Doctors have been told to speak more slowly and use less jargon when talking to patients because their explanations of illnesses and treatments are too often confusing.
A report by the Royal College of GPs (RCGP) urges the UK’s 250,000 medics to avoid the use of words such as “chronic”, “palliative” and “hospice”, and warns that describing a diagnosis of cancer as “positive” can be misinterpreted as good news.
“Doctors, having spent many years immersed in the biology of human health and disease, may overestimate the health literacy of their patients,” says the report.
Doctors may fail to realise that they have failed to make themselves understood to the patient and should check they have done so by asking the patient to repeat the information back to them if they are unsure, it recommends. Equally, some patients are too embarrassed to ask doctors questions they want answered because they do not want to reveal their lack of understanding of what they have been told or their poor reading skills.
It cites the word “chronic” as an example of where “doctors can unintentionally use words that are unfamiliar to their patients, without realising that the meaning is not clear. Some concepts familiar and obvious to doctors may be alien to patients.” While doctors use “chronic” to mean persistent or long-term, the word is widely understood to mean “severe”, giving rise to a potential confusion.
Previous research in 2012 found that between 15 million and 21 million people in England lack what is called health literacy – the ability to understand what health professionals say or what information leaflets advise and then to act on it. That can involve a patient struggling to comprehend the contents or significance of a letter they receive after visiting a hospital clinic, for example.
Research by the RCGP found that one patient told that tests had confirmed a “positive” diagnosis of cancer wrongly assumed that meant it was good news. A man told to go for a chest X-ray did not have one because he did that know that he should go to the “diagnostics” department and was too embarrassed to ask hospital staff for directions.
In a separate piece of work, a team led by Dr Gill Rowlands, a health literacy expert at London South Bank University, found that almost half the population would fail to understand 65 different patient information leaflets found in GPs’ surgeries and hospital wards on subjects such as healthy lifestyles and why women should have smear tests for cervical cancer.
As many as 43% of people may not understand key information such as correct doses of medicines or a blood pressure reading because of a widespread failure to understand words or numbers.
Patients’ failure to comprehend what the doctor has said or what they have read is important because it can stop people understanding the diagnosis they have just received and also lead to treatment errors, such as misunderstanding or not spotting warnings about medication on an information leaflet inside their box of tablets, the report warns.
Dr Maureen Baker, chair of the RCGP, said: “We owe it to patients to make sure that they are as informed as possible about their own health or condition, but medicine is a complex area with lots of complicated terminology. Wherever possible, doctors should explain and demystify the more difficult terms, for instance, using the word ‘x-ray’ or ‘scan’ instead of ‘diagnostics’ can make a real difference in helping the patient feel at ease and more comfortable about asking questions.”
Don Redding, policy director at National Voices, an umbrella group representing scores of charities, said GP appointments were often too short for patients to understand what they had been told and then take a major decision about what form of treatment, if any, to have, given the risks and possible side-effects involved.
GP consultation times needed to be extended or patients offered one or two advice sessions with a nurse instead to ensure that they understood fully the implications of treatment on offer before they decided whether to accept or not, he said. He also urged the NHS to embrace “patient decision aids”, packages of information used in America to help patients to decide what to do.
“Patients when facing key decisions about their treatment can’t do this in seven-minute GP consultations,” Redding said.
National Voices had also come across examples of patients at the end of their lives who were offered “palliative” care or a place in a “hospice”, but did not understand what either involved. “In these cases health professionals need to go behind the jargon, use other terms and explain in simple terms what they are talking about,” he said.
Joyce Robins, co-director of the patient group Patient Concern, said: “There is a real shortage of doctors, and that means consultations can be rushed.
“Doctors must explain carefully the implications of conditions to patients, but often there is just not time for this.
“It would help if leaflets were also a bit clearer. There is a huge range of material offered to patients at the moment. I think the solution is to design a standard set of clear, concise leaflets for every condition, so no one can fail to understand what they are being told.”
The health minister Dan Poulter, who works part-time as an NHS obstetrician, urged fellow medics to use plain English more often. “As a doctor I know how important it is to speak to patients clearly. Patients need to understand what they are being told and have simple information about their treatment and medicines.”