The Borborygus Dyspepsia of Medical Jargon

Proudly smiling at my mother, I announced, “Your cranial nerves are intact.” Instead of returning the smile, she looked surprised and confused. She understood the words but questioned the meaning behind nerves being “intact.” And, truthfully, I did not fully understand it well enough to explain it to her. As a first-year medical student, I had unknowingly immersed myself in the imprecise world of medical jargon.

Since my first year of medical school, I added many more words to my elitist repertoire. These words include flatulence, rhinorrhea, dyspepsia, borborygmus and horripilation. When asked, medical professionals report that these words aid in more effective communication. For example, the single word of borborygmus is meant to describe the intestinal gurgling in a more precise way. As a first-year student I often wondered if this “seeming precision” came with a loss of something else; did we lose effective communication with our patients by being more precise with our medical terminology? At times, I wondered if these words truly helped medical personnel communicate better, especially since we still have words that have eluded a uniform pronunciation, such as duodenum.

However, what was more surprising than talking about farting and boogers on the daily, was learning a new secret language. As a child, I had always wanted to create my own secret language. My goal then was to evade others by using my fabricated language to circumvent understanding. As a medical professional, my goal has changed. Instead of trying to evade understanding, I am trying to connect with patients. I am trying to help them understand complex biological, social, and psychological processes to aid with their decision making. To accomplish this task, I have become proficient in a language that the majority of America does not understand. Evidence suggests that 36% of Americans have basic or below basic health literacy skills [1].

Low health literacy is detrimental in a myriad of ways from not understanding diagnoses or medical procedures to confusion around medical finances (with medical being the leading cause of bankruptcies in the U.S [2]). This especially plays-out when healthcare professionals are discussing sensitive topics that may need timely decision and plans, such as in the field of oncology. Research has shown that common words used in oncology—malignant [3], metastasis [4] and remission [5]—were not understood by patients. At the basic level, the medical community needs this understanding. We should know that terms we use as medical professionals are not found anywhere else in people’s daily lives and, so, are understandably not understood.

Yet, it seems that we already know this fact. A recent study found that many fourth-year medical students are pessimistic about patients’ understanding compared to first-year students (55.5% vs 58%, p=0.004). But, this same study, also showed that this recognition does not change the use of medical terminology or improve the understanding of patients [6]. This then leads to the question of how to foster environments of mutual understanding if increasing awareness about the harms of medical jargon does not lead to improved patient-provider communication.

I believe increased understanding comes from strengthening our own knowledge and applying it through practice. Medical school teaches students to improve their physical exam skills through practice. Similarly, we should work to strengthen communication skills with every patient encounter. We can start by reintroducing words such as boogers and farting into our medical curriculum. We can practice moving from medical terminology to patient-centered language. And before we know it, the borborygmus dyspepsia of medical jargon will be just that, bad episodes of gastritis that we reminiscently joke about.

REFERENCES

1. Cutilli, C. C., & Bennett, I. M. (2009). Understanding the health literacy of America: results of the National Assessment of Adult Literacy. Orthopedic nursing, 28(1), 27–34. https://doi.org/10.1097/01.NOR.0000345852.22122.d6
2. Himmelstein, D. U., Thorne, D., Warren, E., & Woolhandler, S. (2009). Medical bankruptcy in the United States, 2007: results of a national study. The American journal of medicine, 122(8), 741–746. https://doi.org/10.1016/j.amjmed.2009.04.012
3. Raveis, V. (1999). Pan-American Congress of Psychosocial and Behavioral Oncology. New York, New York, USA. October 20-23, 1999. Abstracts: Understanding the Psycho-social Impact of Cancer on Families: Adult Daughter Caregivers to Elderly Cancer Patients. Psycho-Oncology, 8(6 Suppl), 25.
4. Chapman, K., Abraham, C., Jenkins, V., & Fallowfield, L. (2003). Lay understanding of terms used in cancer consultations. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 12(6), 557-566.
5. Pieterse, A. H., Jager, N. A., Smets, E. M., & Henselmans, I. (2013). Lay understanding of common medical terminology in oncology. Psycho‐Oncology, 22(5), 1186-1191.
6. LeBlanc, T. W., Hesson, A., Williams, A., Feudtner, C., Holmes-Rovner, M., Williamson, L. D., & Ubel, P. A. (2014). Patient understanding of medical jargon: a survey study of U.S. medical students. Patient education and counseling, 95(2), 238–242. https://doi.org/10.1016/j.pec.2014.01.014