Psychol Stud (October–December 2014) 59(4):394–400

DOI 10.1007/s12646-014-0262-x

RESEARCH IN PROGRESS

Medical Jargons as Hindrance in Doctor–Patient Communication

Marlyn Thomas & Meena Hariharan & Suvashisa Rana &
Sunayana Swain & Asher Andrew

Received: 21 February 2014 / Accepted: 15 May 2014 / Published online: 24 June 2014
# National Academy of Psychology (NAOP) India 2014

Abstract This study assessed patients’ understanding of the to their line of work. Jargons of a field evolve as shorthand for
jargons used by cardiologists during consultation, and to its affiliates to effectively discuss among themselves the com-
compare the knowledge of these jargons across three patient plex work they undertake. However, in professions that centre
age groups. The Cardiac Jargons Comprehension Schedule on interactions with the diverse public, jargon-based commu-
(CAJCOMPS), consisting of 11 cardiac jargons, was developed nication can turn counterproductive. The medical consultation
and validated. It was found that the proportion of participants is a case in point given that the patient must recount his/her
who were aware of the jargons ranged between 10 % and 96 % experience of illness while the doctor must formulate and
across the 11 jargons; however, mean scores across the jargons communicate the diagnosis, prescription and treatment
ranged only between 0 and 2 on a scale of 0–5. Significant (Caudle et al. 1999; Ha and Longnecker 2010; Martin et al.
effect of age on the overall level of understanding of jargons 2005). The relevance of assessing jargon use and understand-
and of specific jargons (Angina, Heart Failure, Palpitation and ing in Indian settings becomes explicit in view of the enor-
Treadmill Test) was noted. Participants of the youngest age mous volume of patients with cardiovascular conditions and
group (18–45 years) had reported significantly lower level of risk factors, e.g., 30 million patients presented with coronary
knowledge of jargons than their the older age counterparts heart disease and 118 million with hypertension in the year
(46–60 and 61–80 years). Cardiologists’ communication in- 2000 (Gupta 2008; Mohan et al. 2013). This study examined
volving jargons is, thus, not adequately reaching patients, patients’ comprehension of the common medical jargons used
young adults in particular. by Indian cardiologists.
Jargons figure frequently in doctors’ interaction with their
Keywords Age . Cardiology . Health communication . patients. Castro et al. (2007) reported that 81 % of consulta-
Jargon . Patient awareness tions involved the use of at least one jargon not understood by
patients. In the same vein, Deuster et al. (2008) further found
while investigating 86 doctor–patient interactions for prostate
and breast cancer screening that, on average, over 19 jargons
Introduction
were uttered during a visit. However, doctors, on average per
consultation, explained to their patients only 15 % of the
To convey one’s expertise in a specialisation, the apt means
jargons that they had used. When consulting for screening,
may be to communicate through jargons. Jargons refer to the
the patient may not only possess inadequate understanding of
technical terms used by members of a profession, generally
the condition s/he is undergoing tests for but may also harbour
not understood by a lay person, to describe concept(s) related
myths concerning its risks and treatment options. The use of
M. Thomas (*) : M. Hariharan : S. Rana : A. Andrew
medical terminology in this context would only be more intim-
Centre for Health Psychology, University of Hyderabad, Prof. C.R. idating. While doctor’s technical language hindered their com-
Rao Road, Gachibowli, Hyderabad 500046, India prehension of information the information from nurses and
e-mail: [email protected] former patients was reported to be more accessible and
reassuring (Lyons et al. 2002). This reiterates the need for
S. Swain
Department of Psychology, St. Francis College for Women, relevant simplified health talk between medical professionals
Hyderabad, India and patients.
Psychol Stud (October–December 2014) 59(4):394–400 395

