Doctors have unique ways of communication with others. Ostensibly, over the years of gruelling training, busy work schedules and imparting of certain ways of talking during their education, doctors have developed esoteric ways of communication. Typical examples are their prescriptions and notes in the case sheets, which are often deciphered only by the doctor’s nurse or the local pharmacist. The moment it lands outside the realm of the doctor’s practice, it becomes an inscrutable document. Many doctors themselves find it difficult to understand the handwriting of other doctors leading to confusions and commotions.
Once I summoned the services of a psychiatrist for an orthopaedic patient under my care, and the next day when I read it, I was stumbled. She had written just one line in the progress notes in an arcane style of handwriting — the patient was hot on bed. As the patient smiled at me naively, I scratched my head wondering about the infinite possibilities and improbabilities of such an event considering that it was a common ward of about 20-odd patients. Later I found out that the patient was not in his bed when she visited him. Jokes apart, incomprehensible prescriptions are a serious cause of medical errors endangering the safety of patient’s health and well-being.
Communications between doctors are also weird and end-to-end ‘encrypted’ in many instances. Medical abbreviations are generously used in clinical practice, which are not standardised and universal. To give an example, the abbreviation PR is commonly used for two medical things — the pulse rate and a per-rectal examination. Pulse rate (PR) is evaluated by placing one’s fingers on the patient’s wrist and counting the number of pulses felt in a minute. It is a simple assessment and in fact, a soothing gesture that improves the bonding between a patient and the doctor. Whereas the per-rectal examination (also abbreviated as PR) is a slightly harrowing experience for the patient as the doctor inserts his gloved finger through the patient’s bottom end to feel for some internal organs.
Once an intern was reprimanded by his professor since he clearly failed to understand when he was instructed to check PR every 15 minutes for two hours and report to the professor. Obviously, the well-meaning professor intended only a continuous check on the patient’s pulse rate.
There are many such informal medical abbreviations such as MR which could mean mental retardation, mitral regurgitation, magnetic resonance or medical representative depending on the context. Due to brevity of time and pressing work demands, the use of such colloquial abbreviations and short forms have crept into medical practice along with its baggage of problems and miscommunications. With the current generations’ penchant for abbreviations such as LOL, ROLF and B4 and the frugal usage of words in social media, the usage of short forms and abbreviations has become wider in medical practice. For a patient with multiple medical illnesses, a fledgling medico has written k/c/o DM/HT/IHD/CLD/MRD, by which he meant that the patient is a known case of diabetes, hypertension, heart, liver and renal ailments, leaving me saying OMG. Documentation in case notes and prescriptions should avoid short forms, non-standard abbreviations, and a clear handwriting should be encouraged. These are easily said than done in view of the poor doctor-population ratio and burgeoning workload of doctors.
Doctors also use medical jargon during their discussion with the patients. This is many times unintentional, as these words are so familiar for the doctors that they do not perceive it as technical while the patient may hear it for the first time. Sometimes, it could be intentionally used because of the lack of equivalent non-medical terms. Understandably it is difficult to translate medical terms for diseases into easily comprehensible non-medical terms. Further, explaining a disease in vernacular language could be a double-edged sword since it is impossible to fully understand a disease over a brief consultation, and a half-truth can be more discomforting and disastrous. The use of non-medical terms for diseases is also not standardised, and different doctors use different terms for the same disease often leaving the patient discombobulated. For a disc herniation, many terms like disc prolapse, slipped disc, bulge, swelling, wear and tear, and degeneration, and an equal number of bewildering non-medical terms in regional language is used. It is difficult to draw lines here but the intention should be to make the patient understand and feel comfortable. There is no one standard recipe for improving communication between doctors and patients. It should be individualised and an active effort should be made to iron out the inconsistencies in medical parlance.
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