werner@aecom.UUCP (Craig Werner) (10/25/85)
((()))
A Piece of My Mind
JAMA, Oct. 18, 1985 254:2134.
Layman's Terms
Communicating well with patients can be a challenging affair.
Patients often appeal to their physicians "to talk in layman's terms."
This idea, reasonable on the surface, can actually be part of the problem
that prevents their clear understanding of their conditions.
I would submit that emplying layman's terms is not the best means
of discussing medical problems with patients. The terms themselves come
from suprisingly diverse, sometimes untraceable sources. A common medical
term over time and use may degenerate into a catch-all layman's term, or a
common-use phrase may be falsely elevated to the "status" of a medical or
scientific term.
Let me use "pinkeye" as an example. Its definition is "acute
contagious cunjuctivitis," but its meaning has become blurred (no pun
intended). I saw a patient with bilateral viral conjuctivitis and told
him that he had a contagious infection. He responded, "Thank goodness
it's not Pinkeye!"
A pediatric nurse with bilateral bacterial conjuctivitis said "I'm
glad it's not pinkeye so I can go back to work in the nursery."
A woman with viral conjuctivitis wondered if she had pinkeye. When
I asked her what she meant, she answered, "Pinkeye is what you get when
you use your eyes too much."
A patient with severe iritis announced, "I have pinkeye." Yet
another patient clutching his hand over his eye groaned, "It's pinkeye!"
Angle-closure glaucoma was closer to the truth.
Finally, "My eye doctor told me my lazy eye would make me more
subject to pinkeye."
That last statement raises some questions. What is a lazy eye? Is
it a more hyperopic eye? Is it an esotropic eye with or without good
vision? Is ti an amblyopic eye, or has it been traumatized, again with or
without normal vision? Who is the patient's eye doctor? His optician?
His optometrist? His opthamologist?
Obviously, opthamologists aren't the only ones who have problems
with layman's terms. I can imagine that dermatologists spend much of
their time sorting our their patient's confusion about how the rash the
have self-diagnosed as "eczema" is actually due to the "hypoallergenic"
lotion they use so liberally.
Perhaps pediatricians must explain how every cold is not "strep
throat" that requires an injection of penicillin.
Neurologists must be wary when using the term "concussion." Its
definition is "loss of consciousness as the result of a blow to the head,"
but to many lay persons "concussion" has come to mean anything from a
skull fracture with coma to a minor bump on the head.
Meanings of terms change and was once precise may no longer be.
The art of communication in medicine requires clear, accurate speaking at
the patient's level of understanding. This is not accomplished by talking
in layman's terms. The burden is on us as physicians to reeducate our
patient about his terms when they no longer exactly define what his health
problems are. With the better understanding this communication allows,
the patient will probably think that he has a good doctor who talks to him
in "layman's terms."
Donald L. Blanchard, MD
La Grande, Oregon
--
Craig Werner
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