Health Literacy Advice Sucks
Over 90 million of us have poor “health literacy”–that is, we don’t get what the doctor is talking about when he or she slips into medicalese. The linked article goes into strategies doctors should use, but I can’t believe this one was recommended:
Doctors should use plain language, not medical jargon, vague terms and words that may have different meanings to a lay person. They should say chest pain instead of angina, hamburger instead of red meat and, “You don’t have H.I.V.” instead of “Your H.I.V. test was negative.”
This is part of the reason that medicalese is confusing, but saying “Your HIV test was negative” does not mean the same as “You don’t have HIV,” and honestly, especially in a case like HIV, with false-negative windows of several months, it’s scary that that’s being recommended.
Whenever you do a test in medicine, there’s a chance that the test won’t catch whatever disease you’re looking for. This is called the sensitivity of the test. While we try to make sure our initial tests are sensitive ones, sometimes they miss things for any number of reasons.
So when a test is “negative,” that means the test didn’t find what you were looking for. If the test is a good one, it usually means you don’t have whatever disease or condition they were looking for, but it doesn’t always mean that you don’t have it–just that the test missed it.
Is this confusing? Yes, but I don’t think we should be jumping to false conclusions with patients just to simplify things.
Um, not so fast.
To the layperson, “negative” generally connotes “bad.” “Positive” = “good.”
I think the risk here is that the word “negative” is what may register uppermost in the patient’s mind and could lead to misunderstandings about what’s being communicated.
Every profession has its own jargon and vocabulary. To insiders it makes sense; to outsiders, not so much. So it behooves you to be aware of this so you and the patient aren’t speaking separate languages. I think that’s what the authors were trying to get at here.
I grant that HIV testing was perhaps not the best example. Substitute “chest X-ray” and see if it makes more sense.
You’re right about that, pen, good point.
However, again, if we used chest xray, I would say, “You chest x-ray looked good,” or “Your chest x-ray didn’t show any signs of pneumonia,” or “Your chest x-ray was negative for pneumonia.” I could *not* say “You don’t have pneumonia.”
And haven’t surveys shown that people generally *do* understand what “negative” means in the context of a medical test? That this is one of those things that medical people are certain is going to be an issue but when you actually check the evidence, it isn’t?
A really worthwhile resource is the book, “Advancing health literacy: A framework for understanding and action”. Check it out.