Dealing with difficult doctors I: The poor explainer

June 12, 2008  |  General

Over the next couple of months I’ll be putting up the occasional post taken from my new book. This one is the first in a series about communicating with doctors — in particular, what you as a parent can do about it. This post is about the poor explainer.

A physician, like anyone, can be a poor explainer of things for several reasons, but foremost among these is the tendency to use medical jargon. This is not a problem unique to doctors. When I take my car in for repairs I often must ask the mechanic to explain what is wrong in a way I can understand. I have a rudimentary understanding of what the various parts of the engine do, and I even recognize the terms he uses to describe these parts, but I have little understanding of how the parts relate to each other and what can go wrong with them. Automobile mechanics often wrongly assume most people know more than they actually do about car engines. If you spend all day working with engines and talking with colleagues who are doing the same thing it can be difficult to grasp how confusing the subject can be to nonmechanics.

Physicians find themselves in an analogous situation. Most parents know about their child’s body and many of the ailments that can affect it in the same way I know about my car and what can go wrong with it. But even though we know the words for body or engine parts, someone explaining to us what is wrong with a child or a car should not mistake this passing acquaintance with the vocabulary as true understanding–explanations should be in plain, jargon-free English.

There is another way this situation is analogous to auto mechanics: often the non-mechanically inclined, especially men, believe they ought to know about car engines, even if they do not, and are reluctant to press for clearer explanations from the mechanic. So they nod wisely while the mechanic explains, all the while having little or no idea what he is talking about. Likewise parents sometimes feel as if not being medically knowledgeable makes them somehow poorer parents, and they are reluctant to press the doctor for clearer explanations when they do not understand what she is telling them. You should not let your mechanic do anything to your car you do not understand the need for; do not accept any less from your child’s doctor.

What should parents do if they find themselves with a doctor who is a poor explainer, either from her excessive use of medical jargon or some other reason? I think the best approach is to do as a doctor does when we take a history from parents who are vague and imprecise in their descriptions: we pause frequently and rephrase our questions in different ways, and keep doing that until we understand. Parents can do the same thing by stopping the conversation at intervals, restating in their own words what they think they are hearing, and then asking the doctor if that is correct. Thus a parent can respond to a murky explanation from the doctor with something like: “So, what I hear you saying is . . . . Is that right?”

The worst thing to do for your sick child is to imply to the doctor you understand when you do not. One way or another, make her explain it to you so you understand it. Make her draw pictures if necessary. When you insist on continuing the conversation until you comprehend everything you are not being a pest, you are doing your job of being a good parent.

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