Teaching Without Jargon

In this edition of Hospital Pediatrics, Praska and colleagues performed a cross-sectional study at a state fair where they surveyed fair attendees to assess their understanding of commonly used medical abbreviations.¹  The survey was administered in both written and verbal format and participants were randomized to either group. Participants were asked to provide free-text responses instead of being provided multiple choices to choose from to eliminate the possibility of correct answers being attained by guessing. Analysis of the survey results showed that fewer than one-third of the participants guessed the meaning of all 5 acronyms correctly. Some of the responses were astonishing to the indoctrinated physician. The most common incorrect interpretation of the phrase “CBC” was that it was a type of scan and asking, “did you go to the ED?”, was believed to be a question about erectile dysfunction. There was no statistical difference noted between participants in the verbal survey versus written survey and level of education did not correlate with increased understanding of all 5 acronyms. Respondents at the fair were generally similar to the US population as a whole.

There is usually a stark asymmetry between knowledge of medical terminology between clinicians and patients. Given the sometimes complex information being conveyed, effective communication is a critical part of every clinical encounter and has been shown to affect overall health outcomes.²  Providers have long agreed that using plain language is an essential part of effective communication with their patients.^3,4  Despite this intent, the use of medical jargon - technical terminology, abbreviations, acronyms, and Latin terminologies- remains common.^5,6  This is not surprising given that medical abbreviations, a convenient and culturally engrained way to represent biomedical terms or phrases, have been a part of mainstream medicine for more than 200 years, even though their use was initially limited to medication prescriptions.^7,8  Studies, such as the one performed in the reference article, show that despite this long-term use of common medical abbreviations, societal comprehension of medical jargon has not increased. This, coupled with the fact that there is often discrepancy between providers’ intent to avoid use of jargon in communication and the reality where they frequently use it - a term referred to as “jargon oblivion” - highlights the fact that communication in the medical setting still needs to be improved.^3,5 

The move toward patient-centered rounds and the enactment of the 21st Century Cures Act in 2021, which requires that patients have free, easy access to their electronic medical records, are emblematic of efforts to allow patients to be more actively involved in their care.^9,10  Use of medical jargon, with resultant decreased patient comprehension, serves as an impedance to these efforts. There have been systematic efforts to minimize use of medical jargon in the clinical space. For example, some electronic medical records will automatically expand common abbreviations (BID to twice daily, PRN to as needed), however, cultural use of these phrases by physicians persist, especially in personal verbal communications.

As students progress through medical school, they begin to learn the language of medicine and are assessed on their mastery of it when they present patients, discuss plans, write notes, and consult specialists.^3,4  These skills are further nurtured during residency education. The result of this process is medical providers who are comfortable speaking in this new primary language that they are no longer facile with lay terminology.^3,4  Thus, they communicate through a cloud jargon oblivion, unaware that they are overestimating the patients’ reception of language and ineffectively communicating with their patients.^3,4 

In essence, to avoid using medical jargon, medical providers must unlearn the medical language they were taught during their training. We teach, and then we must unteach. We propose the solution to this perplexing problem is minimizing the teaching of this language in the first place, especially for terminology that could be easily eradicated. For example, synonyms for words that already exist and are universally understood adds unnecessary complexity to provider-patient communication. Using “erythema” instead of “redness,” “ambulating” instead of “walking,” “by mouth” instead of “PO” results in confusion that could be easily avoided.³  Medical education must pioneer the change that allows for more effective communication between providers and their patients by beginning to simplify the medical language that is taught to medical students and residents. This will then produce providers better equipped to provide safe, effective, patient-centered care.³  What we need now, instead of further demonstration that jargon is overutilized and poorly understood, is a clarion call for medical institutions to rethink the use of medical jargon in training. To put it simply, the time has come for application of quality improvement methodology in medical education to tackle this problem.