Lost in translation: the impact of medical jargon on patient-centred care

In the days before BuzzFeed, amusing adverts snapped abroad by would-be photojournalists were a staple of email circulars. Who could forget the Chinese KFC ad that translated “finger-lickin’ good” to “eat your fingers off”, or the Italian campaign for “Schweppes toilet water”?

Of course, you don’t have to go overseas to be met with mutual incomprehension. All you have to do is pop into A&E or make an appointment with your GP and you’ll discover a whole new world of bewildering biomedical terminology, with the added frisson of potentially endangering your health. Alternatively, you could become a health professional yourself, after which you’ll be thrown into a seething morass of integrated commissioning, sustainability committees and pump-priming across the piece.

Or so the story goes. Of course, not every doctor is an HbA1c-discussing, chronicity-mentioning biomedical machine, nor every manager a blue-sky-thinking, granularity-seeking driller-down. But there’s no doubt that the NHS does have a problem with jargon. On the medical side, many patients struggle to understand what their doctors, or leaflets, or letters or pill boxes tell them about their medication, treatment or even test results.

The potential for misunderstanding is enormous, especially for disadvantaged sectors of the population with low digital and health literacy levels. This not only makes it more challenging for patients to communicate their own concerns and perspectives, but can also – and often does – lead to serious adverse consequences for their health.

On the managerial side, it’s no secret that the NHS has a healthy (or otherwise) liking for waffly jargon. Whether touting vague initiatives such as the now-defunct world-class commissioning or talking offline about negative uplifts (eg funding cuts), NHS managers are notorious for their mastery of nonsensespeak.

Perhaps it was inevitable that the world’s fifth largest employer should develop its own particular way of abusing the English language. Fortunately, there is a light-hearted side to it all, with NHS staff and others posting lists of their most-despised terms. It’s less amusing, though, when considered as a symptom of a managerial, target-driven culture that, by undermining patient-focused care, has contributed significantly to major disasters, such as Mid Staffs.

It can also be argued that managerial jargon is more than just a symptom of that culture, since it encourages managers to think of healthcare in terms of budgetary and operational challenges rather than patients. (Wittgenstein once warned of “the bewitchment of our intelligence by means of our language”.) It also discourages patients from participating in public consultations, since the documents involved are so impenetrable.

This decentering of patients from their own care is the real problem with NHS jargon, both clinically and in management. The precise jargon involved is different in each case, and arguably more useful (because more precise) in the medical context – but medical jargon is no less obscure to the uninitiated, and no less risky in terms of its potential impacts on patient-centred care.

In neither context can the jargon problem be solved simply by banning the use of particular terminology (though jargon blacklists can be a good start). Part of the wider difficulty lies in the inherent tendency for professions to establish their autonomy through forms of language that are transparent only to fellow professionals.

As long as doctors and managers feel they have to stake out their territory in regard to patients and doctors, respectively, jargon will continue to be a badge of honour. Conversely, greater clinical/managerial collaboration and deeper patient involvement in healthcare could cut jargon off at its source. And jargon is one area in which cuts should be wholeheartedly welcomed.

This article is reproduced with permission from the Guardian, where it appeared on Tuesday 1st July 2014.

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