n elderly woman was hospitalized with a hip fracture. When a nurse came in to check on her, the woman suddenly became hysterical.
“What’s wrong?” asked the nurse.
“The doctor said I’m going to die and the body snatchers are coming after me!” replied the woman.
The nurse hurried out of the room and caught the doctor before he left the unit. “What did you say to that patient?” asked the worried nurse.
“Oh, I just told her there’s nothing more I can do for her, and I’m going to send the bone boys in.”
Whether the story is true I don’t know; my mom heard it in nursing school. Regardless, it illustrates the importance of word choices in medical settings. Some doctors are deft at communicating with patients. But it’s no secret that many are not, often using complex medical jargon that average people (even highly educated ones), let alone know to apply to their own care. In a 1989 article in The Journal of Political Economy, three economists coined the term “the curse of knowledge” to describe such situations, ones in which an expert can’t understand how a person without similar high-level knowledge hears and might respond to an explanation, because high-level knowledge and its vocabulary removes the speaker from being able to communicate simply.
This isn’t unique to doctors. It applies to anyone who’s an expert on anything, from Mustangs to merlot to meteors. In science and medicine, falling prey to this curse of knowledge can have especially devastating consequences. For example, our world faces a number of global scientific crises, including climate change. If scientists can’t communicate these problems to people in easily understood ways, resolving these problems becomes difficult, if not impossible. In medicine, the effects usually hit home individually. When patients don’t understand what their doctors say, whether it’s how to take a new medication or what to do before major surgery, they can get sick, or even die.
There are those trying to reverse the knowledge curse. In 2009, Alan Alda (of M*A*S*H fame) helped start the Alan Alda Center for Communicating Science as part of Stony Brook University’s School of Journalism. The center’s mission is to train scientists, as well as medical students, to “communicate more effectively with the public, public officials, the media, and others outside their own discipline.” This is accomplished through lectures, workshops, and even improvisational theater games. To help scientists learn to talk to the youngest of citizens, there’s also an annual competition called The Flame Challenge. It started with Alda’s own childhood question: “What is a flame?” Now, 11-year-olds from around the world submit their own questions, and scientists send in either video or written answers to be judged by 20,000 kids. “What is sleep?” was the 2015 question.
For doctors, the National Patient Safety Foundation, a U.S.-based nonprofit, has developed a set of “Words to Watch”. Posted in both English and Spanish, these lists include complex and medical jargon that physicians should avoid using with patients, and replacements that are easier to understand. Rather than say “oral,” for example, a doctor could say “by mouth.” “Off and on” replaces “intermittent.” It’s not just about words, though — it’s about how you use them. When a physician explains something to a patient, just asking “Did you understand that?” isn’t enough. Many patients – too embarrassed or overwhelmed to say “no” — will simply nod their heads. Instead, a doctor can say, “Will you repeat that back to me in your own words so I make sure I said it right?” Teach-back is another tool medical practitioners have. When explaining a new concept, like how to inject insulin, asking the patient to show (rather than just tell) what’s just been taught, is better at checking understanding than a quick “Got it?” or “Make sense?”
Scientists are under pressure to win grant money (publish or perish) while doctors are under similar pressure to cram more and more patient visits into a day. So I imagine taking the extra time to communicate effectively with non-experts might seem impractical. But when you consider the alternative, it seems worth it. When I become a doctor, I plan on reminding myself of this truth as often as possible.