Are patients more at ease when you use familiar words?
■ A study suggests that, particularly for sensitive subjects, patients like to hear their language reflected back.
By Victoria Stagg Elliott — Posted Jan. 17, 2005
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When physicians match the vocabulary patients use to describe their symptoms, patients report higher levels of satisfaction, distress relief and intent to comply with recommendations, according to a study published in the December 2004 issue of Family Practice.
Researchers at Guy's King's and St. Thomas' School of Medicine in London randomized 60 patients with problems of a sexual or excretory nature who went to an inner-city primary care physician. The doctor spoke to half of the patients using medical terminology. For the other half, the physician matched the slang and euphemisms used by the patient. Patients in the matched vocabulary group had statistically higher scores for the Medical Interview Satisfaction Scale. The doctor's satisfaction with the interaction was unchanged.
"Patients like matched language," said Jane Ogden, PhD, one of the authors and a professor of health psychology. "Reflecting language is one way that you make people feel comfortable in normal day-to-day conversation, and there's no reason why the consultation should be any different."
Patient-physician communication experts praised the study for its unique design and approach.
"Physicians are the experts in the science, and patients are the experts in themselves. If we can come toward a middle, and speak the same language, then we'd both be happier," said Alan Rubin, MD, who is a general internist and serves as the director of the doctoring skills program at the University of Vermont College of Medicine, Burlington.
Health literacy advocates also complimented the paper for suggesting a possible strategy for physicians to communicate in a clear and meaningful way. Low health literacy long has been viewed as a significant barrier to good health. The American Medical Association Foundation has run numerous projects on the issue, and the Association has policy recognizing the problem. In November 2004, the AMA Press published Understanding Health Literacy: Implications for Medicine and Public Health.
"The results aren't surprising," said Ruth Parker, MD, chair of the AMA Foundation's Health Literacy Initiative and professor of medicine at Emory University School of Medicine in Atlanta. "What is surprising is how often those of us who provide medical care speak in languages that patients don't understand."
Not always the best route
Experts and the authors of the study noted, however, that matched language is not always the way to go. This study looked only at discussions of a sensitive nature, and experts said it might not be easy to generalize results to other situations.
"The conclusions of this study are very dramatic and important but may not actually represent truth in the universe," said Dean Schillinger, MD, advocacy fellow at The Open Society Institute and associate professor of medicine at the University of California, San Francisco and San Francisco General Hospital.
Also, sometimes a patient's vernacular is too far removed from a physician's to be appropriate -- including foul language. Matched language also might be more appropriate for the discussion rather than the conclusion.
For example, a paper by the same research group published in the June 2003 Family Practice found that patients preferred medical terminology over lay terms when it came to a diagnosis. In that study, the labels provided the patients with validation that they were truly sick and improved their confidence in the doctor. For physicians, these labels provided more of a sense of professionalism.
"When you get to diagnosis, you probably do want the medical language," Dr. Ogden said. "But when you're exploring the problem, you probably want the lay language."
Experts suggested that this means communication is far more complicated than simply parroting what a patient says. There are times to use a patient's words, but there are times when medical terminology must come into play.
"It's a complex phenomenon," said Paul Haidet, MD, MPH, a staff physician at the Michael E. DeBakey Veterans Affairs Hospital in Houston. "In general, patients want to go to their doctor and have their doctor have professional expertise and competence. But as the doctor relates to them, they want someone who can relate to them on their terms."
Experts also point out that, as intriguing as this study is, it's very small and flawed. The sole physician-researcher is also the primary author, and some feel this is a conflict of interest. Additionally, communication experts also offered that the improved satisfaction might have less to do with the physician's use of language and more to do with the other factors that go along with this consulting technique.
"Something else is probably happening," said Forrest Lang, MD, professor of family medicine at East Tennessee State University in Johnson City. "Not only is there less confusion when you use the patient's own words, but when they hear their words coming back, it tells them that the physician was listening. That makes a connection that isn't there when one person is speaking in medicalese and the other is speaking English."