In the Hippocratic Oath, we vow to do no harm. This concept helped lead me to a career in family medicine because I was concerned by what can become lost in translation as we intensify the medical care we administer to patients. I continue to prioritize in making sure my patients understand their diagnoses and treatment plans to the best of their abilities or wishes.
Medical jargon is usually first to blame for the verbal disconnect between patient and provider. I remember an exercise during first year of medical school during which we were practicing avoidance of medical jargon in patient-doctor conversations. Despite the intention of the activity, I still remember how we failed to avoid accidentally sprinkling terms into these pretend conversations, such as “glucose” instead of “sugar,” or “renal” instead of “kidney.” It is hard to believe that this was only after being in medical school for a few months.
Seven years later, letters on the license plates of cars driving in front of me now automatically have medical meaning: CBC is a blood test, IIH reminds me of idiopathic intracranial hypertension, C3 is a complement protein. As in any field, it is difficult to step out of a mindset or way of speaking while immersed in it. However, this should not prevent us from remembering that our responsibility is not to talk to patients but to communicate with them.
The medical system already lacks enough intuition for patients as it is. For instance, a positive test result is often actually bad, and a negative result is often good! Each medication has multiple names — I know someone who was doubling one of her medications because she was taking the brand name and the generic version at the same time. What about how a sustained-release (SR) formulation of one medication lasts for 24 hours, but the SR version of a different medication is supposed to be taken twice daily? Speaking of which, some patients naturally assume that “twice daily” means two doses every morning rather than one dose every 12 hours.
The health care system is quick to label patients as “nonadherent” or interventions as “ineffective” and hesitates to examine the barriers. Looking more closely, you might learn that your patient’s condition is undertreated because he is spreading out his medicine to cut down on cost. Or that your patient with congestive heart failure remains fluid overloaded because she did not know that sodium is another term for the “salt” that you advised her to reduce in her diet. Maybe your patient is understandably scared and confused because the MRI scan you ordered for her back pain happens to be scheduled to take place in the cancer center area of the hospital. Or perhaps your patient isn’t testing his blood sugar as advised because he works third shift so “fasting morning blood sugar” doesn’t have a true meaning to him.
Time is precious during the short appointments that we have with people, and patients and providers alike wish for more of it in order to have more effective and fulfilling interactions. However, let’s give this time to the patients, the people we are serving. Rather than talk, try to listen. You can still consider tests, procedures, more medicine, and specialists, but the answers to your questions may very well be right in front of you. Instead of always trying to move forward, we need to sometimes just take a step back.
Samantha Eksir is a third-year resident with the Duke Family Medicine Residency Program. Email samantha.eksir@duke.edu with questions.
Editor’s note: Duke Family Medicine residents guest blog every month. Blogs represent the opinion of the author, not the Duke Family Medicine Residency Program, the Department of Community and Family Medicine, the Duke University School of Medicine, or Duke University.