As an internist, my main procedure is asking questions, so words are very important to me. Early in my medical training, I learned that all doctors are bilingual, speaking both their native tongue and the language of medicine, where terms like myocardial infarction and otolaryngologist become second nature. I learned to translate my thoughts back to the patient’s vernacular when we communicated. Despite this translation, I often found myself flummoxed by the answers I received, until I realized a patient and I were using different languages, even when I was trying my best to avoid medical lingo and to speak in plain terms.
Many years ago, perhaps in medical school, I had an encounter that went something like this:
Your blood tests show elevated liver tests. I am wondering, have you been taking any new medicines or herbs?
No.
Do you drink alcohol?
No, not at all.
Have you been sick recently? A stomach bug, a cold or flu?
No. I’ve been feeling fine.
Any recent stomach pains or vomiting? Any travel?
No and no.
By this point I was stumped, so I circled back to my first question: No alcohol at all? Maybe wine, liquor, cocktails?
Oh, no. Nothing like that.
Hmm, no new medicines or herbs, no over the counter pills, no liquor, wine, or beer?
Well, I do drink three beers every night.
I hadn’t realized that while I categorize beer as “alcohol,” many people may not.
Since then, I specifically ask, “Do you drink any alcohol, including wine or beer?”
I’m sure it sounds funny to any clinical staff who happen to overhear, and to many patients, but repeatedly, I have been rewarded with a patient who says they do not drink alcohol, but they do indulge in wine or beer.
Through the years, I have developed a work-around language to try to meet patients where they are, to make sure we both are talking about the same thing. Besides my definition for “alcohol,” here are a few adjustments that I have made to my history-taking:
Have you had any surgeries?
I now ask Have you had any surgeries or operations? I have found that people sometimes consider these to be different. I may list some common procedures that are frequently forgotten. (C-section, tooth extractions, joint replacements, appendix, or gallbladder removal.) Frequently, a patient would tell me they had no surgeries, then I would observe a big scar from an open appendectomy during the exam. “That was so long ago, I didn’t think you would need to know about that.” If a patient tells me they have no surgeries, I may ask if they had any in their whole lifetime, including their childhood.
Are you sexually active?
The person might say no, then later reveal that they indeed had intercourse in the recent past, maybe even the past week. (Maybe it was a one-off, while they considered “sexually active” to be an ongoing state? Maybe they genuinely forgot until further questioning?) Now I ask, “When was the last time you had sex or were intimate?” which seems to provide a more accurate reply.
Did you take a COVID test?
My patient has new upper respiratory symptoms, and I am wondering if they have already self-tested for COVID. So many times, the patient tells me it can’t possibly be COVID because they had a negative test, and then, it turns out the test was six months ago. To my mind, that test is not relevant to the current symptoms, but I suppose that may not be evident to the layperson. Now I ask if they tested themselves since the current symptoms began.
Are you eating healthy?
Many people seem to think I am asking if they have a healthy appetite. I might get an answer like, “Oh, yes, I am always eating. I have a milkshake every day!” I now know to ask more specific questions, like if they are choosing low-salt foods, if they include fruits and vegetables in their diet, or better yet, I may ask them to list everything they eat on a typical day, including drinks and snacks. I have had patients tell me they “eat nothing” all day, meaning they don’t have any solid meals, but they may constantly imbibe Cokes and nibble on cookies and chips. No wonder their diabetes is out of control!
Do you have a headache?
I have learned that many people differentiate an “ache” from a “pain” or even a “funny feeling.” Not infrequently, patients tell me they don’t have a headache, then later mention a pain in their head, or a “sinuses” (by which they mean a discomfort across their forehead), or a migraine. Or they may become upset when I refer to their “back pain" and they say it’s not a pain, it’s an ache or a feeling. I now try my best to meet the patient where they are by using the patient’s own description of their symptoms.
Your test was negative.
I have previously provoked alarm and fear with this statement. For example, I might say a screening test was negative for hepatitis C, but the patient may believe that the word negative means a bad result. I have learned to specify that a mammogram is normal with no sign of cancer, or a urinalysis shows no infection. Negative to saying “negative”!
I have learned a lot through the years, and have adjusted my communication accordingly. Words are powerful. The wrong words can frighten or stigmatize. The right words can comfort, console, or inspire. Every patient deserves to be understood, even if it takes a little extra work to get to their exact meaning.
What words have you found confusing? What words have you used that confused your patients? Share in the comments.
Melissa Schiffman, MD is a community-based primary care physician who practices in Suburban Philadelphia. She enjoys books, birds, gardens, and word nerdery. Her favorite medical term is "borborygmi." Find her on Twitter at: @MSchiffmanMD. Dr. Schiffman was a 2022–2023 Doximity Op-Med Fellow, and continued as a 2023–2024 Doximity Op-Med Fellow.
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