Words Patients Just Don't Understand

[docB]

This is a totally different issue than those so eloquently coveren in the "Medical Ebonics" thread.

We had a situation recently where a patient came into the ER by EMS under CPR. While the patient was coded the family arrived at the front desk. They told the clerk that their family member was just brought in and "He's a trauma." To them "trauma" meant "really sick." The clerk told them that if the patient was a trauma they would have been taken to the trauma center down the block so the family left and went to the other hospital. At the trauma center no one could find the patient so they called us with the patient's name and by the time the family arrived the code was over. They were really upset but it's easy to see how this happened.

This made me think of some of the words that we use all the time that the majority of patients and families misinterpret.

Word -- What patients think it means
Trauma -- Really bad, they think a "trauma center" is where really sick patients go
Acute -- Severe, "I've had this acute pain for 6 months."
Chronic -- Severe

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[CueDoc]

how about the word emergency? apparently it means any pain or problem you have whatsoever

 

[Chronic Student]

Lesion/Tumor/Cancer is pretty frequently misunderstood. I try to use the word lesion because of the fallout from using the word tumor or cancer but all of them can be misunderstood.

-Mike

 

[killerleaf]

anything the doctor says AFTER the word "tumor" or "cancer"

 

[TheMightyAngus]

Viral vs. Bacterial

 

[GeneralVeers]

Viral vs. Bacterial

"No antibiotics are necessary" - No one ever understands that one

 

[deleted77919]

how about the word emergency? apparently it means any pain or problem you have whatsoever

Or the word "urgent." I like how in medicine we have corrupted the term "urgent" to instead mean "not-urgent", think "urgent care centers." The patient thinks they are being sent to a place that will take care of them because their problem is "urgent" when in reality we just want them out of the way for real emergencies. Everybody ends up happy.

Points to whoever came up with this term.

 

[DrQuinn]

"no refills on your percocets"

work excuse: because the pollen counts are high and you have some allergic rhinitis and post nasal drip, does NOT mean you can have off for a week. (Just had a patient argue to death with me two days ago for this).


Q

 

[Wackie]

Anyone have pt family scream code blue because the pt started vomiting?

 

[GeneralVeers]

My favourite is "Coughed up blood". When trying to dissect the history as to whether the patient vomited or coughed the blood, the patients usually have no clue. Most people don't know the difference betweens stuff coming up from their esophagus and stuff coming up their trachea.

 

[southerndoc]

"no refills on your percocets"

work excuse: because the pollen counts are high and you have some allergic rhinitis and post nasal drip, does NOT mean you can have off for a week. (Just had a patient argue to death with me two days ago for this).


Q

Someone came to the ED the other day for a URI. When I was discharging him, he said "I was going to ask you for a work excuse, but then I saw how you're working with the same thing I have. I guess I'll just tough it out."

I love it when I'm working with a URI or something and a patient with less troubles than me asks for a work excuse. If I'm running a fever or vomiting, that's about the only thing that will keep me home. Otherwise, I just show up to work, wear a mask and wash my hands frequently.

 

[Miami_med]

Here in Miami:

What I say --------- What the patient hears?
Something in English ----- ???????

 

[docB]

For some weird reason my patients don't equate fractured with broken. I've had many patient's say "Oh, so it's just a fracture. It's not broken?"

 

[DropkickMurphy]

work excuse: because the pollen counts are high and you have some allergic rhinitis and post nasal drip, does NOT mean you can have off for a week.

Not even for good ol' DKM? *pops more allergy medication* I hate spring time.

 

[deleted109597]

I had a patient almost blow up on me last year when I asked about the warts on a his hands and he said "It is a herpetic virus". Later in the ROS I mentioned "..you also have one of the herpes viruses" as an afterthought and this guy did not take it well. I might as well have said that he had gonosyphiherpiles or something worse. It probably took a good minute of talking him down before I could even thing of continuing the exam.

 

[NinerNiner999]

Two words - "Follow Up." For some reason, these words elude most of my patients...

 

[CueDoc]

sickle cell disease - free pass to get as much narcotics as you want.
fibromyalgia - full of s*** but still think you can get as much narcotics as you want.

 

[Febrifuge]

For some weird reason my patients don't equate fractured with broken. I've had many patient's say "Oh, so it's just a fracture. It's not broken?"

