- Use simple language and pictures to explain diagnoses and treatments to patients.
- Clearly define any clinical terms you have to use.
- Use the teach-back method and reflection to be sure patients understand.
The topics of health and health care can be complex and confusing, with discussions often full of technical terms and jargon. That’s why using clear and simple language in clinical conversations and health communications is essential to helping people better manage their health.
“It’s easier for doctors to do ‘medical speak,’” said Dr. Jay A. Perman, a practicing pediatric gastroenterologist and chancellor of the University System of Maryland. “People talk in a way that they’re comfortable with. And regrettably, too often for doctors, it’s not a way in which patients and families can absorb the information being given.”
Perman stresses that clear communication must be a core competency for health care providers to ensure positive treatment outcomes. This viewpoint is shared by his colleague Dr. Elsie Stines, a pediatric nurse practitioner and assistant vice president of special projects and initiatives at the University of Maryland, Baltimore.
“When patients are not doing what they’re told to do as part of their treatment plan, it’s often because they just don’t understand their diagnosis, and especially don’t understand how their treatment and medication are supposed to work,” Stines said.
These points were mentioned during the Cigna Healthcare Plain Language Week. During this annual event, clear communication champions and experts from inside and outside the organization shared their latest tips and resources. The goal of the week is to provide information to Cigna Healthcare writers, customer advocates and others who communicate with Cigna Healthcare customers to help them make their interactions more simple, helpful, and clear.
Read on for information about five strategies that help doctors and other health care professionals conduct more straightforward conversations with their patients.
1. Use words they know
Perman stressed the importance of using plain, everyday language when interacting with patients. He said people already are facing challenges when they visit a doctor for care, from the ailment itself to social determinants of health, and shouldn’t also need to figure out medical jargon and scientific terms.
That’s especially true when the patients are young children, Stines said. “Kids don’t know what doctors are saying. You can’t ask kids if they are having any abdominal pain, they don’t know what ‘abdominal’ means. You have to ask if they have a bellyache or a stomachache.” She added that even adults may not know basic medical terms, and doctors should never assume that they do.
Rae Elizagaray, a Cigna Healthcare health coach and certified diabetes care and education specialist, recognizes that some clinical terms cannot be avoided in patient consultations, such as “hypoglycemia” when speaking about diabetes. She suggested defining clinical terms during patient conversations. “I would say, ‘hypoglycemia or low blood sugar,’ for example, to allow people to hear what the clinical words mean, because they do need to know that,” she said.
Ayesha Ali, a Cigna Healthcare informatics consultant, explained that Cigna Healthcare provides its staff clinicians and other employees with reference documents that provide everyday words and phrases for many medical and insurance terms, which is helpful when she meets with clients. Similar guides are available to the public, such as plain language resources from the Centers for Disease Control and Prevention (CDC).
“The more people understand, the more they can advocate for themselves,” Elizagaray said, adding that understanding medical terminology helps people feel more comfortable having those conversations.
Perman and Stines said that doctors using plain language is also beneficial to colleagues on the care team, who can include social workers or lawyers. It’s all about being respectful to everyone involved in the patient’s care, Perman said.
2. Show as well as tell
“You can’t just talk, you’ve got to show,” Perman said, explaining that drawing a picture can be a big help in communicating. For example, he uses a marker to draw pictures on the paper covering the examination table to help explain a medical condition or details of the treatment plan. “I am a terrible artist,” he admitted. “I am flattered by the number of patients who tear the paper off the exam table and take it home.”
Ali shared a similar story. In client meetings, she frequently draws a small diagram or a flowchart to illustrate a concept or procedure.
Visual aids are also helpful, Stines said, such as showing parents the spoons, syringes, or scoops used to measure baby formula or medication. She recalled helping a mother who had a learning disability and couldn’t read written instructions. “The mom was trying to remember everything the doctor told her about the instructions on that piece of paper but was mixing the formula and measuring the medication wrong,” Stines said. She devised ways to clarify the instructions, such as labeling each medication bottle with a colored marker and drawing a line of the same color on the accompanying syringe so the mother would know how much of each medicine to draw for a dose. Stines also drew a sun for the medications prescribed for the morning and a moon for the medications to give at night. From that point forward, the baby’s treatment was successful.
