Chan Michael W, Eppich Walter J
Ann & Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine Chicago IL.
Present address: Children's Hospital of Orange County Orange CA.
AEM Educ Train. 2019 Dec 29;4(4):403-410. doi: 10.1002/aet2.10424. eCollection 2020 Oct.
Keywords, also known as "buzzwords" or "trigger words," serve as memorable descriptors to associate physical findings with specific diagnoses. These terms, such as "target lesion" and "steeple sign," liken a physical or radiographic finding to a nonmedical comparator as a means to elicit an associated diagnosis. Keywords permeate medical literature and clinical conversations. However, the potential for miscommunicating critical information exists and the impact of keywords on communication-related medical error is unknown. We explored the use of keywords and how physicians perceive their use in their clinical communication as part of patient care.
With a grounded theory approach, semistructured interviews were completed in 2016 to 2017 with a purposive sample of 15 resident and attending physicians working in one pediatric emergency department, where clinical conversations occur frequently between providers of different specialties and levels of training. Constant comparative analysis for emergent themes was conducted. We identified key themes and examined their relationships to theorize how keywords affect clinical communication.
We identified three major aspects: 1) keywords belong to the culture of medicine, by which providers connect with each other using specialized terms that imply a shared experience and knowledge base. This culture encourages keyword use. 2) By encapsulating a pattern of clinical findings into one word or short phrases, keywords allow for convenient, efficient communication of both diagnoses and of thought processes between providers. 3) Keywords, however, may mislead; if incorrectly applied to a given clinical situation, they may be misinterpreted by the receiver, or they may introduce bias to diagnostic decision making.
More than simple descriptors, keywords can communicate entire diagnoses and activate illness scripts between providers. Also, keywords are integral to the culture and language of medicine. However, providers should be aware of the potential negative effects of keywords in clinical conversations and must balance the demands of efficient and accurate communication with the potential for miscommunication and error.
关键词，也被称为“流行语”或“触发词”，是用于将体格检查结果与特定诊断相关联的易于记忆的描述词。这些术语，如“靶病变”和“尖塔征”，将体格检查或影像学检查结果比作非医学对照物，以此引出相关诊断。关键词充斥于医学文献和临床交流中。然而，存在传达关键信息有误的可能性，且关键词对与沟通相关的医疗差错的影响尚不清楚。我们探讨了关键词的使用情况以及医生如何看待其在作为患者护理一部分的临床交流中的使用。
采用扎根理论方法，于2016年至2017年对在一家儿科急诊科工作的15名住院医师和主治医师进行了半结构化访谈，该科室不同专业和培训水平的医护人员之间临床交流频繁。对出现的主题进行持续比较分析。我们确定了关键主题并研究了它们之间的关系，以理论化关键词如何影响临床交流。
我们确定了三个主要方面：1）关键词属于医学文化，医护人员通过使用暗示共同经验和知识库的专业术语相互联系。这种文化鼓励使用关键词。2）通过将一系列临床检查结果概括为一个词或短语，关键词便于医护人员之间便捷、高效地交流诊断结果和思维过程。3）然而，关键词可能会产生误导；如果在特定临床情况下应用不当，可能会被接收者误解，或者可能会给诊断决策带来偏差。
关键词不仅仅是简单的描述词，还能传达完整的诊断信息并在医护人员之间激活疾病脚本。此外，关键词是医学文化和语言不可或缺的一部分。然而，医护人员应意识到关键词在临床交流中可能产生的负面影响，并且必须在高效准确沟通的需求与误传和差错可能性之间取得平衡。