One of my proudest tech moments, when I said something a more professional, educated person probably shouldn't, was when I helpfully answered a patient's umpteenth request to remove the C-collar with "dude, you have five different broken bones in your neck and back."

It felt good in a very unusual way.

 

[leviathan]

Who was it on here that said something to the tune of, "the better you felt when you said it is correlated to the amount of trouble you're in after?"

So true.

 

[ERMudPhud]

For some weird reason my patients don't equate fractured with broken. I've had many patient's say "Oh, so it's just a fracture. It's not broken?"

Here in Colorado we have serious bodily injury law that raises assualts from a misdemeanor to a felony under certain conditions. One of the listed conditions is a "fracture of any bone." That means that in domestic violence cases I get nasal bone xrays if there is any sign of nasal trauma as a broken nose counts. Anyway, I was testifying once in a DV case and the defense attorney kept going round and round about the injury somehow trying to get me to say the orbital wall was broken but not fractured (or vice-versa). I think he was trying to make the point that if wasn't displaced it was just fractured or just broken and therefore not a "serious bodily injury'"

 

[Chronic Student]

I forgot the single word that is most often misunderstood.

"No"

It apparently has thousands of alternatives meanings including yes and maybe.

-Mike

 

[Dr.Evil1]

Migraine - people think that any headache that is severe is a migraine

Sexually active - I think that this sometimes implies more than 1 partner. Had a guy last night who claimed he wasn't sexually active...he was just having regular sex but only with his one girlfriend

Fracture - agree with above, have to repeatedly tell people that yes a fracture is the same thing as broken

 

[docB]

Migraine - people think that any headache that is severe is a migraine

That's so true. I usually ask the "migraine" patients "So you've been diagnosed with migraines by a doctor or you just mean you have bad headaches?" This conversation invariably ends with a discussion about the letter "D" anyway so maybe it doesn't make too much difference.

 

[EM2BE]

Migraine - people think that any headache that is severe is a migraine

What's odd is that different doctors diagnose a person with a migraine while others will say it's just a headache. I have gone to a conference of some type and I remember the speaker saying something about if a person has a headache for 3 days straight it can be considered a migraine. (I guess I'm trying to say the term is sometimes confused among physicians.)

 

[AmoryBlaine]

Easy one: "allergy."

"I'm allergic to penicillin."
"what happened when you took it?"
"my stomach hurt."



Another one: "stress"
So many pts I saw on my primary care rotations seemed to think that "stress" was biochemically equivalent to a pheochromocytoma.

"sir, your BP is 170/100"
"yeah, I've been under alot of stress lately."

 

[DrQuinn]

Easy one: "allergy."

"I'm allergic to penicillin."
"what happened when you took it?"
"my stomach hurt."

Brings me to someone I had last night. Had a young woman with a 2nd degree burn to the back of her hand. She had an "allergy" to sulfa drugs. I didn't bother asking her what it was, but wasn't sure if you could use silvadene with sulfa allergies. I called the pharmacist, and was on hold for like 15 minutes. They came back and said "You might be able to use it."

This, of course, made me realize that he probably googled it. My belief that pharmacists are over paid web surfers (atleast the ones in my hospital) was confirmed.

Well, I end up going back to talk to her, and she said she's allergic, becasue whenever she takes sulfa drugs, she gets a yeast infection.

*sigh*

Silly me.

Q

 

[soxfan87]

Brings me to someone I had last night. Had a young woman with a 2nd degree burn to the back of her hand. She had an "allergy" to sulfa drugs. I didn't bother asking her what it was, but wasn't sure if you could use silvadene with sulfa allergies. I called the pharmacist, and was on hold for like 15 minutes. They came back and said "You might be able to use it."

This, of course, made me realize that he probably googled it. My belief that pharmacists are over paid web surfers (atleast the ones in my hospital) was confirmed.

Well, I end up going back to talk to her, and she said she's allergic, becasue whenever she takes sulfa drugs, she gets a yeast infection.

*sigh*

Silly me.

Q

Fantastic. As a patient, this explains the skeptical reactions I've gotten when I've told doctors I have a sulfa allergy. It usually disappears when I tell them that no, this does not just mean common side effects like a stomach ache, it means the weird side effects like palpitations, chest aches, insomnia, and SOB that come with "Call your doctor immediately if. . ." labels next to them on the drug sheet, plus massive, itchy, burning hives on every skin surface that take a Zyrtec Rx and a vat of Cort-Aid to fix. Oddly, after this explanation, they accept at face value my claim that I also can't take amoxicillin.