3. Know your audience
Stines’ example also highlighted the importance of understanding the person’s communications style and issues. “The problem was not just that that the mom didn’t know how to read, but that no one bothered to ask her that,” she said.
Elizagaray added that her work involved regularly assessing a patient’s learning competency. “I usually ask if they have any learning disabilities or problems reading,” she said, noting that some of her patients have dyslexia. “I’ll ask them, ‘Are you comfortable with written materials?’ and they’ll often say, ‘Yes, it just might take me a little longer to read them.’” Elizagaray always offers to review and explain the written materials with these patients, and most of them accept.
“You’ve got to know who you’re talking to and be sensitive to that,” Perman said. In their pediatric work, Perman and Stines talk not just to parents but also to aunts, uncles, grandparents, and other people in charge of a child’s care. “You have to tailor your communication for each person you’re talking to,” he said, adding that cultural sensitivity can help make sure that what is said will be well received.
Empathy is critical for effective communication, said Rene Garcia, a Cigna Healthcare behavioral clinical strategist as well as a licensed marriage and family therapist, licensed professional counselor, and licensed chemical dependency counselor. “I was having these conversations with family members and loved ones about what can be done at different levels of substance use care, and being able to hear these patients out and hear their concerns helps a great deal,” he said, while “putting himself in their shoes” helped him answer their questions.
Ali agreed with the importance of being a good listener. “Listen to people as they tell us what they need, or the questions they have, and then respond to them in the same way that they’re speaking to you,” she said.
4. Confirm that everyone understands
Patients may not admit that they don’t understand what the doctor tells them, Perman said. “Too many folks are embarrassed, or think they are being disrespectful,” he said, and as a result they may inadvertently follow treatment plans incorrectly or worse, stop treatment all together.
The experts recommended the teach-back method – having the person explain back what was being said to them – as an effective way to clarify how much they understood. Instead of saying, “I’ll see you next time,” Perman advises doctors to use the end of a visit to ask the patient what they are going to tell their family when they get home.
“That’s where we’re able to understand whether or not patients really understood what their diagnosis is and how we’re going to treat it,” Stines said, adding that the teach-back method is as critical as using plain language.
Ali agrees this method improves her conversations with customers. “I can see what they picked up from what I just said, and where I need to be more clear in pointing out the areas that they have missed.”
Elizagaray recommended providers also use the reflection technique, which is restating the words and feelings of what the patient or customer expressed during the conversation. “The other person knows that they are being heard, and they can let me know if I had understood them correctly,” she said. As an added benefit, she said, utilizing the teach-back method and reflection also helps people remember more details of the conversation.
5. Seek out good examples to follow
A good way to improve plain language skills is to observe and learn from communicators who have mastered them, Garcia said. “If you know of somebody who’s doing these types of communications that meet the needs of clients or customers, lean into what that person is doing,” he said. He added that identifying various methods that work for different speakers can help build a communication style that works for you.
Ali agreed, saying she listens to different speakers to learn how they explained certain health care terms and concepts. Elizagaray said that in her previous work as a teacher, she would sit in sessions run by more experienced instructors to observe how they lectured. “I don’t feel like you can ever learn enough,” she said. “There’s always something you can learn from someone else.”
Stines spoke about the value of modeling clear communication for her students at the University of Maryland, Baltimore and agreed there is always room for improvement. “In my own instructions to patients, I still sometimes find areas that I could have been clearer on,” she said. “We always need to do more.”
Promoting clear communication in health care is an ongoing issue, Perman said, adding that it takes more than just experiential learning, but also a scholarly approach. He mentioned that the University of Maryland, Baltimore is home to the Horowitz Center for Health Literacy, which provides research and services to improve health literacy in both student education as well as in the surrounding community.
Perman believes that striving for health literacy is also an ethical imperative. “It’s the human thing to do, because people are trusting their care to us,” he said.
(Note: Some of the quotes in this article were lightly edited for clarity.)
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