In medicine, there is a magnetic force that draws physicians to read medical literature. We are a peer group that loves gaining new knowledge, and this mystical force feeds on that desire. It challenges you to constantly read within your field and to enrich your knowledge so you stay on the cutting-edge. Unfortunately, as with most professional fields, one could read 24/7 and never master all the content out there, leaving little time to read anything non-medical. I have often gotten caught up in this force field and been guilty of reading too little outside of the medical world. This year, I discovered a book from beyond those walls of medicine, titled "Blah Blah Blah: What to Do When Words Don't Work" by Dan Roam. I am late to the game, admittedly - it was first published in 2011. Although the examples in the book were tailored to the business world, the medical world needs it all the more, in my opinion. In fact, doctors may simply need to be smacked in the head with this book.
The general message of the book is fairly simple, and yet so profound. The majority of us are visual learners and the more complex words we use, the more we lose our message in the blah blah blah. There are few fields that are so word-heavy as medicine. Looking at the medical school course titles helps you understand the....well...blah blah blah problem of medicine: biochemistry, histology, pharmacology, pathophysiology, and so on. Being a physician demands a diverse skill set. While we do get training in communication skills, that training tends to focus on the actual medical visit - the value of making eye contact, asking open-ended questions, letting the patient ask questions, and so on. These are crucial skills, but there is a big-picture view that we lose during the four years of medical education: speaking in plain language.
We enter medical school as (for the most part) normal people and work so hard at becoming fluent in the language of medicine. When we come back out of that haze, we can speak the medical blah blah blah, but we don't know how to explain it to normal people (i.e., our patients). As a lipidologist, I am guilty of charting terms like "hypoalphalipoproteinemia" on a regular basis. With a patient portal allowing my patients access to their medical records, wouldn't it be kinder to just say "low HDL" so they know what I am talking about? And could I be more consistent in calling myself a cholesterol doctor, not a lipidologist? I might not sound as brilliant to my medical colleagues, but perhaps their brains would welcome less blah blah blah too. Some of the smartest docs I know are the most down-to-earth folks as well. They are the skilled clinicians who can deliver effective treatment plans to patients, in words they understand and can act on.
Plain English isn't enough
Now, the premise of Dan Roam's book goes even further - forget about the words entirely. After all, the majority of us are visual learners. That means that our mind welcomes pictures and tires of words quite quickly. This is worrisome; I have yet to hear of a med school curriculum that teaches sketching or medical illustration. The concept of communicating through fewer words and more visuals shook me up a bit. I decided to perform what I will call the "Blah Blah Blah Handout Test" (BBBHT). We know that patients forget much of what we tell them in an average visit - information overload. So we give out handouts to take home and read. Do my handouts pass the BBBHT? How many of them have clear images that reinforce the message? How many of them have plain language words and clear action plans? Not enough. And I am guessing my colleagues will find the same problem in their offices. How many of these handouts get tossed in the garbage every day, labeled by our patients as more medical blah blah blah? The same can be said for online material (including this blog post); no pictures makes for a tougher time getting your message across clearly and quickly.
The problem isn't limited to the doctor-patient relationship. The doctor-doctor blah blah blah is brain-numbing. I cringe when I think back to my first years in medicine. I was known to include 60-100 slides, with mostly words, in a single 30 minute powerpoint. So much info that was so important to get out to people, right? I dished those words out in rapid fire to stay within my 30 minute time limit. My colleagues helped fuel that fire by graciously thanking me for the thorough presentations. They seemed impressed with my depth of knowledge. But did I serve them well? Probably not. Maybe they left knowing I had a lot of knowledge to share on managing cholesterol, but I taught them less than I could have with simpler words and a more focused message. And maybe under their breath they were saying "What a lot of Blah Blah Blah!"
Perhaps reading Dan Roam's book is more a curse than a blessing for me. Now I often sit at medical conferences and fight the urge to run out of the room and break free; my head spins from all the blah blah blah. So much MORE we could say, if we just cut it out and focused our message. When you give a medical lecture, spend more time on teaching me something actionable, please. I'll try to do the same. And we'll both walk away having learned it in words we can directly use with our patients. This book certainly taught me that I need to carve out time to read even more beyond the magnetic force field of medical literature; I hope my colleagues join me along the way.
If we, as doctors, ever want to make meaningful progress in preventing illness or managing chronic disease, we need to partner with our patients to give them the right tools. Patients need to have clear information about their health conditions and the treatment options. If they have this tool of knowledge, they will be empowered to find a healthier future. Knowledge = power. All of us are patients at some point in our lives and we all deserve to be empowered.
My blog is just beginning. It is meant to help readers better understand the world of cholesterol along with some tidbits about technology in medicine along the way. I am honored to have you here, reading these words. I also challenge those same readers to keep me on task and limit my blah blah blah. In the meantime, I'm off to burn my handouts and take a class in cartooning.
Ann Liebeskind, physician and founder/owner of Mobile Health Team