Stupid people like the woman described above not only make doctors' jobs more irritating, IMO, they also spill over onto other patients.

 

[edinOH]

How about "worst headache of my life"?

I know alot of times what you are meaning to tell me is that your headache is "really bad" and you "really need that medicine that starts with a D" and that you "really wouldn't be here if it really wasn't the worst headache ever and that you really can get a ride home and that you really need a work excuse for tomorrow"

What I "really want to explain to you is that if you really have such a headache I really need to stick a really long needle into your really fat back to hopefully get some really clear fluid after your really unecessary head scan was read as really normal".

Sigh.

 

[AmoryBlaine]

"Are you taking any medications?"

I don't understand why this confuses people so much. Invariably the conversation goes like this:

Me: "Are you taking any medications?"

Pt: "No."

Me: "It says here that you have diabetes and high blood pressure. Are you taking any medications for those?"

Pt: "Yes."

Me: "What are you taking?"

Pt: "I take a water pill and Toprol for my blood pressure, and something that starts with a 'G' for my diabetes. I forget the name."

Me: "So actually you are taking medications?"

Pt: "Yeah, I guess so."

Ha ha ha, great laugh with the morning coffee!

Variations:

Me: "Do you have any medical problems?"
Pt: "No, very healthy."
Me: "Hmm, well you wrote down that you take Metformin, HCTZ, Lipitor, Allopurinol, Toprol, and Vicodin...."
Pt: "Oh, yeah, I guess I do..."


Me: "Have you ever had surgery?"
Pt: "Nope, I've always been very healthy."
Me: *begins to examine pt, notices 6 inch long sternotomy scar*
"what happened here?"
Pt: "Oh, that was when I had my bypass last year."

 

[gutonc]

Well, I end up going back to talk to her, and she said she's allergic, becasue whenever she takes sulfa drugs, she gets a yeast infection.

When I was a med student on surgery, I had a physician as a pt who said she was allergic to clindamycin. Reaction? "It gives me C. diff." She wanted to get Vanc instead.

She was a radiologist but she at least had 1 year working as a real doctor!

 

[docB]

It's not a word but it's a concept that patients don't get. If you've had a work up in one ER keep going to that ER. The idea of "They had their chance so I'm going to the place across town." may make sense to lay people used to dealing with auto mechanics and the like but in medicine it's pure stupidity. The new place won't have your records and will have to start out at squate one. Sometimes you just have to wait for a disease process to declare itself.

 

[CueDoc]

has anyone ever had a patient who understands the 1-10 pain scale? I haven't. Scenario:

Me: On a scale of 1-10, with 1 being no pain and 10 being the worst pain you can possibly imagine, how would you rate your pain?

Pt. - 10! .. ( or 12! etc.)

Me: Have you ever had children?

Pt. - Yes, one was a natural birth

Me - So your tootache is worse than tnatural childbirth?

Pt. - (completely straight face) No

.... I don't get it... no wonder we are behind in the technology race

 

[roja]

"Were you trying to get pregnant?"

"no"

invariably followed by:

"So you're using birth control?"

"No"

"So you're trying to get pregnant"


sigh

 

[group_theory]

Easy one: "allergy."

"I'm allergic to penicillin."
"what happened when you took it?"
"my stomach hurt."

Are you allergic to any meds?
Pt: YES
Which ones?
Pt: Lasix
What happens when you take Lasix?
Pt: It makes me pee


Different patient
Are you allergic to any meds?
Pt: I think so.
Which ones?
Pt: Epinephrine
What happens when you get epinephrine?
Pt: It makes my heart rate go up

 

[Hawkeye Kid]

Different patient
Are you allergic to any meds?
Pt: I think so.
Which ones?
Pt: Epinephrine
What happens when you get epinephrine?
Pt: It makes my heart rate go up

kinda makes you wonder why they know that, doesn't it? it's along the same lines as those that are benadryl- or prednisone-allergic.

 

[FoughtFyr]

When I was an MSIII a patient had "magnesium citrate" listed on his allergy sheet. As a good and dutiful medical student, I asked him what had happened when he took the mag citrate. His reply "I got the runs real bad, for like 5 hours!". He had it prescribed for constipation.

