From Our Lips To Whose Ears? Consumer Reaction to Our Current Health Care Dialect

Abstract

Every profession spawns a dialect, a language that facilitates efficient communication among insiders. In written communication, that dialect often becomes even more compact, as acronyms and code words are substituted for “plain text.” This tendency has received some attention in the government sector (where efforts to translate bureaucratic jargon into English periodically gain media attention) but much less so in health care. Yet we may well have reached the point in health care at which the dialects spoken by practitioners and health policy experts are not just confusing to outsiders, but actually prevent us insiders from achieving our goals. The findings presented here emerged from what began as a qualitative marketing study, but which revealed a tremendous gap between what health care professionals say and what health care consumers hear. That the unfettered use of our professional dialect may be counterproductive is highlighted as two recent health care trends collide: the ever-increasing complexity in the language of health care occurring at the same time that we are asking lay people—as patients, consumers, and voters—to take a more active role in their health and health care choices. The language of health care and health policy has grown more complex over time as new diseases and conditions have been identified, new treatments discovered, and new ways of reimbursing providers implemented. Physicians who once could do little about heart attacks now treat “acute myocardial infarctions” with “beta blockers, angiotensin-converting enzyme inhibitors, and drug-eluting stents.” The Medicare program that once paid whatever numbers physicians wrote on their bills, now bases payments on “resource-based relative values” that are multiplied by a “geographic practice cost index” and a “conversion factor” and whose growth over time is determined by a “sustainable growth rate mechanism.” Twenty, perhaps even ten years ago, the discrepancy between professional and lay dialects did not particularly matter. Just as one need not be an engineer to drive a car, patients did not need to understand medical jargon or health care policy. But that has changed. Increasingly, we want consumers to be “empowered” and to take an active role in maintaining their health, not to be passive recipients of medical care. Consumer “choice” forces health care organizations to differentiate themselves, which they try to do by packaging and selling their new and improved services. We want voters to understand policy alternatives and assess options for change. Perhaps most importantly, we want to enlist patients and consumers to advocate for change in the way that health care is delivered and force the system to improve quality and efficiency. American health care consumers do not speak our dialect, and they perceive and understand our health care system in a very different way. Patients have strong opinions about health care based on their individual health conditions and their experience with that part of the largely fragmented delivery system in which they receive care. The problem is that in trying to enlist these patients and consumers, the provider and policy communities have gone full speed ahead in developing new ideas without bothering to investigate whether those new ideas and the words used to describe them resonate with the audience. Professional journals, trade publications, and policy blogs are replete with terms such as evidence-based medicine, care coordination, health information technology, medical home, and comparative effectiveness. From an insider perspective, these terms all describe ideas intended to make our health care system better. But do they mean anything to consumers? Before true health care reform can take place, we must convince patients that their needs will be fulfilled through whatever changes are made: at the national level to heal the ailing health care system, and locally, in individual physicians' offices to heal ailing patients themselves. But how do we convince them that any new model of health care delivery will benefit them? What words will work?