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Patients who listen to medical slang will learn a lot about their doctors’ attitudes towards them
The advent of coronavirus has led to a noticeable rise in the use of jargon. Lockdowns, reproduction number and herd immunity are just some examples of terms that have shot to prominence in 2020. The same phenomenon occurred during the financial crisis years. British writer John Lanchester, commenting on the explosion in jargon at the time, said that “you are left wondering whether somebody is trying to con you, or to obfuscate and blather so that you can’t tell what’s being talked about”. There is some evidence to suggest that people are more likely to use jargon when they feel insecure. A recent study showed how some groups use jargon specifically to make up for having a low social status. One experiment looked at 64,000 dissertations from hundreds of universities in the US and found that those written by students from lower-status institutions used more jargon. In another part of the study, researchers asked participants to pick a pitch for a start-up. When people were put into a lower-status position, they found they were more likely to pick jargon-laden pitches. Unnecessary jargon hurts patients too. Jargon can make non-experts see new technologies in a more negative light.
When new technologies are presented to people using jargon, they tend to see them as much riskier. Jargon is, by definition, exclusionary. This means it can get in the way of understanding crucial information. Jargon poses challenges for doctors and patients who are trying to gain a mutual understanding of what may be wrong. In his book, The Secret Language of Doctors, Brian Goldman, host of the Canadian Broadcasting Corporation’s radio programme White Coat, Black Art cracks the code of hospital slang and takes readers behind the medical curtain. “If you want to understand the culture of medicine, you should pay attention to how doctors and other health professionals talk,” he says. In other words, if you listen to their slang you will learn a lot about doctors’ attitudes towards patients, situations they find frustrating and problems they have with each other. One way to alleviate the problem of jargon in medicine lies with the campaign for “Open Notes”, which advocates for patients to be able to freely access their electronic medical notes. A research paper published in the Annals of Internal Medicine in 2012 described an “OpenNotes” experiment that let more than 13,000 US patients read what their primary care providers wrote about them. In the study, when the note was finalised by the doctor, the patient would be notified by email. The patient could then log in to the doctor’s records from home. The results were striking: Some 81 per cent of patients who saw their records reported a better understanding of their medical conditions and said they were more in control of their health.
Two-thirds reported that they were more likely to take prescribed medication. Some 60 per cent of patients said they would like to be able to add comments to the doctor’s note. Were there any downsides? Between 1 and 8 per cent of respondents reported the notes caused confusion, worry or offence. Up to one-fifth of doctors said it took more time to write up patient notes. One-in-three patients believed that they should be able to approve the notes’ contents, but about 90 per cent of doctors did not agree. At the end of the experiment, 99 per cent of patients wanted OpenNotes to continue, and no doctor elected to stop. In a major breakthrough, Dr Charlotte Blease, an Irish researcher with Open Notes, says the programme has succeeded in harnessing bipartisan support in the US Senate and House of Representatives for the groundbreaking initiative, and was due to become law on 2 November. “During the pandemic, with the added risks of missed appointments and errors driving excess mortality, this is a huge win for patients,” she said.
“On a broad level, it restores a sense of control for patients. And research shows, minorities, older patients, those with fewer years of formal education, report more benefits of reading their notes than everyone else.” The original brainchild of Dr Tom Delbanco, the John F Keane and Family Professor of Medicine at Harvard Medical School in Boston, with whom Blease works, Open Notes, in the form of the 21st Century Cures Act, is set to bring huge changes to medical practice. It will be interesting to see how direct patient access changes doctors’ use of jargon in their case notes. And will it change how they converse with one another? After all, while jargon may be infuriating, it’s also useful. Jargon sums up complex issues in fewer words. This enables doctors to talk precisely to each other about concepts they are familiar with. I reckon jargon-free medicine is some way away yet.