Patients too have been found to utilise jargons during Of the 119 participants, 82.4 % were men and 17.6 % were
consultations. Černý (2008) recorded this trend but point- women. They were aged between 18 and 80 years (M=52.37).
ed out that patients had used medical terms to a lesser The participants’ educational qualification included primary
extent than doctors and these were terminology related to school (10.9 %), middle school (13.4 %), secondary school
disease, medication and procedures but not to medical (15.1 %), senior secondary school (17.6 %), graduation
tools. Interestingly, patients had used these terms in their (39.5 %) and post-graduation (3.4 %). The sample comprised
responses after they were mentioned by the doctor. With employees (37 %), businessmen (15.1 %), housewives
the ubiquity of media and health information sources in (12.6 %), farmers (10.9 %), retirees (22.7 %), students
recent times, Černý (2008) fittingly affirmed that patients (0.8 %) and unemployed (0.8 %).
too must be viewed as experts in their own right and as
being capable of using jargons. Nonetheless, the provi-
sion of explanation and consistent verification that the Measures
patient has understood the jargon were proposed as al-
ternatives to complete avoidance of medical terms. This Cardiac Jargons Comprehension Schedule (CAJCOMPS) This
recommendation is noteworthy in context of chronic schedule consisting of 11 medical terms related to cardiac
diseases where education is feasible and jargons are health was developed by the authors. Initially, a list of 99
unavoidable considering the long-term management of cardiac terms was identified by the investigators from stan-
the disease which involves diagnostic procedures, dard medical dictionaries. Three practising cardiologists other
treatment and health events. Further, health knowledge than those whose patients contributed to the sample were
varies across patients as Lerner et al. (2000) reported that asked to tick those terms in this list that they normally use in
age, education and suburban hospital location were pos- their communication with patients. The inclusion criterion
itively related to the score on a test of common medical was that they should be attached to a corporate hospital as
terms. This makes it vital and also convenient for cardiologists. Thirty nine jargons were ticked by the three
healthcare providers to tailor their communication to suit cardiologists. These 39 terms were then screened for estab-
patients’ characteristics such as age. lishing content validity. Six practising cardiologists indepen-
Despite the rise in chronic diseases such as cardiac ailments dent of those three cardiologists who identified 39 out of 99
which demand a biopsychosocial approach in diagnosis and jargons were given the list of 39 jargons with the instruction
treatment (Deter 2012), the parlance of cardiologists which is that they should indicate those terms which essentially consti-
key to such a holistic consultation, however, has received tute their day-to-day cardiac health communication with pa-
minimal attention from the Indian research community. Our tients. Additionally, they had to tick in a separate column those
study, therefore, had two objectives. First, we aimed to evaluate items which do not essentially form part of their communica-
patients’ level of understanding of common medical jargons tion with patients. Applying Lawshe’s (1975) criterion,
used by cardiologists in their health communication with pa- jargons having a content validity ratio of 0.99 and above
tients. Secondly, we sought to compare variations in the under- across the six doctors were retained to be included in the final
standing of jargons used in cardiac health communication schedule. The final list of CAJCOMPS consisted of 11
across three age groups of patients. medical jargons related to cardiac health (Angina, Blockage,
Cholesterol, Echocardiogram, Electrocardiogram, Heart At-
tack, Heart Failure, Hypertension, Lipid Profile, Palpitation
Method and Treadmill Test). This schedule was individually adminis-
tered on the sample. The responses were recorded and
Participants transcribed verbatim. To identify the participant’s understand-
ing of jargon score, each jargon was rated by three medical
The study involved a two-stage sampling process in order to experts on a scale of 1–5 (ranging from ‘poor response’ to
select hospitals and participants. In the first stage, two corpo- ‘excellent response’). ‘Do not know’ and ‘wrong answer’ for
rate hospitals were selected, from Hyderabad (India) on the each participant against each item were counted separately.
basis of permission obtained. In the second stage, 119 cardiac The mean of the three experts’ scores for each of the 11 terms
outpatients, who consulted cardiologists in the respective was the composite score of the patient’s understanding of that
hospitals were recruited. The inclusion criteria indicated that jargon. To calculate the total CAJCOMPS score for each
the participants must be aged 18 years and above, and that participant, the mean scores of the participant across 11 items
they should be literate. In order to ensure that the participants were added together, where ‘do not know’ and ‘wrong an-
had sufficient interaction with their respective cardiologists, swer’ were given a score of ‘0’.
we excluded patients who were consulting cardiologists in the Demographic details were also recorded in the ‘Patient
said hospitals for the first time. Information Sheet’.
396 Psychol Stud (October–December 2014) 59(4):394–400

