How to communicate with patients

[mustangsally65]

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So I've been thinking a lot about the doctor-patient relationship, and I usually pay attention when I go see a doctor, to evaluate what works and what generally doesn't. There's a lot of stuff to think about, such as the age of your patient, the level of education/vocabulary, the mental state of your patient, the gender of your patient, and any cultural or religious beliefs.

I sometimes think doctors are talking down to me, dumbing things down to a level that feels like a kindergartener could understand it. Other times they assume I have a level of knowledge that I don't have yet, and it's kind of embarassing to ask for further explanation. So how do you think we can achieve a good balance between the two while still being professional and empathetic?

I think the one event that made me realize the importance of this type of communication was when I saw a general surgeon last week. He was explaining the developmental differences between males and females during gestation, and while discussing the way the testicles descend, he actually used the word "nutsack." I was shocked. I'm female, he was male, and he actually said nutsack to me. Is that the proper word? Would any of you guys be offended by that? It didn't offend me per se, but I was amazed that he would use that term in such a casual manner. I don't think he was a day over 35.

We should compile a list of acceptable and unacceptable terms to use with patients. In the above example, I think it would have been okay to say nutsack to another male, but to a female I think it was inappropriate. Like I would have been offended if a male had said "boob" to me instead of "breast."

What do you guys think?

 

[jebus]

So I've been thinking a lot about the doctor-patient relationship, and I usually pay attention when I go see a doctor, to evaluate what works and what generally doesn't.

I'm surprised he said nutsack for a few reasons. It seems inappropriate and what kind of person still calls it a nutsack? Seriously, I haven't heard that since middle school.
Usually when I go to the doctor (or more often, go with a family member) I pay more attention to how well they tend to my/my family's emotional needs. How responsive they are to non-verbal cues by the patient - sighs and deep breaths, visible facial tension when discussing something, fast talking and a slightly higher pitch, and especially how well they listen to and actually respond to what we say, rather than what they feel we need to know.

 

[Labslave]

So I've been thinking a lot about the doctor-patient relationship, and I usually pay attention when I go see a doctor, to evaluate what works and what generally doesn't. There's a lot of stuff to think about, such as the age of your patient, the level of education/vocabulary, the mental state of your patient, the gender of your patient, and any cultural or religious beliefs.

I sometimes think doctors are talking down to me, dumbing things down to a level that feels like a kindergartener could understand it. Other times they assume I have a level of knowledge that I don't have yet, and it's kind of embarassing to ask for further explanation. So how do you think we can achieve a good balance between the two while still being professional and empathetic?

I think the one event that made me realize the importance of this type of communication was when I saw a general surgeon last week. He was explaining the developmental differences between males and females during gestation, and while discussing the way the testicles descend, he actually used the word "nutsack." I was shocked. I'm female, he was male, and he actually said nutsack to me. Is that the proper word? Would any of you guys be offended by that? It didn't offend me per se, but I was amazed that he would use that term in such a casual manner. I don't think he was a day over 35.

We should compile a list of acceptable and unacceptable terms to use with patients. In the above example, I think it would have been okay to say nutsack to another male, but to a female I think it was inappropriate. Like I would have been offended if a male had said "boob" to me instead of "breast."

What do you guys think?

I think you made the most important point: you need to be aware of things like culture, age, gender, etc. and just try to be as sensitive to those things as humanly possible. Of course, we all have our own ideas about what is and isn't acceptable, so some might feel completely comfortable referring to scrotums and breasts as nutsacks and boobs with their patients. Personally, I wouldn't even consider using such vocabulary in a clinical setting... 😉

Not to hijack the thread or anything, but it's kind of funny that you said you would be offended by a male doctor using the word boob instead of breast. I, being a male, wouldn't be offended at all by a female doctor using the word nutsack (in context, of course 😉 ). Looks like it may be a difference between men and women. What say you, fellow SDN addicts?

 

[DeadorAlive]

I can't think of anyone saying "nutsack" without thinking that person is either 12 or stoned. Definitely not what I'd love to hear from my doctor...

