BACKGROUND:

Although plain language is recognized as essential for effective communication, research reveals that medical providers regularly use jargon terminology that may be misunderstood by patients. Little is known, however, about the types and frequency of jargon used in the pediatric inpatient setting. We aimed to quantify jargon use by medical team members during inpatient family-centered rounds (FCRs) and to identify the most common categories of jargon used.

METHODS:

One of 3 trained medical students audited FCRs on a general pediatric service once weekly for 12 weeks, recording and categorizing jargon used with a published classification framework. Jargon usage was classified by category and quantified by using descriptive statistics. Rates were calculated by patient encounter and per minute. Feedback was provided to rounding teams after each observation.

RESULTS:

During 70 observed FCR patient encounters, there were a total of 443 jargon words or phrases spoken, of which 309 (70%) were not explicitly defined to the patient or family by the health care provider team. The mean number of undefined jargon words or phrases used per patient was 4.3 (±1.7), with a mean of 0.4 (±0.1) uses of undefined jargon per minute. The most common categories of undefined jargon used include technical terminology (eg, bronchiolitis), medical vernacular (eg, cultures), and abbreviations and acronyms (eg, NPO for “nothing by mouth”) at 34%, 30%, and 17%, respectively.

CONCLUSIONS:

Undefined medical jargon was used frequently by health care providers during pediatric FCRs. We found it was feasible to measure provider jargon use and to use a jargon classification scheme to provide real-time, concrete feedback.

Despite understanding that plain language is essential for effective communication, medical providers continue to use jargon (terminology used within a specific group but often misunderstood by those outside of that group) throughout interactions with patients.15 

After learning a new vocabulary in medical school, intended to improve communication precision and efficiency, providers often lose sight of what average people understand and come to overestimate patient vocabulary.1,2,6  Jargon use creates opportunities for misunderstanding, potentially leading to poor adherence to therapy and worse outcomes.6  Conversely, efforts to increase patient understanding are found to improve satisfaction scores and health outcomes.79 

Previous studies reveal that patients want to be actively involved in their care, specifically during inpatient rounds.10,11  In response, numerous facilities began implementing a patient-centered approach to rounding, better known as family-centered rounds (FCRs) in pediatric settings. In contrast to traditional rounds, the purpose of FCRs is to encourage participation of the patient and family in daily rounds presentations and medical decision-making.10  The crucial step in shared decision-making is a mutual understanding between medical providers and families. Examining and reducing jargon use by providers are important steps toward improving patient understanding.

Much of the research on jargon usage in medicine falls into 2 categories: survey-based work in which the variance between what patients understand and what providers believe they understand is revealed,6,1216  and observational studies in which researchers attempt to quantify jargon usage in patient scenarios.14  Surveys used to assess layperson understanding of medical jargon have helped reveal types of commonly misunderstood phrases. For example, Chapman et al found that confusion exists even without using traditional medical language; only 52% of people understood that a tumor “progressing” was bad news because in everyday usage, progress is a good thing.12  Disconnects like these play a significant role in medical providers’ overestimation of their patients’ ability to understand them.5,6,12,17  In their 2019 article, Pitt and Hendrickson called this phenomenon “jargon oblivion” and proposed a classification system separating medical jargon into 7 main categories to aid providers in identifying the types of language that may ultimately confuse their patients.18  The other arm of jargon research has focused on attempts to quantify provider jargon usage. In these studies, researchers generally assess simulated or standardized patient encounters24  or, in 1 case, coding of audiotaped encounters.1 

To our knowledge, the use of real-time jargon quantification in an inpatient setting has not been reported. Here we describe an initiative to quantify and categorize jargon usage during FCRs at an academic children’s hospital by using a published classification system.18  In addition, we assessed the feasibility of providing timely feedback to the medical team about their jargon usage and jargon categories, with the goal of promoting more effective patient-provider communication.

This observational study was conducted via direct patient encounter observations, with real-time quantification of jargon. The study was performed at a 250-bed, university-affiliated, freestanding children’s hospital in the upper Midwest after receiving exemption from our institutional review board.

