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How Do I Tell My Patients?

New study finds careful choice of words helps people understand medical findings better

Jan 22, 2021

Making facts understandable: A careful choice of words when delivering a diagnosis can improve communication.

Making facts understandable: A careful choice of words when delivering a diagnosis can improve communication.
Image Credit: picture alliance / Westend61

In everyday life the word “positive” generally refers to something good, something that is advantageous or desirable. In a medical report, however, the opposite is usually the case. For example, a positive coronavirus test is anything but pleasant for those affected. This discrepancy between everyday and technical language can be a reason why some patients misinterpret their lab results. A simple change in the choice of words can help here, as a new study shows. Researchers from Freie Universität Berlin were involved in the study.

Technical Terms Often Difficult for Laypeople to Grasp

“Conversations between physicians and patients is communication between experts and laypersons. Patients do not always have the prior knowledge to understand all the medical terms,” says Carolin Auschra, a postdoctoral researcher at the School of Business & Economics at Freie Universität Berlin. Before studying business administration, she worked as a physiotherapist. Together with Jana Möller, a junior professor in the Marketing Department of the School of Business & Economics at Freie Universität Berlin, she designed an experiment to find out whether physician-patient communication could be improved by a slight change choice of words.

As part of an online survey, the test subjects were asked to first imagine that they had gone to their family doctor for weeks of abdominal pain and then saw a specialist for breath test for food intolerance – namely fructose and lactose. Then they got their test results. A random half of the participants received a report stating that the lactose test results were “positive” and the fructose test results were “negative.” For the other half of the participants, these terms were replaced with the “everyday” adjectives “abnormal” and “normal.” The rest of the text stayed exactly the same.

The idea for the study, which was funded by the Wagener Foundation for Social Pediatrics as part of a third-party funded project at Jacobs University Bremen, originally came from the Bremen pediatrician Professor Peter Borusiak, who often thought about how he could treat his patients in his everyday work so as to explain medical findings as quickly and comprehensibly as possible to patients, when he did not have much time due to the tight budget system. He found that this worked better when he translated the laboratory results into real-life language.

Watch Out with Positive and Negative

Borusiak's professional experience was confirmed by the study. The test subjects answered a few questions that indicated whether they had correctly understood their fictitious test results. When the words “positive” and “negative” were used, 54 percent understood correctly. If these terms were replaced by “abnormal” and “normal,” about 65 percent of the test subjects understood correctly.

A total of 1131 men and women took part in the survey, representing the population of Germany in terms of age, gender, and level of education. “We were able to determine an even clearer gain in comprehensibility in the group of test subjects with a low level of education,” says Möller. Only 25 percent of the participants without a school leaving certificate interpreted the finding correctly if it was conveyed by the terms “positive” and “negative.” On the other hand, 62 percent understood it when the everyday language was used.

Likewise, the physician's choice of words can also play a similar role when discussing other medical examinations, for example, when submitting test results for malaria or HIV, in antibody examinations, or for the early detection of cervical cancer, so-called HPV tests.

“Patients can only participate in their own therapy or take preventive action when they understand the findings correctly,” says Auschra. If they have a food intolerance, they can only feel better if they avoid the relevant ingredients. In case of a positive coronavirus or HIV test, they could infect others if they misinterpret the test results. The pregnancy test is a very special case because whether a woman is given the finding as “positive” and “negative” or in everyday language can be understood very differently.

“Physicians could get into the habit of adding a sentence in simpler language after reporting medical findings to a patient,” says Möller. “The study should also encourage people to ask questions if they are unsure whether they have understood everything.”  Often people hesitate to do so because they have great respect for physicians. Improved communication could strengthen the relationship of trust between patients and physicians – one of the most important factors for good medical care.

This text originally appeared in German on December 5, 2020, in the Tagesspiegel newspaper supplement published by Freie Universität.

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