Why does the NHS routinely
use medical language such as ‘Renal’ rather than ‘Kidneys’, and ‘Radiology’
rather than ‘X-ray’ in patient facing areas?
What is in a name? Would an
otolaryngologist by any other name still be able to treat your sense of smell?
Making Health care professionals’ roles and the names of services easier to
understand, remember and pronounce would aid patients in understanding and
navigating the services they are using, help them to discuss their care, and
may result in fewer missed appointments.
As a non-clinical NHS staff
member and a fairly health-literate patient, I see the NHS as confusing and
difficult to negotiate, and I wish that someone would translate it all into non-clinical
language for me. Given the profusion of patient leaflets, websites, and books
designed to help explain it all, it seems I am not alone in this. Recently I
had a hospital appointment but the department I needed was not marked on the
map, and the signs didn’t help me. I noticed in passing that there was a small
sign for the phlebotomy department, and it made me wonder how many people
wander around hospitals getting lost and are late for appointments, and how
much the complicated names of the departments and services make this worse? What
is it like for people who have difficulty reading or communicating?
The NHS wants patients to be
engaged with their health, actively involved in healthy lifestyles or self-care
and to work in partnership with their Health Care Professionals to enable
Shared Decision Making “No decision about me without me”, however the language
routinely used in healthcare services does not support this.
The 2014 WHO report1
on health literacy shows that an inability to understand health information
results in less healthy choices, riskier behaviour, poorer health, less
self-management and more hospitalization.
A report by Rudd2
assessing US healthcare environments described them as having a high literacy
demand, and a recent report from an RCGP-led health literacy workshop3
included a call for “clear signage avoiding jargon and using lay terms whenever
possible, for example ‘heart section’ rather than ‘cardiology department’”. The RCCG report included
this personal communication from a GP:
A patient referred for a chest X-ray
didn’t have it done because he walked round the hospital and couldn’t find the
department because the sign read ‘Radiology’. He was too embarrassed to ask for
directions.
Instead of making leaflets
or a website to explain the difficult language, why not change the language? Is
there any benefit to holding onto the medical terminology when naming services?
There have been recent NHS standards4
on accessible information published, which state that they should show respect,
understanding and accessibility: “due to the complex subjects we deal with, the
words we use need to be as simple and accessible as possible. This means they
need to be: free of jargon; free of acronyms; and free of overly technical
language.” However we know that the NHS printed health information currently in
circulation is written at too complex a level for 43% of working age adults
(16-65 years).5
NHS Patients in England
should now be able to request access to their GP medical records online, but
how many patients are able to understand them? Hospitals often give out
discharge summaries to patients full of abbreviations, medical terms and short-hand.
What is the point of this if the patient or family or carers can’t decipher
them?
So what would the NHS look
like if made easy to understand for non-clinicians?
When we are invited to an
appointment it would be obvious from the letter sent what it is for, and what
it will entail. The signs and maps will use the same easy to understand names
for the departments to help us get there.
In the consultation we will
be told about any results, tests required and what will happen next in the same
way as usual, but patients would then get any further follow up appointments
for tests or clinics using the same language, or will have a patient-friendly
summary included.
When we have to go for a
blood test we will not need to know that it is the phlebotomy department we
need to find – it will be called something straightforward like blood tests.
We will be told who we will
see, and what they do, requiring no prior knowledge such as why some doctors
are called Mr or Miss, and it will be made clear that if the clinic is covered
by different staff that we might see someone different next time, and we will
be given information including their names after each consultation in case we
need it to ask a question or complain.
If we use other services we will
be able to tell them about the problems or treatments we have had in our own
words, rather than trying to remember and say the technical terms, and this
will be perfectly fine.
What difference will this
make?
- Patients (including me) might find it easier to understand what appointments are for and be better prepared for them.
- We might be more likely to be able to communicate details of our medical history to others who need to know e.g. ambulance staff.
- We might be more able to get information or support for our problems, and feel more able to discuss them.
- We might feel more able to ask questions if we don’t understand something.
- We might be more able to understand our medical notes and more likely to access them, perhaps even collaborate by providing information e.g. blood sugar level monitoring.
- We might feel more able to point out errors in medical records and avoid mistakes.
- We might be able to look after ourselves or others better.
- We might be more likely to become active participants in our health and care and have better health outcomes.
- Additional benefits could be that non-clinical health and care staff (like me) will find it easier to negotiate the system too, and there may be particular benefits to certain groups who have difficulty with complex terminology such as those with communication problems, dyslexia, or learning difficulties.
I also fondly imagine the
discussion and training required to implement these changes may also result in
more of a focus on inclusion, and improved communication between Healthcare Professionals
and patients overall.
Importantly I think that
these changes would send the message that the NHS is run for the benefit of the
patients rather than the staff, and signal that patients are equal partners who
are included and respected, as set out in the NHS vision:
“We want everyone to have greater control of their health
and their wellbeing, and to be supported to live longer, healthier lives by
high quality health and care services that are compassionate, inclusive and
constantly-improving.”
1. WHO Health literacy: The solid facts 2014
2. R. Rudd Navigating Hospitals: Literacy barriers, Literacy
Harvest 2005
3. Health Literacy Report from an RCGP-led health literacy
workshop June 2014
4. SCCI1605 Accessible Information – the ‘Accessible
Information Standard’ 2015
5. Department for Business Innovation and Skills. The 2011
Skills for Life Survey: a survey of literacy, numeracy and ICT levels in
England. BIS research paper number 81. London: DBIS, 2012
Zoe Ashton
Zoe Ashton
Submitted to the Kings fund "the NHS if" competition November 2016
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