What is pneumonia? Education and communication between physicians

Article by Ben Gallarda, PhD; Head of Scientific Services at EPG Health

What do the words used by physicians mean – to specialists, to general practitioners, to patients? Take something as apparently simple as pneumonia, which means ‘inflammation of the lungs’…or is it ‘infection of the lungs’? The UK National Health Service (NHS) says the former¹; the US Centers for Disease Control (CDC) say the latter². The reasons for this are ancient³, but the consequences may lead to confusion.

Is pneumonia inflammation or infection of the lungs? This example illustrates the fact that medical communications are often unclear, misunderstood, or incorrectly applied.

Whether it is physicians speaking to colleagues, experts speaking to generalists, or clinicians speaking to patients, the opportunities for miscommunication abound

Clinical researchers and academics, who spend most of their time thinking about technical details, might take for granted their highly specialised terminology. But a busy doctor who has to consult an online reference in the few minutes between consultations lacks the time to consider deeply the implications of the language being used, much less how it might be received by a patient. This difference in time and intellectual energy devoted to comprehension of dense medical terminology can lead to misunderstanding.

How physicians communicate with other physicians

Before patients are even in the picture, how well is scientific and medical information conveyed within the field of medicine? Many doctors are not scientists⁴. Learning and practising medicine in caring for patients is fundamentally different from designing and conducting scientific experiments. Yet specialists, especially those involved in research (who certainly are scientists), may take for granted the highly specific vocabulary they employ. Two examples from research on healthcare professional communications, one from the field of oncology and the other from diabetes, highlight existing communication and education needs.

As cancer care becomes more specialised, with increasing use of targeted therapies and immune checkpoint inhibitors augmenting and even replacing chemotherapy, the need for multidisciplinary teams (MDT) is of increasing importance. A qualitative survey of oncology specialists and medical residents in the Netherlands uncovered the following issue related to the educational function of such teams in training new oncologists⁵. Specialists running the MDT meetings emphasised the need to establish MDT-related educational objectives beyond the basic medical competencies residents were expected to obtain; but residents pointed out that the MDT meetings were not incorporated into their medical school educational programme, and that they were evaluated only on the expected medical competencies. Such a discrepancy could lead to misaligned expectations and a failure to fully realise effective MDT participation from young physicians.

Another study examined the reasons for suboptimal uptake of sodium-glucose co-transporter 2 (SGLT2) inhibitors in managing type 2 diabetes⁶. This is another therapeutic area with multiple opportunities for misunderstanding and miscommunication, as treatment with SGLT2 inhibitors necessarily implicates primary care and endocrinology, but also touches on cardiology and nephrology. While multiple factors were discussed in this analysis, the lack of communication between general practitioners, endocrinologists and other diabetes specialists, and cardiologists stood out. Primary care physicians hesitated to prescribe SGLT2 inhibitors because of concerns about safety (something a specialist would likely know more about), but cardiologists hesitated to prescribe because of a lack of clarity on whether they needed clearance from a patient’s general practitioner or endocrinologist. The section on the communications between these various medical roles concludes:

Other opportunities for education and communication

Numerous other areas exist where miscommunication can hinder appropriate medical care, and where a focus on education and communication may lead to improvements.

Clinician–patient communication, to ensure that a patient is capable of giving informed consent, is a significant concern in medicine, with various strategies for improvement⁷. Other original content on Medthority touches on this topic.

Government and health system communications to physicians, or even to the general public, can also cause confusion. Perhaps the pneumonia example mentioned above seems trivial, but consider the discrepancy between the CDC and the World Health Organization (WHO) mask guidance for children in relation to the COVID-19 pandemic: the CDC recommends masking anyone over 2 years of age⁸; the WHO recommends not masking anyone under 6 years of age⁹. How is a physician to reconcile this discordant guidance in order to best serve patients?

What is a suitable age for children to begin to wear masks as protection against COVID-19?

There is also the translation of medical information into numerous languages and the vast numbers of non-native English-speaking physicians who are reading international guidelines in highly technical English. One personal experience: an English-to-Spanish translation of the type 2 diabetes therapy dipeptidyl peptidase IV (DPP-IV) might have resulted in physicians unfamiliar with this drug thinking it was delivered intravenously. A medical translator similarly unfamiliar with this drug mistook the Roman numeral IV (equivalent to the Arabic numeral 4) for the abbreviation of ‘intravenous’ and translated it into Spanish as such.

Finally, there are vast numbers of clinical practice guidelines, regularly updated prescribing information and summaries of product characteristics, and other lengthy, technical documents, which not only need to be correctly understood, but appropriately applied. Another example from experience: concomitant with the launch of nucleoside analogues to inhibit hepatitis C virus (HCV) replication…

How easy it is to slip into scientific terminology that may be difficult to understand…

With the launch of HCV therapies designed to prevent the virus from replicating and significantly more effective than previous options, at least one physician initially failed to treat a patient as recommended because of a simple misunderstanding of the prescribing information and the various HCV genotypes, a mistake fortunately corrected through communication and further education¹⁰. How often are suboptimal treatment decisions made due to the complex nature of the guidelines and prescribing information meant to support their use?

While it is imperative for physicians to acquire the necessary medical skill to best treat their patients, perhaps they, and all others working within healthcare systems should consider communication and education as crucial aspects of their respective roles.

Learn more on Medthority’s Infectious Disease Page

References

1. NHS. Overview Pneumonia. https://www.nhs.uk/conditions/pneumonia/. Accessed 5 July 2022.
2. CDC. Pneumonia. https://www.cdc.gov/pneumonia/index.html. Accessed 5 July 2022.
3. McKeown JC, Smith J. The Hippocrates Code: Unraveling the Ancient Mysteries of Modern Medical Terminology. Indianapolis: Hackett; 2016.
4. Smith R. Doctors are not scientists. BMJ. 2004;328(7454).
5. Walraven JEW, van der Meulen R, van der Hoeven JJM, Lemmens V, Verhoeven RHA, Hesselink G, et al. Preparing tomorrow's medical specialists for participating in oncological multidisciplinary team meetings: perceived barriers, facilitators and training needs. BMC Med Educ. 2022;22(1):502.
6. Khunti K, Jabbour S, Cos X, Mudaliar S, Mende C, Bonaca M, et al. Sodium-glucose co-transporter-2 inhibitors in patients with type 2 diabetes: Barriers and solutions for improving uptake in routine clinical practice. Diabetes Obes Metab. 2022;24(7):1187-1196.
7. Seely KD, Higgs JA, Nigh A. Utilizing the "teach-back" method to improve surgical informed consent and shared decision-making: a review. Patient Saf Surg. 2022;16(1):12.
8. CDC. Use and Care of Masks. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html. Accessed 5 July 2022.
9. WHO. Coronavirus disease (COVID-19): Children and masks. https://www.who.int/news-room/questions-and-answers/item/q-a-children-and-masks-related-to-covid-19. Accessed 5 July 2022.
10. Gallarda B. A PhD and medical writing: A good match. Medical Writing. 2016;25(2):18-20.