Procedure find out the proportion of awareness in different age groups of

patients.
During Phase II, CAJCOMPS was individually administered As Table 1 reveals the participants of the 46–60 years age
to each participant. The data were collected over a period of group consistently constituted the highest percentage (over
one month after obtaining administrative permission from the 50 %) of participants who knew the jargons compared with
management of the concerned hospitals and after seeking the oldest and the youngest age groups. Participants of the
informed consent from individual participants. Each partici- youngest age group (18–45 years) contributed the lowest
pant was told that the investigator would read out a list of 11 percentage of participants who knew the jargons relative to
terms related to cardiac health. S/he was requested to explain the older age groups for 7 out of 11 terms (i.e., Angina,
in her/his own words what the term meant to her/him. The Blockage, Echocardiogram, Heart Failure, Lipid Profile, Pal-
responses were audio recorded using a dictaphone. Those pitation and Treadmill Test). It is evident from Table 1 that not
were later transcribed into written responses which were given even a single cardiac jargon used by cardiologists is under-
to three medical experts for evaluation and rating. Phase III stood by all the patients. It is not sufficient to know whether
was elaborate as it involved the transcription of responses by participants in different age groups understood the jargons
the investigator and the individual evaluation of these re- or not. It is equally important to estimate and compare
sponses by three doctors who independently rated every re- patients’ level of knowledge of these jargons based on
sponse of the individual participant using a scale of 1–5 their age.
(ranging from ‘poor response’ to ‘excellent response’). The
scoring for the individual participant was evolved by taking
the mean scores of the three experts’ ratings. Variations Across Age Groups in the Level of Understanding
of Cardiac Jargons

Table 2 presents the mean understanding of the 11 jargons for

Results patients of different age groups. Figure 1 gives a visual repre-
sentation of the mean understanding of the 11 jargons in
The data were analysed to find out the extent of awareness different age groups of participants.
among patients about the medical jargons inadvertently used It may be noted from Table 2 that although the mean scores
by cardiologists during the process of consultation. It was also of understanding for the jargons could range between 0 and 5,
aimed at determining the role of age on patients’ understand- no age group, in fact, had a mean score >2 for any of the 11
ing of jargons. In order to meet the above objectives, percent- jargons. The mean scores of the sample, as a whole, also
ages, M, SD, and One-way between-subjects ANOVA were varied between 0 and 2 only. This indicates a below average
computed. understanding of the medical terms commonly used by cardi-
ologists. Furthermore, participants in the youngest age group
Proportion of Patients Aware of Cardiac Jargons (18–45 years) had the lowest mean scores across the 11
jargons while those of the oldest age group (61–80 years)
Based on the participants’ total scores, the frequency and the consistently scored the highest and were followed closely by
percentage of participants who ‘know’, ‘do not know’ or gave participants in the middle age group (46–60 years). It can be
the ‘wrong answer’ for the 11 jargons are presented in Table 1. clearly observed from Fig. 1 that the understanding of cardiac
The percentage of patients who understood the 11 jargons jargons among participants in the 18–45 years age group was
varied from as low as 10.1 % (for Palpitation) to as high as consistently low for every jargon, indicating a poorer under-
95.8 % (for Hypertension). It was observed that only five out standing in contrast to those of the older age groups.
of the 11 terms, i.e., Blockage, Cholesterol, Electrocardio- The results of One-way ANOVA (Table 2) revealed a
gram, Heart Attack and Hypertension, were known to a ma- significant difference, F(2,116) = 5.17, p = 0.007 across
jority (over 80 %) of the participants. The least understood participant age groups on total CAJCOMPS scores. Given
terms were Angina (21.8 %) and Palpitation (10.1 %). In fact, the significant result, post-hoc comparisons using Tukey
Angina was the most wrongly understood term (by 13.4 % of HSD test were carried out. These showed that the mean of
patients) when compared with the other 10 jargons. It is the total CAJCOMPS score of participants of the 18–
evident from these findings that the knowledge of two essen- 45 years age group (M=10.70, SD=4.35) differed signif-
tial cardiac symptoms, namely Palpitation and Angina, was icantly (p<0.05) from those of the 46–60 years age group
substantially low. Awareness of such symptoms is indispens- (M=14.21, SD=6.42) and of the 61–80 years age group
able as these may warrant consultation. While these figures (M=15.74, SD=7.59) while the mean scores of partici-
about the whole sample give a classification of the percentage pants in these two older age groups did not differ signif-
of patients’ understanding of the jargons, it is also necessary to icantly from each other’s.
Psychol Stud (October–December 2014) 59(4):394–400 397

Table 1 Frequency and percentage of patients (N=119) with respect to the understanding of cardiac jargons

Jargon Understanding of jargon

Know Do not know (Total) Wrong answer (Total)

Total Age group

18–45 (n=31) 46–60 (n=62) 61–80 (n=26)