 

[BooMed]

Eeewwwwwww

 

[Larch]

I think that when discussing the body, esspecially sex organs, no euphamisms should be used. It implies that there is something dirty or taboo about that part of the body. This topic came up recently when I was having a discussion about sexual education.

Feces are feces, and they are only poop if someone doesn't know what "feces" means. A vagina is a vagina. A scrotum is a scrotum. Labia are labia. So on and so forth.

I think it is best to be accurate, but simple. Use layperson language while at the same time avoiding slang. Be sure to tell patients that it is alright to stop you and ask for clarification if they don't understand something or just want more info. Don't appear overly rushed if you can help it (of course, you often will be, esspecially in certain specialties).

I would be livid if I ever heard a doctor use slang terms for sexual anatomy. It's always been a pet peeve of mine.

 

[Law2Doc]

So I've been thinking a lot about the doctor-patient relationship, and I usually pay attention when I go see a doctor, to evaluate what works and what generally doesn't. There's a lot of stuff to think about, such as the age of your patient, the level of education/vocabulary, the mental state of your patient, the gender of your patient, and any cultural or religious beliefs.

I sometimes think doctors are talking down to me, dumbing things down to a level that feels like a kindergartener could understand it. Other times they assume I have a level of knowledge that I don't have yet, and it's kind of embarassing to ask for further explanation. So how do you think we can achieve a good balance between the two while still being professional and empathetic?

I think the one event that made me realize the importance of this type of communication was when I saw a general surgeon last week. He was explaining the developmental differences between males and females during gestation, and while discussing the way the testicles descend, he actually used the word "nutsack." I was shocked. I'm female, he was male, and he actually said nutsack to me. Is that the proper word? Would any of you guys be offended by that? It didn't offend me per se, but I was amazed that he would use that term in such a casual manner. I don't think he was a day over 35.

We should compile a list of acceptable and unacceptable terms to use with patients. In the above example, I think it would have been okay to say nutsack to another male, but to a female I think it was inappropriate. Like I would have been offended if a male had said "boob" to me instead of "breast."

What do you guys think?

Dumbing down language is the general rule -- that's the hardest thing for some med students, as you will learn all the technical terms in school, and then you talk to patients and don't have the ability to communicate. Some of the patients are smart, or experienced with the vernacular, and you can ask them anything using your normal vocab. But unfortunately that is not the rule, and large chunks of the population may not have as high an education level, or english may not be their first language. You can't always ask patients if they are having "respiratory" problems or "circulation" problems, or use words like "testicle" because there will be people who do not understand. Yet you still need to communicate with them or else you will be unable to take a medical history, or provide instructions. Thus you are forced to develop your own style of communicating with people with less of a textbook vocabulary. I agree that nutsack isn't a word of choice. But then again, there was no confusion as to what this doctor meant, so it accomplished its purpose.

 

[Gatewayhoward]

The nutsack thing wouldn't offend me personally but it sounds a little unprofessional. As a paramedic, I wouldn't ever say that.
I've found that medicine is a language in and of itself, and I'm not talking about latin at all. I found I do dumnb what I say down a whole lot to people who don't know medicine. I may say a fancy word then explain what it means. What I usually do is explain something in layman's terms and see how the patient responds. It takes finesse and I certainley don't have it yet. What you should do is find docs who are excellent at communicating to patients and take note on their strategy to communicate so well. Also, ask.

 

[Larch]

You can't always ask patients if they are having "respiratory" problems or "circulation" problems, or use words like "testicle" because there will be people who do not understand.

I think there is a difference between asking, "Are you having problems breathing?" and, "Does your nutsack/p*ssy itch?" when trying to determine problems in a clinical setting.

 

[mustangsally65]

You're right, he did get the point across, but it was extremely surreal to be sitting across the room from a young, well-educated good-looking guy and have him say nutsack like it was any other word. And I also wondered why he was discussing the male reproductive development with me (I was having an inguinal hernia exam).

