Use of Jargon Patients understand relatively few of the complex terms that providers often use. Provid- ers learn a complex vocabulary for understanding ill- nesses and communicating about them to other professionals; they often find it hard to remember that patients do not share this expertise. In some cases, jargon- filled explanations may be used to keep the patient from asking too many questions or from discovering that the provider actually is not certain what the patient’s prob- lem is. The use of jargon may also stem from an in- ability to gauge what the patient will understand.
Baby Talk Because practitioners may underesti- mate what their patients will understand about an ill- ness and its treatment, they may resort to baby talk and simplistic explanations. One woman, who is both a can- cer researcher and a cancer patient, reports that when she goes to see her cancer specialist, he talks to her in a very complex, technical manner until the examination starts. Once she is on the examining table, he shifts to very simple sentences and explanations. She is now a patient and no longer a colleague. The truth about what most patients can understand lies somewhere between the extremes of technical jargon and baby talk.
Nonperson Treatment Depersonalization of the patient is another problem that impairs the quality of the patient-provider relationship (Kaufman, 1970). One patient—a psychologist—reports:
When I was being given emergency treatment for an eye laceration, the resident surgeon abruptly terminated his conversation with me as soon as I lay down on the operating table. Although I had had no sedative, or anesthesia, he acted as if I were no longer conscious, directing all his questions to a friend of mine—questions such as, “What’s his name? What occupation is he in? Is he a real doctor?” etc. As I lay there, these two men were speaking about me as if I were not there at all. The moment I got off the table and was no longer a cut to be stitched, the surgeon
understand important details about the illness or treat- ment (Golden & Johnston, 1970). Whereas dissatisfied patients complain about the incomplete or overly tech- nical explanations they receive from providers, dis- satisfied providers complain that even when they give clear, careful explanations to patients, the explanation goes in one ear and out the other. With patients assuming more responsibility for their own care, the issue of health illiteracy has come to the fore. Although millions of young people graduate from high school each year, many of them lack the basic literacy skills needed to adhere to medical prescriptions, comprehend the meaning of their risk factors, or inter- pret the results of tests from physicians. Poorly educated
In comparison with male physicians, female phy- sicians generally conduct longer visits, ask more ques- tions, make more positive comments, and show more nonverbal support, such as smiling and nodding (Hall, Irish, Roter, Ehrlich, & Miller, 1994). The matching of gender between patient and practitioner fosters rap- port and disclosure (Levinson, McCollum, & Kutner, 1984; Weisman & Teitelbaum, 1985). However, phy- sicians of both genders prefer male patients (Hall, Epstein, DeCiantis, & McNeil, 1993). Patients who are regarded as seeking treatment largely for depression, anxiety, or other forms of psy- chological disorder also evoke negative reactions from physicians. With these patients, physician atten- tion may be cursory (Epstein et al., 2006). Physicians prefer healthier patients to sicker ones (Hall et al., 1993), and they prefer acutely ill to chronically ill pa- tients; chronic illness poses uncertainties and raises questions about prognosis, which acute diseases do not. Chronic illness can also increase a physician’s distress over having to give bad news (L. Cohen et al., 2003). Patients who are the objects of stereotypes are more likely to become distrustful and dissatisfied with their care.
Patients’ Contributions to Faulty Communication Within a few minutes of having discussed their illness with a provider, as many as one-third of patients can- not repeat their diagnosis, and up to one-half do not
Patients are often most comfortable interacting with a physician
who is similar to themselves.
© Henk Badenhorst/Getty Images RF
B O X 9.1What Did You Say?: Language Barriers to Effective Communication
More than 25.2 million people in the United States have limited English proficiency (Pandya, McHugh, & Batalova, 2011). Consequently, language barriers are a formidable problem in patient-provider communication. Increasingly, language barriers contribute to communica- tion problems (Halim, Yoshikawa, & Amodio, 2013). Consider the experiences of a 12-year-old Latino boy and his mother attempting to communicate what was wrong:
“La semana pasada a él le dio mucho mareo y no tenía fiebre ni nada, y la familia por parte de papá todos padecen de diabetes.” (Last week, he had a lot of dizziness, and he didn’t have fever or anything, and his
dad’s family all suffer from diabetes.) “Uh hum,” replied the physician. The mother went on. “A mí me da miedo porque él lo que estaba mareado, mareado, mareado y no tenía fiebre ni nada.” (I’m scared because he’s dizzy, dizzy, dizzy, and he didn’t have fever or anything.) Turning to Raul, the physician asked, “OK, so she’s saying you look kind of yellow, is that what she’s saying?” Raul interpreted for his mother: “Es que se me vi amarillo?” (Is it that I looked yellow?) “Estaba como mareado, como pálido” (You were dizzy, like pale), his mother replied. Raul turned back to the doctor. “Like I was like paralyzed, some- thing like that,” he said (Flores, 2006, p. 229).
