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Carol Heiberger, the author of ExecuSpeak Dictionary, believes that glossaries and lexicons need to be re-recognized as valuable tools. Carol has parlayed her Wharton MBA and business experience into business tools for the 21st Century. ExecuSpeak Dictionary® creates toolkits to support the knowledge transfer and language learning needs of patients and professionals. Using our proprietary text analysis software and your electronic documents, we identify, organize, and distribute the glossaries that put technical language, lingo, and acronyms in your pocket.

Carol Heiberger

How Do Patients Learn the Language of the Diagnosis?

Effect of Shifting Forces in Healthcare on Patient Literacy

Part 1 of this blog series asserted that the healthcare literacy challenge is akin to the language and communications challenges faced by every industry. Indeed, every market, company, and every project has its own lingo.Although the healthcare industry attempts to educate its patients and caregivers, it is teaching exactly opposite to how people actually learn language. Perhaps it is time to adjust the learning process to improve healthcare literacy. Current Approach Cannot Be Sustained According to the United States Department of Health and Human Services (HHS), 90 percent of Americans need help understanding healthcare instructions. Dumbing down the language is not the best solution because the lingo and the language actually have meaning. A better approach is to smarten up the patients.  Research in linguistics, language acquisition, and neuroscience has uncovered the means by which adults learn new English terms and words.  That’s good; the path is known. (You can check out a summary in Part 1 of this series or review a detailed summary in another ATD blog series, “The Language of the Workplace.” In fact, adding words to patients’ vocabularies makes it easier to add even a few more words, thus building up a literacy capability.  Maybe words like “modality,” “asymptomatic,” and “lesion” simply need to be treated as new vocabulary words. The specific words that any one individual needs to learn will be hard to gauge. Language is a moving target, ranging from basic healthcare to disease-specific terminology to health and wellness. The good news: People are learning new terms all the time. Each new product introduction, television program, job, or neighborhood, and so on requires a new vocabulary. It stands to reason that, as a population, we can learn the language of healthcare—what we need and when we need it. If the language is continually stripped of its nuance and complexity, by presenting everything at the 6th grade level, then we are doomed to remain challenged by the vocabulary. Yet, the very definition of literacy is about the ability to comprehend complex vocabulary and concepts, and that includes medical terms or probability and risk.  The English language is rich in words and meanings. The greatest challenge to the healthcare community is that there is no way of knowing, in advance, which words and concepts are already in the vocabulary of its patients and caregivers. Let’s describe the complexity of the challenge with some data points:  There are 2400 words in the “kernel lexicon,” or those words needed for readers to understand 75 percent of what they read. Second language speakers are considered “fluent” with a vocabulary of 3000 words. The size of the vocabulary of a native English speaker depends on age, education, and experience, but it ranges from 10,000 to 25,000 words. For reference, the Oxford English Dictionary has 250,000 entries, including 50,000 obsolete words. There are 1 million words in the English language. People Want to Learn Is it possible for someone with a large vocabulary to not know the meaning of COBRA or NSAID?  Absolutely. Just as members of the medical community might not be comfortable talking about five-year ARMS or semi-definite positives. Patients and caregivers want to learn. According to Pew Research, 59 percent of U.S. adults looked up medical information on the Internet in 2013. Healthcare providers can help with this learning and educational challenge. Enter language learning tools. The way out of healthcare illiteracy isn’t to give in to it and talk to people in simplistic terms. Instead, let’s provide support and tools that enable patients and caregivers to grow their vocabularies and understanding. For example, while glossaries are considered “old school,” there are 21st century options. Healthcare provider can become the curator of language, identifying terms, abbreviations, and acronyms that will be valuable and useful to a specific patient and caregiver population. Imagine giving the newly diagnosed patient a complete collection of terms, with usage and meaning, that covers the entire topic of their care, including hospital locations and labs, medical terms, testing and monitoring lingo , as well as frequently used acronyms, phone numbers, and more. This information could be made available for reference on their smartphone—while they’re talking to family and friends, reading on the web, or looking at directions.  Bottom line: Rather than hoping patients took good notes, caregivers could take advantage of modern technology to support the language learning needs of healthcare consumers.

How to Achieve Healthcare Literacy, Part 2

Healthcare literacy is a major issue. Unfortunately, the healthcare industry is teaching its users exactly opposite to how people actually learn language.  In some ways, the healthcare communication challenge is no different than any other industry, because every industry, specialty, and company has its own lingo. Certain words, phrases, and acronyms serve as a communication link between co-workers, providers, practitioners, and vendors. Indeed, the language of medicine and healthcare is complex and precise, and the professionals using these terms were trained for years to become fluent and comfortable with its jargon. For the rest of us, however, this lingo can be confusing and alienating—no different than the jargon of computers, motocross racing, or accounting is to those outside of those communities. Not surprisingly, such confusing language is a chief factor of the healthcare consumer’s frustration and dissatisfaction, with the language barrier a key stressor of communicating with doctors and nurses.  In fact, the terminology of the healthcare industry is particularly challenging for patients and consumers—those served by the system, but also outside the system. (And this is not a reference to those dealing with English as a Second Language.)The Educated “Illiterate” There are all kinds of initiatives and advice on how to train physicians and healthcare professionals to “speak” to patients. The latest iteration seems to be a move toward patient-centric communication. In addition, Plain English efforts to identify the “best language” for the healthcare industry seem to be the prevailing solution to this issue., whereby everything is written at the 6th grade level.  However, according to the U.S. Department of Education’s National Center for Education Statistics, 90 percent of the U.S. population has a high school degree, and of that group, another 30 percent have attained college degrees (or higher).  Clearly, the issue of healthcare “literacy” applies to college graduates and PhDs, as well as high school dropouts. In other words, the issue has little to do with the educational level of patient or consumer. Perhaps, it is time for a new approach.How Adults Learn LanguageExecuSpeak Dictionary® has conducted research on how adults learn language, which has been detailed in previous ATD blog posts. In a nutshell, the research shows that while adults need seven to 20 repetitions of a new word or phrase to make it their own, they do not learn well under stress (unlike students cramming for a test). Just as experts recognize that doctor’s office setting compromises blood pressure tests, so is learning. Additionally, neuroscientists who research how people process language have discovered that the brain reacts to words it doesn’t in specific ways. The brain may either fill in a meaning (maybe the correct meaning, but maybe not), or it may slide right over the word as though it doesn’t exist. But how can the healthcare industry apply this research? My experience in the telecommunications industry has altered the way I think about sending and receiving information—in that “send” is one verb and “receive” is another verb. Can we turn the healthcare communication and language challenge into a two-way street, akin to the way communications actually takes place? Instead of just teaching medical personnel how to properly speak to patients, maybe we should “train” patients to share the language of the medical personnel.  Moving Forward How can healthcare professionals know what is going on after the appointment a patient? It’s easy to think that patients fail to follow prescribed treatments because they don’t remember instructions and simply need to take the time to write down notes. But perhaps another reason may be lurking: Patients may be confused by unfamiliar terms that need to be defined. Bottom line: While it’s impossible to know what terms will be new or confusing to any one individual, it is possible to provide patients with the support they need once the language learning process is understood.  In Part 2, we will examine how adjusting the learning process can improve healthcare literacy among patients and consumers.

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