Curbside Consult with Dr. Jayne 12/5/22

This weekend was all about starting some end-of-year organization and making a plan for conferences and travel for 2023.

I’ll be attending many of the same conferences I did this year, but might throw in a couple of new ones if the dates work out. I had mentioned after the HLTH conference that I was disappointed in the lack of COVID precautions, so I was happy to see that HIMSS has an entire Health and Safety section that attendees must agree to. We all know that many people don’t read the details of “terms and conditions” type documentation, and even if they do, there’s no guarantee that they will follow the rules. However, it’s good to see a common sense approach to public health since it addresses not only COVID, but other communicable diseases.

Long story short: If you have symptoms of any communicable illness, including COVID, within five days preceding the conference, you need to stay home. You should also stay home if you’ve tested positive for anything, or if you’ve been in contact with anyone who is confirmed or suspected of having a communicable disease.

These are generally good rules for any gathering. I think that many people want to push back against any kind of health and safety measures because we’re all fatigued from talking about it the last few years. However, we seem to have forgotten the crud that everyone used to catch at HIMSS and bring home with its associated sore throat, runny nose, and fatigue.

HIMSS left the door open for other measures, including the possibility of “vaccination, proof of COVID status, self-monitoring, biometric screening, symptom checkers, contact tracing, use of personal protective equipment and social distancing, or other similar measures.” These will be determined at the time of the conference and will meet or exceed local public health requirements.

My in-person clinical colleagues are absolutely drowning in sick people right now, and the numbers they’re seeing in the emergency department and urgent care settings are commensurate with what they were seeing during the worst COVID surges. Flu is surging in my area and I’m not seeing any public health messaging encouraging people to stay home or to get tested, so I guess we’ve just collectively decided to let it rip.

This time of year, things are generally fairly slow in the realm of healthcare IT. Most of the large healthcare organizations I’ve worked with are out of money by now if they are on a calendar-based fiscal year and are waiting until January rolls around to sign contracts and start new projects. Given the economy, there are a lot of hiring freezes in place, and I don’t see that changing soon. Even in organizations that have fully funded and staffed healthcare IT projects that they were going to complete in December, I’m seeing things placed on hold because the clinical teams that the projects would involve or impact are being absolutely buried. If the flu season curves hold the same shapes they have had in pre-COVID years, it might be several months before these initiatives are pulled off the back burner.

I also spent part of the weekend trying to clean up an ever-ballooning inbox. It seems like when I unsubscribe from a newsletter, two new ones take its place. I was happy, though, to stumble across this article from JAMA Network Open which looked at “Accuracy in Patient Understanding of Common Medical Phrases.” Now that patients have full access to most of the notes and documents generated in the course of their care, it is more important than ever for clinicians to write in a clear manner that patients can understand. The authors surveyed 215 adults outside the medical setting and gauged their understanding of commonly used phrases (in case you are curious, the outside venue was the Minnesota State Fair.) Where 96% of patients knew that “negative” cancer screening means they didn’t have cancer, fewer patients (79%) knew that “your tumor is progressing” wasn’t good news. An even smaller number (67%) knew that having positive lymph nodes meant that cancer had spread.

The authors discussed the possibility of confusion around words such as “negative,” which means something good when it is associated with a screening test, but means the opposite in other contexts, such as “negative reviews” or “negative feedback.” They also spent some time discussing medical jargon and noted a concept which was new to me: that of “jargon oblivion,” which refers to the mismatch between our intent to avoid jargon and the reality of our frequent use of it.

While medical jargon is one thing, acronyms are another entirely. I’ve seen plenty of patient-facing notes that have acronyms that don’t immediately register with me as a clinician, so I can only imagine the confusion that patients have as they are trying to understand it. If I search something and it’s four or five entries down on the Google results, then I would feel safe in suggesting that clinicians probably shouldn’t be using it. “NPO,” which is a Latin-based phrase for “nothing by mouth,” was one of the items tested. Other medical words such as “febrile” were included. The researchers noted that the use of the phrase “occult infection” was interpreted by those surveyed as having something to do with a curse than being associated with a hidden infection.

The authors noted a concern for bias since they selected state fair attendees who were attending a university-sponsored research exhibit. A more generalized sample of the community might produce differing results. Participants who agreed to take part in the survey received a backpack with the University logo. As a visitor to several different state fairs, I think I woud be more motivated to participate if there was the potential for a funnel cake or perhaps a fried Twinkie at the end.

The authors suggest that further studies would be helpful to boost understanding of how patients understand medical jargon, as well as to test recommended alternatives to improve communication with patients. The study involved both audio and written test questions and there was no difference in the results, allowing researchers to conclude that the less time-intensive written approach would be valid for future studies. If anyone is looking for a research assistant who knows how to deep fry things, I might know someone who is available.

What’s your favorite state fair food? Leave a comment or email me.

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