Kermit Muhammad, M.D.
OAK Orthopedics
Many times, I find that miscommunication between patients and their orthopedic surgeon leads to unfulfilled expectations and unnecessary confusion. At the root of this problem is the fact that medical training is focused and based on learning an entirely new language, let’s call it “medicalese” or “doctor speak.” It’s not a foreign tongue but it might as well be. It’s so technical and specialized that even doctors in different subspecialties can have a hard time talking to each other sometimes. The anatomy terms are Latin, and the shop talk of the orthopedic surgeon is highly technical.
It is inevitable that something gets lost in translation when the surgeon is explaining the problem and the solution to the patient. To illustrate this, consider when a patient goes to the ER and the ER doc says that you have a hairline fracture, which sounds pretty innocuous. Then the patient shows up to the orthopedic surgeon who says that it is an intra-articular (in the joint) fracture which is highly unstable. This doesn’t give the patient a sense of confidence in the whole scenario but in reality, the ER doctor and orthopedic surgeon were describing the same thing using different terminology.
Here is another example; I will very often explain to the parents that their child has a broken wrist. In response they may look at me with a great sigh of relief and say, “I’m so glad it’s not fractured.” Meanwhile I might have to convey that I need to take the child to surgery to properly set the bone and this can lead to a big confusion. The interpretation of the parents is that it’s not that serious and in the same breath I’m recommending surgery. To a surgeon a fracture and a break mean the same thing with a wide gradient between simple and complex. I have observed that to most patients these terms are not synonymous, and an extra effort is needed to give a clear picture of the problem.
To solve this problem there are several avenues of approach. As a patient it’s important that if the doctor uses a word that you are not familiar with just stop and ask for a definition that you can easily understand. If that doesn’t help, maybe have the surgeon use diagram or plastic model if it’s available for demonstration. Surgeons have a tendency to revert to technical language, but most will respond readily if you clearly state that you don’t understand. An example I’ll give is that I will tell the patient that I have to fix their fracture with a plate and screws, that can mean a lot of different things to the patient, but it only means one thing to the surgeon. So, it’s the job of the surgeon to find the right language to duplicate the mental picture that he has in his mind for the patient.
What is the solution to the problem of miscommunication in medicine and in the doctor patient relationship? It’s definitely good practice on the surgeon’s part to use common language and not technical language in explaining procedures to patients. But when the natural tendency comes to start using the big words, as a patient you can stop your doctor and either ask “what does that mean” or get the explanation in a different way. The good news is that technology has given us a way to circumvent this problem. The best education that I have found is the surgical educational videos that we have on the internet and on our website (oakortho.com). Of course, you can look anything up on the web, but most practices offer a select group of standard videos which can give an easy understanding of the orthopedic problem and the treatment. As well as surgical videos without all the blood and gore.
The success of any procedure depends on the technical skill of the surgeon, but it also depends on the understanding and expectations the patient has about his condition. It’s one thing for a surgeon to tell a patient that he has a wrist fracture. What mental picture does the patient get when he hears those words? He may see a little crack in a bone, or maybe a bone shattered into a million pieces. Either one may be correct. The severity has an important implication on prognosis so If the patient is thinking that it’s a pretty straight forward injury and they really have a shattered bone they may have unrealistic expectations. So, the goal here is to match the expectations of the surgeon and patient through proper understanding which leads to happiness on both sides.
In sum, the combination of visual aids including diagrams, brochures with pictures, and videos can help bridge the gap in communication between you, the patient, and your orthopedic surgeon. It’s important that as a patient you have a complete understanding of your condition, procedure or treatment plan and it does not require medical knowledge to get these concepts, just a little extra translation.