We developed a scoring sheet for quantifying jargon usage in real-time, adapted from published material. The scoring sheet captured the following data: patient age and length of stay, time spent in room, composition of the rounding team, and use of a medical interpreter. For each rounding encounter, observers documented jargon words or phrases spoken and indicated whether the jargon was subsequently defined by the medical team. Author M.P.18  provided training to 3 medical student observers (V.C., C.E.P., and R.G.) on jargon identification and had them practice real-time scoring on prerecorded standard objective structured clinical examination patient encounters until the 3 of them were able to reach a percentage agreement of >90%.

Over the course of 12 weeks, 1 of the 3 medical students audited pediatric FCRs once per week using the jargon scoring sheet. Encounter durations were recorded as the time between the first team member entering the room and the last team member leaving. Patients aged <14 years who did not have a caregiver present and those with psychiatric diagnoses as their primary reason for hospitalization were excluded from study. Our institution uses a medical interpreter for every encounter in which the patient or family has limited English proficiency (LEP). Because these interpreters are tasked with providing a verbatim translation of what is spoken by the providers, we opted to include these encounters, documenting any jargon used by team members in English before being translated.

At the conclusion of FCRs, the observing student provided formative feedback to the rounding team regarding jargon use that day, including the quantity and types of jargon used; the ability to do this on each observation day, completely, without disruption and within just a few minutes time was used as a proxy for feasibility of the intervention.

After gathering the data on the scoresheet, each jargon word or phrase was categorized into 1 of the 7 jargon categories from the published framework,18  and the categorization was reviewed and agreed on by all 3 medical students. The 7 categories of jargon are depicted in Fig 1. At the conclusion of the study, we quantified total jargon words and phrases used and calculated means and SDs for jargon use per minute, jargon use per patient encounter, and the frequency of each jargon category captured, as well as interquartile ranges (IQRs) for data.

FIGURE 1

Jargon pocket card. (Adapted with permission from Pitt, MB, Hendrickson, MA. Eradicating jargon-oblivion–a proposed classification system of medical jargon. J Gen Intern Med. 2020;35[6]:1861–1864.)

FIGURE 1

Jargon pocket card. (Adapted with permission from Pitt, MB, Hendrickson, MA. Eradicating jargon-oblivion–a proposed classification system of medical jargon. J Gen Intern Med. 2020;35[6]:1861–1864.)

Close modal

We included 70 patient encounters over 12 weekly observation days (summarized in Table 1). The rounding team typically consisted of an attending, a senior resident, 1 to 2 interns, and 1 to 2 students. The presenter was either an intern or student in all observed encounters. Among included patients, the mean length of hospital stay was 4.1 days. The mean patient age was 5.5 years. A caregiver was present for 68 (97%) observed encounters; an interpreter was present for 8 (11%) encounters. The median number of people on the rounding team was 5.5 (IQR: 5–7); the median number who spoke in the patient room was 3 (IQR: 2–3). The mean observed patient encounter time was 12.2 minutes.

TABLE 1

Jargon Usage Summary of 70 Patient Observations

MeanRange
Rounding time per patient, min 12.2 1.9–30.5 
JPP 4.3 0–15 
Jargon words or phrases per minute 0.4 0–1.5 
MeanRange
Rounding time per patient, min 12.2 1.9–30.5 
JPP 4.3 0–15 
Jargon words or phrases per minute 0.4 0–1.5 

During these encounters, we captured 443 uses of jargon, 309 (70%) of which were not defined by the medical team. Over the course of the study, the mean number of undefined jargon words or phrases per patient (JPP) was 4.3 (SD ± 1.7), and the mean rate of undefined jargon per minute was 0.4. JPP had a normal distribution, as calculated by a Kolmogorov-Smirnov test of normality in Microsoft Excel (version 16.44).