I don't think I'd want a woman saying "boob" to me either, or any of the euphamisms for vagina. But I think I would have been more accepting of a female using slang for the male reproductive system than I am for men. Ideally, I prefer the proper terms because it takes away some of the inherent embarassment that comes from discussing things in public that should be discussed in private. When you use medical terms it's okay, for some reason.

I know I will lose a lot of my inhibitions when I get to med school and am exposed to these terms and situations every day, but right now it's still kind of weird. Especially when it comes from a hot young blonde doctor. 😛

 

[tigress]

This is why I'm SO thankful that I'm working for a year in a clinic before going to med school. I've learned a ton about interacting with patients, some of it just from seeing the mistakes that other people make. And while I agree that it's important to simplify language, often it's possible to gauge the level of the person you're talking to and respond accordingly. For example, I was speaking to a couple today and I could tell they were well educated by the responses they were making, so I correspondingly used more technical language. I also said something like, "I'm not sure of your background . . ." when referring to a document with scientific language in it, and when I found out that they're both engineers and she has a background in biology, I knew how to approach the conversation better. Sometimes little openings like that come up. OTOH, I have also learned not to assume that somebody will understand medical terms just because they're well educated. Overall I'm about 300% more comfortable communicating with patients now than I was 6 months ago.

I have to agree that a doctor shouldn't use the word "nutsack" in general conversation. Especially since he could probably have figured out from talking to you that you are an educated person. I think it would have been more appropriate for him to say something like, "the scrotum, where the testicles, or 'balls', are," if he wasn't sure you'd understand him. Like when I explain something to patients that uses the word "inflammation," I always say, "inflammation, which is swelling in the body." Respect them enough to use the real word, but explain it in case they don't understand. That has become my philosophy.

I know I have a ton more to learn about this, which I'm looking forward to in med school. But this time doing full-time patient care has made a huge difference for me. Even just little things, like knowing when and how to make appropriate small talk. I really recommend this type of job (clinical research, with tons of patient contact, both in person and on the phone) for anybody with time off before med school!

edit: I know that inflammation isn't the same thing as swelling. But how the heck else are you supposed to explain it in simple terms? 😛

 

[mustangsally65]

Thanks for your thoughts, Tigress. I just started my one-semester phlebotomy course yesterday, and we have 1 month of class and 3 months of clinicals, so I'm hoping I will get much better by May. I live in a really small area and when I've volunteered before all I did was sit at the nurses' desk and listen to them talk. There just isn't much to do around here that gets you clinical experience! It sounds like you're having a good time and learning a lot, though!

 

[kimmcauliffe]

I think that when discussing the body, esspecially sex organs, no euphamisms should be used. It implies that there is something dirty or taboo about that part of the body.
I would be livid if I ever heard a doctor use slang terms for sexual anatomy. It's always been a pet peeve of mine.

Agreed. There is nothing dirty or taboo about body parts, only arguably how we use them. 😉 To each their own.

We need to teach the young bucks how to talk to people. It's not so much about classwork anymore as much as it is being able to talk to somene and related to them on a personal level. This is where I think non-trads might have the upper hand; you've had careers and experiences for years outside of school that can only serve to help you. Then there are those people who just have a gift with others... either way, we need more docs with a more personal approach without sacrificing clinical expertise.

 

[Its_MurDAH]

So I've been thinking a lot about the doctor-patient relationship, and I usually pay attention when I go see a doctor, to evaluate what works and what generally doesn't. There's a lot of stuff to think about, such as the age of your patient, the level of education/vocabulary, the mental state of your patient, the gender of your patient, and any cultural or religious beliefs.

I sometimes think doctors are talking down to me, dumbing things down to a level that feels like a kindergartener could understand it. Other times they assume I have a level of knowledge that I don't have yet, and it's kind of embarassing to ask for further explanation. So how do you think we can achieve a good balance between the two while still being professional and empathetic?

