David Oliver: Clinical records, plain English, and professional terminologyBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4487 (Published 30 October 2018) Cite this as: BMJ 2018;363:k4487
In 2014 the award winning author John Lanchester argued in his book How to Speak Money1 that the global financial crash had occurred partly because most of us have little understanding of finance, especially of its professional terminology and jargon. But he also acknowledged that, while jargon can be lazily or deliberately obfuscating and can exclude the public, it can also provide precise, succinct shorthand that’s much harder to explain in plain English.
Among his glossary were “derivatives markets,” “consumer surplus,” “short selling,” “Laffer curve,” and “VIX index.” Search these online, and they require lengthy explanations in plain English, with further definitions of the terms used to describe them. For instance, a derivative is “a contract that derives its value from the performance of an underlying entity which can be an asset, index or interest rate.”2 The Laffer curve “illustrates a theoretical relationship between rates of taxation and the resulting rates of government revenue.”3 Those are just the start of their explanations on Wikipedia.
Doctors have a professional terminology of our own, which can seem equally inaccessible to patients and their families. A well written medical court report, newspaper column, or leaflet explaining conditions and treatments to the public, if it is to be useful, requires plain English explanations alongside the clinical language. This can make a court report longer as each technical term is explained in parentheses.
Yet such terminology can convey immediate precision to fellow practitioners that would require far more words in plainer language, often losing that precision. For instance, try explaining the TNM staging of a tumour or the subtype of cardiac arrhythmia, glomerulonephritis, or fracture with the precision and brevity of terms designed by professionals for professionals—or in accordance with the International Classification of Diseases or medical textbooks. It’s just as hard as decoding finance speak.
Technical terms can convey immediate precision that requires far more words in plainer language
The Academy of Medical Royal Colleges is encouraging doctors to write to patients in plain English, copying in GPs—rather than copying patients in on letters written to GPs.4 I certainly support this. What I love about the initiative is that it comes with clear guidance on how to structure letters, as well as tips to make prose clear, readable, and less likely to cause upset or anxiety. It also states that precise professional terminology is still OK in its place within a letter, such as in a clinical problem list.
There’s a growing policy push towards patient held or patient accessible records—increasingly, electronic ones. This is likely to feature again in NHS England’s forthcoming 10 year plan, which has its own plain English consultation guide,5 as well as its existing guidance such as Offering Patient Access to Detailed Online Records.6 I’m just as supportive of this, bearing in mind that we shouldn’t inadvertently exclude large numbers of patients who don’t or can’t use the internet or some devices. Records are as much the patients’ notes as the practitioners’, and it’s their lives we are discussing.
Yet, if doctors have to check and clarify their prose to avoid needless jargon, will that take time away from direct patient contact or other work? Might it mean that we have to spend more time giving long form explanations of precise shorthand terminology, abbreviations, and acronyms, mindful that patients may read them? Will it hamper inter-professional communication? I have no idea, but I’d love to hear from any readers who have done this already and to find out how it went.
Competing interests: See www.bmj.com/about-bmj/freelance-contributors/david-oliver.
Provenance and peer review: Commissioned; not externally peer reviewed.