In Table 2, we provide a breakdown of the jargon categories identified during this study period. For both defined and undefined jargon, the 3 most common categories were technical terminology (37%; eg, bronchiolitis), medical vernacular (31%; eg hemoglobin), and abbreviations and acronyms (18%; eg, NPO for “nothing by mouth”). In the subset of undefined jargon words, all categories except judgmental jargon were represented. Among undefined jargon, the most common categories were, similarly, technical terminology (34%), medical vernacular (30%), and abbreviations and acronyms (17%).

TABLE 2

Jargon Usage by Category

Jargon CategoryExamplesPercentage of Use, Total (Defined and Undefined)Percentage of Use, Undefined
Technical terminology Bronchiolitis, urinalysis 38.2 34.0 
Medical vernacular Cultures, anemia 28.2 30.0 
Abbreviations and acronyms Endo, NPO 17.1 16.8 
Medicalized English Negative, artifact 8.2 10.4 
Unnecessary synonym Ambulating, urine output 6.1 6.1 
Euphemism Bugs, shadow (on radiograph) 1.8 2.6 
Judgmental jargon Failed (treatment), denies 0.5 0.0 
Jargon CategoryExamplesPercentage of Use, Total (Defined and Undefined)Percentage of Use, Undefined
Technical terminology Bronchiolitis, urinalysis 38.2 34.0 
Medical vernacular Cultures, anemia 28.2 30.0 
Abbreviations and acronyms Endo, NPO 17.1 16.8 
Medicalized English Negative, artifact 8.2 10.4 
Unnecessary synonym Ambulating, urine output 6.1 6.1 
Euphemism Bugs, shadow (on radiograph) 1.8 2.6 
Judgmental jargon Failed (treatment), denies 0.5 0.0 

NPO, nothing by mouth.

This study reveals that the use of undefined jargon by health care providers was common during FCRs in the inpatient pediatric setting. In our sample, we identified ∼4 JPPs, signifying 4 instances in which patient and family understanding were potentially compromised. This mirrors the average of 4 jargon uses per encounter in the outpatient study by Castro and colleagues, who coded audio recordings of visits for patients with diabetes.1  FCRs are often used in the inpatient pediatric setting to improve communication. Multiple studies reveal that this style of communication, with the goal of using plain language, is positively correlated with parental satisfaction scores and quality-of-care ratings.1921 

In our study, researchers both capture the frequency of jargon usage in a real-world setting and provide a breakdown of the types of jargon used, which can help educators and providers determine target areas for intervention. To our knowledge, this is the first attempt to categorize specific jargon words used during clinical encounters. Approximately 85% of the jargon words spoken fell into 3 categories: technical terminology, medical vernacular, and abbreviations and acronyms. This was fairly consistent between total jargon words and the subset of undefined jargon words. With focused education and interventions on these 3 areas, health care providers could significantly reduce their jargon usage. We hypothesize that these top 3 categories are most common because they consist of the terminology taught in medical school, including names of diseases and abbreviations, and words that one might quickly forget they did not know before medical school (eg, febrile, sepsis). Medical students are typically taught to present patients in a formal manner, with precise medical language, and may subsequently forget which words will not be understood by patients.6  Of note, all of the 7 categories of jargon were represented in this study, which highlights areas for growth because even 1 misunderstanding between patient and provider is a potential setup for harm.

By quantifying and classifying jargon usage in real time, we could feasibly provide timely feedback to the rounding team. Quantitative jargon report cards have previously been revealed to enhance providers’ explanation of jargon terms.4  However, researchers in that study audited telephone encounters of standardized patients, and providers received their report cards well after the initial encounter. Our use of a jargon scoring sheet to provide timely feedback in a nonsimulated environment is novel, and it could help providers avoid the jargon oblivion of simply forgetting which terms merit explanation to their patients.1,2,6,18  We determined that feedback was feasible because it was provided to rounding teams on 100% of observation days and took <5 minutes to deliver.

