Deuster Lindsay, Christopher Stephanie, Donovan Jodi, Farrell Michael
Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI 53226-0509, USA.
J Gen Intern Med. 2008 Dec;23(12):1947-52. doi: 10.1007/s11606-008-0729-3. Epub 2008 Aug 1.
Jargon is a barrier to effective patient-physician communication, especially when health literacy is low or the topic is complicated. Jargon is addressed by medical schools and residency programs, but reducing jargon usage by the many physicians already in practice may require the population-scale methods used in Quality Improvement.
To assess the amount of jargon used and explained during discussions about prostate or breast cancer screening. Effective communication is recommended before screening for prostate or breast cancer because of the large number of false-positive results and the possible complications from evaluation or treatment.
Primary care internal medicine residents.
Transcripts of 86 conversations between residents and standardized patients were abstracted using an explicit-criteria data dictionary. Time lag from jargon words to explanations was measured using "statements," each of which contains one subject and one predicate.
Duplicate abstraction revealed reliability kappa = 0.92. The average number of unique jargon words per transcript was 19.6 (SD = 6.1); the total jargon count was 53.6 (SD = 27.2). There was an average of 4.5 jargon-explanations per transcript (SD = 2.3). The ratio of explained to total jargon was 0.15. When jargon was explained, the average time lag from the first usage to the explanation was 8.4 statements (SD = 13.4).
The large number of jargon words and low number of explanations suggest that many patients may not understand counseling about cancer screening tests. Educational programs and faculty development courses should continue to discourage jargon usage. The methods presented here may be useful for feedback and quality improvement efforts.
行话是医患有效沟通的障碍，尤其是在健康素养较低或话题复杂时。医学院校和住院医师培训项目已着手解决行话问题，但要减少众多执业医师的行话使用，可能需要采用质量改进中使用的大规模方法。
评估在前列腺癌或乳腺癌筛查讨论中使用和解释的行话数量。由于大量的假阳性结果以及评估或治疗可能带来的并发症，建议在进行前列腺癌或乳腺癌筛查前进行有效沟通。
内科初级保健住院医师。
使用明确标准数据字典提取住院医师与标准化患者之间86次对话的文字记录。使用“陈述”来测量从行话词汇出现到解释的时间间隔，每个陈述包含一个主语和一个谓语。
重复提取显示可靠性kappa = 0.92。每份文字记录中独特行话词汇的平均数量为19.6（标准差 = 6.1）；行话总数为53.6（标准差 = 27.2）。每份文字记录平均有4.5次行话解释（标准差 = 2.3）。已解释行话与总行话的比例为0.15。当行话得到解释时，从首次使用到解释的平均时间间隔为8.4个陈述（标准差 = 13.4）。
大量行话词汇和少量解释表明许多患者可能不理解癌症筛查测试的咨询内容。教育项目和师资发展课程应继续不鼓励使用行话。此处介绍的方法可能对反馈和质量改进工作有用。