The annoying part - the nurse threatened to write me up if I removed the notation of an allergy to magnesium citrate on the chart. She said "If they say they are allergic - they are!". Despite my protests that this wasn't even an adverse reaction, or a known side effect, it was the expected reaction, it stayed on the list. I really wanted to go to my chart and put down that I was allergic to ibuprofen and list the effect as a "reduction in pain". And I would have, except that everyone in the ED knows that ibuprofen doesn't work! Gimme Dilaudid!

Yep, common sense isn't.

- H

 

[DropkickMurphy]

"sir, your BP is 170/100"
"yeah, I've been under alot of stress lately."

Sounds like my grandmother.....she was non-compliant with her meds and developed a nosebleed (among other symptoms) due to HTN. I took her BP (she asked me to) and it was somewhere around 210/190, so I told her we were going to the ED and she was like, "No, it's just I'm under a lot of stress with Tom (my grandfather) being sick and all." I love her to death, but God she makes my head hurt sometimes.

 

[deleted6669]

I used to think this too until I actually saw it!

One night in the Peds ER, we had a child with aan itchy bug bite who we gave benadryl to, and I literally watched him develop hives and puffy lips in the twenty minutes after we gave it to him. No history allergies, no new foods or contacts, etc etc. It was a true benadryl allergy, as bizarre as that sounds.

How about progressive sx from the original bug bite? far more likely.....

 

[AmoryBlaine]

Sounds like my grandmother.....she was non-compliant with her meds and developed a nosebleed (among other symptoms) due to HTN. I took her BP (she asked me to) and it was somewhere around 210/190, so I told her we were going to the ED and she was like, "No, it's just I'm under a lot of stress with Tom (my grandfather) being sick and all." I love her to death, but God she makes my head hurt sometimes.

That's kinda scary man. I did a health fair last week where I took about 50 blood pressures. Not suprisingly most of the people were obese, and most of them were elevated. Every single person said "oh I just ate" or "well I'm stressed because I was at work" or my personal favorite "of course it's going to be high, I just walked over here from across the park."

I resisted that urge to say, "yeah, it could have been the walk or your lunch, but I think the fact that this folding chair is creaking ominously under your girth could also be involved..."

 

[deleted87716]

I did a health fair last week where I took about 50 blood pressures. Not suprisingly most of the people were obese, and most of them were elevated. Every single person said "oh I just ate" or "well I'm stressed because I was at work" or my personal favorite "of course it's going to be high, I just walked over here from across the park."

Pretty typical. Denial isn't just a river in Egypt.

Last week, I had a fairly well-educated guy vehemently deny that he could possibly be a diabetic despite having had two fasting blood sugars greater than 140, a GTT with a two-hour reading of over 200, and a HbA1c of eight-point-something. Him: "The tests could be wrong, couldn't they?" Me: "Um...no."

 

[Wackie]

It's not a word but it's a concept that patients don't get. If you've had a work up in one ER keep going to that ER. The idea of "They had their chance so I'm going to the place across town." may make sense to lay people used to dealing with auto mechanics and the like but in medicine it's pure stupidity. The new place won't have your records and will have to start out at squate one. Sometimes you just have to wait for a disease process to declare itself.

This slightly irritates me. I get family/friends asking me if they should sue someone (like I'd know!). They've bounced around and their problem isn't solved. They've either never followed up with a doctor outside of the ER or have bounced around doctors because they leave that doctor once he/she puts them on the same meds as they've had. Or, their problem has gotten worse. Did they call their doc? No. I ask them how is their doctor to fix something they don't know about and they return a blank stare. I try to explain how different medications can be tried rather than expensive testing to figure out what is wrong with them and it's a completely foreign concept. Of course by then, they have to admit their approach only hindered things so they fall back on, "Well, he/she didn't listen to me!" Ugh. If it's bad enough, they'll call their doc back, so I guess it's worth it.

Sorry for the rant.

 

[SoCuteMD]

Words patients just don't understand:

"Medical Student" when they come from the mouth of a young female

"Oh, so you're going to be a nurse, honey? Well that's just great!!!"

I don't even bother to clarify anymore!!

 

[Bill59]

I realize now that all my training in medical nomenclature was completely useless. And I never use "fracture" with patients any more. It's broken. For the obviously lower-educational level patients, I'll even violate every grammatical principle in my body and say, "It's a little bit broken" or "It's a lot broken." But it's always broken, never fractured.