I think the one event that made me realize the importance of this type of communication was when I saw a general surgeon last week. He was explaining the developmental differences between males and females during gestation, and while discussing the way the testicles descend, he actually used the word "nutsack." I was shocked. I'm female, he was male, and he actually said nutsack to me. Is that the proper word? Would any of you guys be offended by that? It didn't offend me per se, but I was amazed that he would use that term in such a casual manner. I don't think he was a day over 35.

We should compile a list of acceptable and unacceptable terms to use with patients. In the above example, I think it would have been okay to say nutsack to another male, but to a female I think it was inappropriate. Like I would have been offended if a male had said "boob" to me instead of "breast."

What do you guys think?

How did you not laugh when he said nutsack...Id just be like "Dude, are you serious?? NUT sack? hahahahah" I'd be rolling around on the floor.

He'd be all like "Wait, isn't that the term you young kids use these days??? I was just trying to be cool and hippity hip!"

Then I'd thank him for the laugh, give him the finger, and be on my way.

 

[Law2Doc]

I think there is a difference between asking, "Are you having problems breathing?" and, "Does your nutsack/p*ssy itch?" when trying to determine problems in a clinical setting.

I totally agree. However you will at some point in your career come across people who won't know what you mean when you try to use words like testicle, scrotum, labia etc. so you need to have some flexibility in vocabulary, and not get hung up on "taboo" (as you suggested in the earlier post) to get your point across. Communicating in slang is better than not communicating at all.
Brings to mind the old joke where the doc tells his patient that she has "acute angina" and she blushes and takes it as a graphic complement.

 

[mustangsally65]

How did you not laugh when he said nutsack...Id just be like "Dude, are you serious?? NUT sack? hahahahah" I'd be rolling around on the floor.

He'd be all like "Wait, isn't that the term you young kids use these days??? I was just trying to be cool and hippity hip!"

Then I'd thank him for the laugh, give him the finger, and be on my way.

It's kind of funny the range of emotions I experienced during those few moments. Before he actually said nutsack, I was concentrating on not looking bored, since I had hernia surgery in 2001 and I had heard this spiel several times before about the inguinal canal etc. I was only half listening, and was waiting for the rest of the conversation to start. Then all of a sudden I realized what he had said, and what was also kind of funny was that he gestured towards his groin when he said nutsack, since he was talking about testicles moving down from the pelvis to the scrotum. All of a sudden I realized he had just said 'nutsack' and motioned towards his privates. There was a fleeting moment of shock and disbelief, then I suddenly wanted to laugh at him. I realized that wouldn't be prudent at all, so I pushed that thought of my head and concentrated on anything but the thought of what he had just said. I estimated that he was younger than 40, and I'm 24 so there's not that much of an age difference.

It was a good thing that he had finished the exam already, because I don't think I could have lasted very long after that.

I kind of have a perception that surgeons are weird, because the general surgeon who fixed my hernia in 2001 was pretty strange. Not in a bad way, of course, but he seemed more comfortable when you were sedated or asleep than he did when you were awake and he had to converse with you. It wasn't that he didn't try, he just seemed really uncomfortable talking about anything else but surgically-related topics. After this encounter with Dr. Nutsack I think I will always consider general surgeons "weird" until I get to know some who are more "normal."

 

[Hoberto]

I totally agree. However you will at some point in your career come across people who won't know what you mean when you try to use words like testicle, scrotum, labia etc. so you need to have some flexibility in vocabulary, and not get hung up on "taboo" (as you suggested in the earlier post) to get your point across. Communicating in slang is better than not communicating at all.
Brings to mind the old joke where the doc tells his patient that she has "acute angina" and she blushes and takes it as a graphic complement.

I agree with Law2Doc and Larch, it's best to use the correct words, but sometimes, you can't.

