Friday, November 17, 2006

On students, stumps and succinct speech

For the next few weeks I am mentoring a student who is completing his masters degree in physiotherapy this year. I enjoy having students and find it motivating and rewarding to share my experience as well as to learn from them.
Our current student has fit into the routine quickly and is well liked by staff and patients alike. His factual knowledge base is very impressive and he is keen to improve his abilities to communicate with and motivate patients in their rehabilitation. I enjoy reading his new textbooks and will inquire about new outcome measures and treatment techniques that have been taught in the academic setting.
I have my grandparents' old medical textbooks from the years they were in medical school.(1914-1919) It is fascinating to read the pathology and physiology texts from this era. Diagnostic and treatment options were far more limited and the diseases commonly seen were quite different than the ailments seen most frequently now. Some of the terminology used in the past to describe patients can make us cringe today. Words like “Mongolian idiots”, “cripples”, “retarded”, and “senile” are no longer used, with gentler, more politically correct terms in use.
Well, my student showed me this week how out of date I have become with one of my descriptive words. We were teaching a patient how to bandage her stump in order to shape it properly for prosthetic fitting. I was informed that the word “stump” is out, and that amputees now have “residual limbs”. So now we are teaching “residual limb bandaging” so that the “residual limb” will fit well into the prosthetic socket. This particular patient is having a very difficult time dealing with her loss and doesn’t really care what we call her remaining leg. Calling it a residual limb is not making it easier for her to look at or touch it. New phrases like this are invariably wordier and take longer to write or type out when doing charting.
Medical jargon varies greatly from centre to centre. I sometimes receive reports from other hospitals and cannot figure out what certain acronyms and phrases mean. “NPH” is a type of insulin as well as the acronym for normal pressure hydrocephalus. I struggled to understand a surgeon’s report that included the word “rtc”. I called his office to discover it meant “return to clinic”.
I am all for clarity as well as simplicity of speech. Patients need to hear words they understand as they are easily intimidated by the lofty and specialized words used by some health professionals. I haven’t decided whether to continue using the word stump or to switch to the latest terminology. "I’m having trouble being politically correct. How about if I'm just theoretically appropriate?"

Folks don't like to have somebody around knowing more than they do. It aggravates em. You're not gonna change any of them by talking right, they've got to want to learn themselves, and when they don't want to learn there's nothing you can do but keep your mouth shut or talk their language. - Harper Lee


  1. Sometimes I think professionals use big words/terminolgy to distance themselves from their clients. Not appropriate in the medical field, IMO, when talking to patients because they need to be able to understand you!

  2. How true, Laura. We have been told to keep our hand outs and teaching materials at a sixth grade level, as that is the average reading level of the general public. There is ongoing research at one of our local universities about health literacy , and their findings show that many people misunderstand much of what they hear from health professionals and the media.


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