176 Part Four Seeking and Using Health Care Services
tions, patients may feel that their concerns have been ignored. Patients sometimes give providers misleading in- formation about their medical history or their current concerns. Patients may be embarrassed about their health history (such as having had an abortion) or their health practices (such as being a smoker), and so may not report this important information.
Interactive Aspects of the Communication Problem Qualities of the interaction between practitioner and pa- tient can perpetuate faulty communication. A major problem is that the patient-provider interaction does not provide the opportunity for feedback to the provider. The provider sees the patient, the patient is diagnosed, treatment is recommended, and the patient leaves. When the patient does not return, any number of things may have happened: The treatment may have cured the disorder; the patient may have gotten worse and de- cided to seek treatment elsewhere; the treatment may have failed, but the disorder may have cleared up any- way; or the patient may have died. Not knowing which of these alternatives has actually occurred, the provider does not know the impact and success rate of the advice given. Obviously, it is to the provider’s psychological advantage to believe that the diagnosis was correct, that the patient followed the advice, and that the patient’s disorder was cured by the recommended treatment. However, the provider may never find out for certain. The provider may also find it hard to know when a satisfactory personal relationship has been estab- lished with a patient. Many patients are relatively cau- tious with providers. If they are dissatisfied, rather than complain about it directly, they may simply change providers. If a patient has stopped coming, the practitioner does not know if the patient has moved out of the area or switched to another practice. When providers do get feedback, it is more likely to be nega- tive than positive: Patients whose treatments have failed are more likely to return than are patients whose treatments are successful (Rachman & Phillips, 1978). Two points are important here. First, learning is fos- tered more by positive than by negative feedback; posi- tive feedback tells one what one is doing right, whereas negative feedback may tell one what to stop doing but not necessarily what to do instead. Because providers get little feedback and more negative than positive feed- back, this situation is not conducive to learning.
people, the elderly, and non-English speakers have par- ticular problems adopting the consumer role toward their care (Center for the Advancement of Health, May 2004). As people age, their number of medical problems usually increases, but their abilities to present their com- plaints effectively and follow treatment guidelines declines. About 40 percent of patients over age 50 have difficulty understanding their prescription instructions. Extra time and care may be needed to communicate this vital information to older patients.
How Patients Compromise Communication Several patient characteristics contribute to poor com- munication with providers. Neurotic patients often present an exaggerated picture of their symptoms (Ellington & Wiebe, 1999), compromising a physi- cian’s ability to gauge the seriousness of a patient’s condition. When patients are anxious, their learning can be impaired (Graugaard & Finset, 2000). Anxiety makes it difficult to focus attention and process incom- ing information and retain it (Graugaard & Finset, 2000). Negative affectivity more generally compro- mises adherence (Molloy et al., 2012). To the extent that a practitioner can reduce anxiety, anger, and other negative emotions, communication may improve (Ger- hart, Sanchez Varela, Burns, Hobfoll, Fung, 2015; van Osch, Sep, van Vliet, van Dulmen, & Bensing, 2014). Some patients are unable to understand even simple information about their case (Galesic, Garcia- Retamero, & Gigerenzer, 2009; Link, Phelan, Miech, & Westin, 2008). Lack of intelligence or poor cogni- tive functioning impedes the ability to play a con- sumer role (Stilley, Bender, Dunbar-Jacob, Sereika, & Ryan, 2010). Patients for whom the illness is new and who have little prior information about the disorder also have difficulty comprehending their disorders and treatments (DiMatteo & DiNicola, 1982).