In the southeastern US there's a well understood grading scale for fractures:

Nondisplaced fracture - cracked
Simple displaced fracture - broke
Comminuted fracture - broke all to hell
Fracture with extensive soft tissue injury -- tore slap up

 

[Apollyon]

It's not a word but it's a concept that patients don't get. If you've had a work up in one ER keep going to that ER. The idea of "They had their chance so I'm going to the place across town." may make sense to lay people used to dealing with auto mechanics and the like but in medicine it's pure stupidity. The new place won't have your records and will have to start out at squate one. Sometimes you just have to wait for a disease process to declare itself.

For once, I have to disagree with docB. In one book, Corey Slovis and Keith Wrenn wrote that "for any problem, there is a doctor for it. Your job is to find that doctor".

Had a patient this morning that fell 2 weeks ago. Seen at 2 other hospitals, but one stinks of "dumping", as she is uninsured. Short story, cauda equina, now in post-op.

Sometimes starting at square one is the way to go.

 

[c.bear]

How about this:

me: "Do you have high blood pressure?"

pt: "no"

(later)

me: "Do you have any medications?"

pt: "I take something for my hypertension."

me: "I thought you said you did have high blood pressure"

pt: "I don't have high blood pressure. I just have hypertension."

Hu????

 

[AzMichelle]

What about when a patient's temp is normal and they swear their usual temp is very low, if it is 98.6 they have a "serious" illness!

They usually have fibro as well.

 

[beyond all hope]

#1
I've been vomiting

What have you been vomiting?

Cold?

From your nose?

Yes.
10-20% of 'vomiting' is rhinorrhea/cough.


#2
My arm is numb.

You mean, tingling, like pins and needles?

Yup.
90% of 'numb' is paraesthesias or pain

#3
I can't keep anything down.

You mean you're vomiting?

No, it all comes out the other end
5% of 'I can't tolerate PO' is diarrhea.

#4
My baby can't keep anything down

When's the last time she ate?

2 hours ago. But only 2 oz. She normally takes four.

90% of pediatric 'She can't tolerate PO' is...crap.

 

[llayne]

I used to think this too until I actually saw it!

One night in the Peds ER, we had a child with aan itchy bug bite who we gave benadryl to, and I literally watched him develop hives and puffy lips in the twenty minutes after we gave it to him. No history allergies, no new foods or contacts, etc etc. It was a true benadryl allergy, as bizarre as that sounds.

Did he get the po liquid? My father is actually allergic to the dye in otc benadryl syrup (similar rxn as your pt) and has to use the dye-free variety.

 

[MasterintuBater]

NONE of my patients understand the word "About".
"Mr. Johnson, ABOUT how long ago did you have your heart attack?"
"Well, let me see it was right after Peggy Sue's wedding and right before we went camping but I can't think where.......[family chimes in...."No, no, no, it was BEFORE the wedding and remember we had just bought the new dog and the car broke down and....][more family chimes in...."It was right after Christmas.....No, no, no it was HOT out, remember because he was sweating like a Pig and it was about the time that I had those bad hemorrhoid flare ups and....."]

This is why I try to avoid questions involving the estimation of "time" and recollection of events all together.

 

[SoCuteMD]

NONE of my patients understand the word "About".
"Mr. Johnson, ABOUT how long ago did you have your heart attack?"
"Well, let me see it was right after Peggy Sue's wedding and right before we went camping but I can't think where.......[family chimes in...."No, no, no, it was BEFORE the wedding and remember we had just bought the new dog and the car broke down and....][more family chimes in...."It was right after Christmas.....No, no, no it was HOT out, remember because he was sweating like a Pig and it was about the time that I had those bad hemorrhoid flare ups and....."]

This is why I try to avoid questions involving the estimation of "time" and recollection of events all together.

I find the biggest problem with the patients I encounter is that they'll say "I don't know" rather than saying "Oh, sometime about 2 or 3 years ago" which would be INFINITELY more helpful than "I don't know."

As a result, if someone says "I don't know," I'll ask "A day, a week, a month, a year, or 10 years ago?" Seems to work, but takes forEVER.

Disclaimer: I'm still a 2nd year and required to take internal medicine-esque histories. No avoiding these questions for now!