1. Angina 26 (21.8) 4 (15.4) 14 (53.8) 8 (30.8) 77 (64.7) 16 (13.4)

2. Blockage 96 (80.7) 21 (21.9) 52 (54.2) 23 (24) 23 (19.3) 0 (0)
3. Cholesterol 107 (89.9) 28 (26.2) 56 (52.3) 23 (21.5) 10 (8.4) 2 (1.7)
4. Echocardiogram 78 (65.5) 17 (21.8) 42 (53.8) 19 (24.4) 38 (31.9) 3 (2.5)
5. Electrocardiogram 108 (90.8) 28 (25.9) 57 (52.8) 23 (21.3) 7 (5.9) 4 (3.4)
6. Heart attack 109 (91.6) 28 (25.7) 58 (53.2) 23 (21.1) 9 (7.6) 1 (0.8)
7. Heart failure 68 (57.1) 7 (10.3) 40 (58.8) 21 (30.9) 46 (38.7) 5 (4.2)
8. Hypertension 114 (95.8) 29 (25.4) 60 (52.6) 25 (21.9) 3 (2.5) 2 (1.7)
9. Lipid profile 36 (30.3) 5 (13.9) 21 (58.3) 10 (27.8) 80 (67.2) 3 (2.5)
10. Palpitation 12 (10.1) 0 (0) 3 (25) 9 (75) 106 (89.1) 1 (0.8)
11. Treadmill test 76 (63.9) 14 (18.4) 42 (55.3) 20 (26.3) 41 (34.5) 2 (1.7)

Figures in parentheses indicate percentages

We then computed separate One-way ANOVAs to ex- 60 years age group (M = 0.35, SD = 0.73) did not differ
amine differences among the participants of the three age significantly from those of the other two age groups. For
groups for each of the 11 jargons. The scores of the par- the jargon Heart Failure, the mean score of participants in
ticipants in the three age groups differed significantly for the 18–45 years age group (M=0.29, SD=0.58) was sig-
the terms Angina, Heart Failure, Palpitation, and Treadmill nificantly different (p<0.05) from those of participants in
Test. Post-hoc comparisons using Tukey HSD test revealed the 46–60 years (M=0.92, SD=0.85) and the 61–80 years
that in case of the jargon Angina, the mean score of age groups (M=1.02, SD=0.71) although mean scores of
participants in the 18–45 years age group (M = 0.13, participants in the latter two older age groups did not vary
SD=0.34) differed significantly (p<0.05) only from that significantly. The mean scores of participants in the 18–45
of participants in the 61–80 years age group (M=0.63, years (M=0.00, SD=0.00) and the 46–80 years age group
SD=1.04) while the mean score of participants in the 46– (M=0.14, SD=0.63) differed significantly (p<0.05) from

Table 2 Mean scores of patients’ understanding of cardiac jargons across the three age groups and the whole sample

Jargon Whole sample (N=119) Age group

18–45 (n=31) 46–60 (n=62) 61–80 (n=26) F(2,116) p

1. Angina 0.35 (0.75) 0.13 (0.34) 0.35 (0.73) 0.63 (1.04) 3.23 0.043
2. Blockage 1.77 (1.05) 1.39 (1.10) 1.88 (1.03) 1.98 (0.95) 2.99 0.054
3. Cholesterol 1.77 (0.93) 1.72 (0.87) 1.77 (0.89) 1.85 (1.10) <1 0.870
4. Echocardiogram 1.33 (1.11) 1.09 (1.10) 1.40 (1.13) 1.46 (1.08) 1.05 0.353
5. Electrocardiogram 1.51 (0.73) 1.38 (0.61) 1.55 (0.74) 1.58 (0.84) <1 0.519
6. Heart attack 1.89 (0.88) 1.75 (0.83) 1.93 (0.86) 1.97 (0.98) <1 0.576
7. Heart failure 0.78 (0.81) 0.29 (0.58) 0.92 (0.85) 1.02 (0.71) 8.82 <0.001
8. Hypertension 1.95 (0.79) 1.77 (0.69) 1.99 (0.79) 2.06 (0.91) 1.06 0.348
9. Lipid profile 0.67 (1.09) 0.28 (0.68) 0.82 (1.22) 0.78 (1.08) 2.81 0.064
10. Palpitation 0.21 (0.68) 0.00 (0.00) 0.14 (0.63) 0.65 (0.97) 8.03 0.001
11. Treadmill test 1.39 (1.21) 0.90 (1.09) 1.46 (1.18) 1.78 (1.29) 4.15 0.018
Total 13.63 (6.46) 10.70 (4.35) 14.21 (6.42) 15.74 (7.59) 5.17 0.007

Figures in parentheses indicate standard deviation scores

398 Psychol Stud (October–December 2014) 59(4):394–400

Fig. 1 Mean scores of patients’ 2.5

Mean scores of cardiac jargons

understanding of the cardiac
jargons across the three age 2
groups and the whole sample
1.5

