanings of the noun coffee, for instance. You know about all of the ones that were mentioned and more.  When we are in conversation, or we read or watch something, we choose from among these possible general meanings based on our specific situation.

In other words, we choose one meaning, from among all the potential meanings we know a word may hold, by using cues from our specific situation.

The problem comes when we think other people share our same meaning. And this is easy to do, because as I pointed out earlier, we are generally surrounded by folks who more or less do share our same meaning.

You have power here

Where a conversation occurs influences the meaning people make of the conversation, its function, and the significance people attach to it (as well as to the words and phrases that tend to be used).

Why is this good news?

Because you are there. You and your patient. This is great because you get to be clear with each other about what words mean.

Like what?

• medical jargon
• sound-alikes
• figurative language, especially metaphors
• terms that have one meaning in everyday life, and a different meaning in a specialized context (like “critical” and “orientation”:)
• quirky names that pharmaceutical companies give their products

But wait, there’s more! As I’ve pointed out before, in the patient encounter, you have first say in determining what’s on the conversational table (and what isn’t). Another way of putting this: you have more relative power to make topics talk-about-able. So use that power to find out what you both are thinking about the meaning of terms.

• Check for your own understanding of their perspective. “If I hear you right, what you mean is this…”
• Use your patients’ words back to them. As closely as you can get to what your patient actually said. “I heard you call it x.”
• Ask clarifying questions about differences in meaning. “You mentioned x. Tell me about that.”

Your patient conversations are places where words have meaning. So don’t let autopilot take over. Because trouble comes when you and your patient do not share an understanding of the meaning of a word.