Our study was preliminary and did not allow for assessment of improvement in jargon use after this type of feedback. Observing once weekly did not allow us to measure the impact of feedback on the same team because individual students, residents, and attending hospitalists frequently rotated on and off the service. Furthermore, our results are limited by a small sample size, with only 12 FCR days observed. Additionally, we recognize that the Hawthorne effect had potential to skew jargon scores22 ; by introducing our purpose before FCRs, we acknowledged the issue of jargon and may have inadvertently led team members to be more cautious about jargon use. This may have led to underrecording of what true jargon usage would be in an unobserved setting. Another study limitation was that we were unable to assess what interpreters were saying to patients. We opted to include LEP encounters using interpreters because we aimed to quantify jargon used by the medical team members rather than interpreters. Interpreters are charged with explaining exactly what is stated and should therefore reflect the language used by medical providers.23  Future research could focus on jargon use among both the medical team and interpreters during LEP patient encounters. Our small sample size of 70 included patients did not allow for statistical analysis of confounding factors, such as chronic medical conditions, length of hospital stay, and families with medical backgrounds. As a pilot study, we recognize that our conclusions may reveal trends not reflected in larger sample sizes and other settings; further research should examine these factors. Additionally, further studies may help elucidate the differences between teams that use more or less jargon because we encountered a wide range of jargon use between medical teams.

Our end goal remains to reduce daily jargon use without depending on medical student observations or tallies during rounds. During our study, medical student observers reviewed the jargon scoring sheet before FCRs as a reminder of the different jargon categories. We modified the scoring sheet into a “jargon pocket card,” (Fig 1) which may be applied in future settings to visually remind teams about jargon use, and further study may examine whether these types of reminders indeed reduce jargon use. Additional study by using quality improvement methodology will be an important next step to further identify and assess optimal interventions to reduce jargon use at the bedside.

This study reveals that it was feasible to track jargon usage during FCRs and provide immediate feedback to the medical team. We identified the most common categories of jargon used to provide precise and timely feedback and to develop resources for jargon avoidance in everyday practice. If we can reduce jargon in our conversations with our patients, we will make space for open communication, mutual understanding, and improved health care outcomes.

This project was not conducted as part of a clinical trial.

Ms Charpentier formulated and conducted the research project, performed the data analysis, and was the primary person to draft and edit the manuscript; Ms Gotlieb and Ms Praska formulated and conducted the research project, performed the data analysis, and substantially edited the manuscript; Dr Hendrickson reviewed the data analysis and substantially edited the manuscript; Dr Pitt oversaw the research design, reviewed the data analysis, and substantially edited the manuscript; Dr Marmet oversaw the research design, reviewed the data analysis, and assisted with the drafting and substantial editing of the manuscript.

FUNDING: No external funding.