It wasn't that long ago I was talking to a good friend whose second language is English. She had recently went for birth control pills and didn't know or understand why the doctor wanted her to take her underwear off and lay down on the table. She didn't know what a Pap Smear was or how it related to BC. Unfortunately, her doctor didn't explain and just let her leave. So, when she asked me about it she used words like, "down there" and "between my legs". Now, this is a really intelligent person, who just didn't know the correct English words. All it took was a 2 minute drawing and labels for her to have the correct words. It took considerably longer to explain paps and whatnot, but there's no way she would ever have learned without some extra effort from me. Imagine, if she had no real understanding of the female anatomy? This would have been even more difficult to explain and almost surely would have resulted in slang or other alternative words.

With a man's anatomy, the slang words are more well-known across languages, cultures and educational backgrounds. I can see where it would be necessary to draw a diagram or use slang. However, it does seem that a better word than nutsack must be available.

 

[Goodergirl]

I work in a hospital and oversee new hires in my department. One of the new hires went in to do a patient interview one day and asked the patient if she had any "vag bleeding"- and although usually in the back room we use slang abbreviations out of patient earshot frequently, you just don't say something like that in front of a patient. Now when I train new hires I give them that example when I caution them to be careful with slang.

 

[45408]

This thread will be filed under the category of: Conversations you would only have in the medical field.....

I just remember standing in the hallway at Northwestern and seeing a group of med students walk by talking loudly about Foleys and such and thinking, "Only in medicine...."

 

[Law2Doc]

This thread will be filed under the category of: Conversations you would only have in the medical field.....

I just remember standing in the hallway at Northwestern and seeing a group of med students walk by talking loudly about Foleys and such and thinking, "Only in medicine...."

I suspect nutsacks are discussed in grade school locker rooms as well as med school forums. Bottom line though is that the more advanced you get in your medical education, the more difficult it might become to express yourself in terms the average joe can understand. Boiling things down to layman's terms is a skill, and not one everybody does well (as evidenced by the doctor in the OP's example). You will never get a course in this, and will learn on the job, probably inelegantly at first.

 

[beary]

I usually just try to follow the patient's example. For example, if a patient's chief complaint involved his "nut/balls/whatever", I would be fine using that word when discussing his problem with him.

 

[45408]

I suspect nutsacks are discussed in grade school locker rooms as well as med school forums. Bottom line though is that the more advanced you get in your medical education, the more difficult it might become to express yourself in terms the average joe can understand. Boiling things down to layman's terms is a skill, and not one everybody does well (as evidenced by the doctor in the OP's example). You will never get a course in this, and will learn on the job, probably inelegantly at first.

I doubt those junior highers are also debating the validity of using such phrases in lieu of the correct anatomical jargon.

 

[Pewl]

I think people need more of a sense of humor. As long as it's not grave news being delivered, I think using slang is fine. (balls, nutsack, etc.)

I'm not gonna judge a doctor by his choice of vocabulary. Instead, I want to see whether or not he cares and whether or not he knows what he's doing. I've had 4+ surgeries so I know very clearly the qualities that I look for in a doctor. Using funny vernacular is not a big concern of mine. =P

 

[p00psicleSTICK]

I think people need more of a sense of humor. As long as it's not grave news being delivered, I think using slang is fine. (balls, nutsack, etc.)

I'm not gonna judge a doctor by his choice of vocabulary, but whether or not it seems that he cares and that he knows what he's doing. I've had 4+ surgeries so I know very clearly the qualities that I look for in a doctor.

👍 people who get offended easily suck. 😉

 

[21JumpStreet]

"I have also learned not to assume that somebody will understand medical terms just because they're well educated." Tigress

I totally agree with this statement. Someone can have a doctorate in oceanography and have no idea how blood flows through the heart.

 

[21JumpStreet]

I usually just try to follow the patient's example. For example, if a patient's chief complaint involved his "nut/balls/whatever", I would be fine using that word when discussing his problem with him.

This is a cool and rather smart thing to do. You'd probably develop a great repoire with the patient.

 

[mustangsally65]

So does anyone have a list of things that would not be appropriate to say to a patient?

(this has been a great discussion so far! )

 

[chef_NU]

👍 people who get offended easily suck. 😉

👍 👍 😉