0.5

18-45 years (n=31) 46-60 years (n=62)

61-80 years (n=26) Whole sample (N=119)

that of participants in the 61–80 years age group (M=0.65, Boyle (1970) compared doctors’ and patients’ interpreta-
SD = 0.97) for the jargon Palpitation. However, mean tions and illustrations of medical terms. With the exception
scores of participants in the 18–45 years and the 46– of the term ‘a good appetite’, patients’ and doctors’ respec-
60 years age group demonstrated no significant difference. tive definitions of the other jargons (e.g., ‘jaundice’, ‘least
The mean score for the jargon Treadmill Test among par- starchy food’, ‘heartburn’ and ‘palpitation’) and illustra-
ticipants in the 18–45 years age group (M=0.90, SD=1.09) tions of body organs (e.g., heart, lungs and liver) differed
differed significantly (p<0.05) only from that of partici- significantly. The continued use of medical jargons in such
pants in the 61–80 years age group (M=1.78, SD=1.29). instances raises a question whether doctors misperceive the
The mean score of participants in the 46–60 years age knowledge possessed and needed by patients. This was
group (M=1.46, SD=1.18) did not show any significant found to be true in Jukic et al.’s (2011) study wherein
difference from those of participants in the 18–45 years 30–50 % of doctors felt that they had provided adequate
and the 61–80 years age groups for this jargon. information to their patients about procedures and treat-
ment refusal while only 8–11 % of patients reported re-
ceiving the same.
Our second important finding related to the dismal level of
Discussion comprehension of jargons overall and particularly with refer-
ence to Angina, Heart Failure, Palpitation and Treadmill Test,
In a bid to understand the recipient’s perspective of cardiac among participants in the youngest age group (18–45 years)
health communication, our study evaluated the proportion of relative to those in the two older age groups (46–60 and 61–
patients who conceptually comprehended cardiologists’ jar- 80 years). This reiterates Lerner et al.’s (2000) observation
gons, and examined the differences in the levels of knowledge that younger patients are less likely to comprehend medical
of these jargons across three patient age groups. We found that terms. The trend presents the potential risk of this group
our participants, in general, had a below par understanding of ignoring or bearing a serious cardiac symptom which warrants
cardiac jargons, and further that participants in the youngest emergency consultation. The fact that younger age groups are
age group were at risk of ignorance about essential concepts increasingly coming under the bracket of risk for cardiac
related to cardiac health. problems rings an alarm for the Indian healthcare system to
The proportion of awareness across the 11 jargons ranged protect this productive young group from cardiovascular
from 10 % to 96 % of the participants. Surprisingly, only a deaths or irreversible medical consequences that incapacitate
minimal section of participants understood fundamental car- them. Healthcare professionals cannot be complacent about
diac symptoms such as Palpitation and Angina although they the lack of awareness of these symptoms as these very symp-
had all been visiting cardiologists for review. Since the instru- toms may necessitate emergency consultation. Considering
ment used in this study (CAJCOMPS) was developed through the relatively premature age of onset of heart disease (50 % of
content validation involving medical experts themselves, it acute myocardial infarctions occur among Indians aged
can be inferred that doctors’ inadvertent use of these jargons <50 years) and its risk factors in India (Enas and Senthilkumar
without prior explanation paves way for patients’ lack of 2001; Prabhakaran and Singh 2011), cardiologists must pay
understanding about these terms. For example, a study by added attention to patients in the youngest age group.
Psychol Stud (October–December 2014) 59(4):394–400 399

Patient-friendly communication not only positively im- deficits in cardiac health knowledge. Future research must be
pacts upon knowledge but additionally influences patients’ directed to evaluate Indian doctors’ perceived use of jargons
prognosis and satisfaction. Adherence (i.e., how well the and the information actually received by their respective pa-
patient follows medical advice), for instance, is central to the tients. Such comparative observations will help inform edu-
maintenance of well-being in chronic diseases. In their review, cation modules for patients and training programmes for med-
Zolnierek and DiMatteo (2009) concluded that patients of ical professionals.
doctors who communicate inefficiently tend to have 19 %
higher risk of non-adherence. Further, an Indian study
Acknowledgments We extend our thanks to the doctors and the hos-
(Nikumb et al. 2009) found that effective doctor–patient com- pital staff for their cooperation.
munication was inversely related to pre-surgery anxiety. Doc-
tor–patient interaction, therefore, impacts upon the patient’s
physical and psychological health. In view of the observation
that doctors’ jargons hinder patients’ comprehension of health
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