1
Castro
CM
,
Wilson
C
,
Wang
F
,
Schillinger
D
.
Babel babble: physicians’ use of unclarified medical jargon with patients
.
Am J Health Behav
.
2007
;
31
(
suppl 1
):
S85
S95
2
Farrell
M
,
Deuster
L
,
Donovan
J
,
Christopher
S
.
Pediatric residents’ use of jargon during counseling about newborn genetic screening results
.
Pediatrics
.
2008
;
122
(
2
):
243
249
3
Deuster
L
,
Christopher
S
,
Donovan
J
,
Farrell
M
.
A method to quantify residents’ jargon use during counseling of standardized patients about cancer screening
.
J Gen Intern Med
.
2008
;
23
(
12
):
1947
1952
4
Farrell
MH
,
Christopher
SA
,
La Pean Kirschner
A
, et al
.
Improving the quality of physician communication with rapid-throughput analysis and report cards
.
Patient Educ Couns
.
2014
;
97
(
2
):
248
255
5
Howard
T
,
Jacobson
KL
,
Kripalani
S
.
Doctor talk: physicians’ use of clear verbal communication
.
J Health Commun
.
2013
;
18
(
8
):
991
1001
6
LeBlanc
TW
,
Hesson
A
,
Williams
A
, et al
.
Patient understanding of medical jargon: a survey study of U.S. medical students
.
Patient Educ Couns
.
2014
;
95
(
2
):
238
242
7
Maguire
P
,
Pitceathly
C
.
Key communication skills and how to acquire them
.
BMJ
.
2002
;
325
(
7366
):
697
700
8
Stewart
MA
.
Effective physician-patient communication and health outcomes: a review
.
CMAJ
.
1995
;
152
(
9
):
1423
1433
9
Jackson
LD
.
Information complexity and medical communication: the effects of technical language and amount of information in a medical message
.
Health Commun
.
1992
;
4
(
3
):
197
210
10
Sisterhen
LL
,
Blaszak
RT
,
Woods
MB
,
Smith
CE
.
Defining family-centered rounds
.
Teach Learn Med
.
2007
;
19
(
3
):
319
322
11
Rotman-Pikielny
P
,
Rabin
B
,
Amoyal
S
,
Mushkat
Y
,
Zissin
R
,
Levy
Y
.
Participation of family members in ward rounds: attitude of medical staff, patients and relatives
.
Patient Educ Couns
.
2007
;
65
(
2
):
166
170
12
Chapman
K
,
Abraham
C
,
Jenkins
V
,
Fallowfield
L
.
Lay understanding of terms used in cancer consultations
.
Psychooncology
.
2003
;
12
(
6
):
557
566
13
Pieterse
AH
,
Jager
NA
,
Smets
EMA
,
Henselmans
I
.
Lay understanding of common medical terminology in oncology
.
Psychooncology
.
2013
;
22
(
5
):
1186
1191
14
Peckham
TJ
.
‘Doctor, have I got a fracture or a break’?
Injury
.
1994
;
25
(
4
):
221
222
15
Wiener
RS
,
Gould
MK
,
Woloshin
S
,
Schwartz
LM
,
Clark
JA
.
What do you mean, a spot?: a qualitative analysis of patients’ reactions to discussions with their physicians about pulmonary nodules
.
Chest
.
2013
;
143
(
3
):
672
677
16
Dua
R
,
Vassiliou
L
,
Fan
K
.
Common maxillofacial terminology: do our patients understand what we say?
Surgeon
.
2015
;
13
(
1
):
1
4
17
Schwartzberg
JG
,
Cowett
A
,
VanGeest
J
,
Wolf
MS
.
Communication techniques for patients with low health literacy: a survey of physicians, nurses, and pharmacists
.
Am J Health Behav
.
2007
;
31
(
suppl 1
):
S96
S104
18
Pitt
MB
,
Hendrickson
MA
.
Eradicating jargon-oblivion-a proposed classification system of medical jargon
.
J Gen Intern Med
.
2020
;
35
(
6
):
1861
1864
19
Homer
CJ
,
Marino
B
,
Cleary
PD
, et al
.
Quality of care at a children’s hospital: the parent’s perspective
.
Arch Pediatr Adolesc Med
.
1999
;
153
(
11
):
1123
1129
20
Co
JPT
,
Ferris
TG
,
Marino
BL
,
Homer
CJ
,
Perrin
JM
.
Are hospital characteristics associated with parental views of pediatric inpatient care quality?
Pediatrics
.
2003
;
111
(
2
):
308
314
21
Ammentorp
J
,
Mainz
J
,
Sabroe
S
.
Parents’ priorities and satisfaction with acute pediatric care
.
Arch Pediatr Adolesc Med
.
2005
;
159
(
2
):
127
131
22
Oswald
D
,
Sherratt
F
,
Smith
S
.
Handling the Hawthorne effect: the challenges surrounding a participant observer
.
Rev Soc Stud
.
2014
;
1
(
1
):
53
73
23
National Council on Interpreting in Health Care
.
NATIONAL STANDARDS OF PRACTICE for Interpreters in Health Care COMMITTEE. 2005. Available at: https://www.ncihc.org/assets/documents/publications/NCIHC%20National%20Standards%20of%20Practice.pdf. Accessed February 11, 2021

Competing Interests

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.