Editor—Misunderstandings between patients and their doctors have featured in several recent papers in the BMJ.1–4 At Gloucestershire Royal Hospital we completed an outpatient study of 100 parents or carers (after a pilot study in 20) to see what their understanding of the words “positive” and “negative” in relation to test results might be (because these words have opposite meanings in general usage and in medical terms). We also assessed their understanding of two phrases that a doctor might use in passing, which do not denote any disease (“the haemoglobin was a bit low” and “she's small but normal”). We used a semistructured questionnaire, and the same interviewer (DH) spoke to all the subjects. Verbal and non-verbal clues as to the “correct” answer were minimised, and no feedback was given as to whether the answer given was correct.
The sample was representative (in terms of age, sex, and reason for attendance) of the parents and carers we would expect to see in outpatients. Of the 100 questioned, 15 said that they had had previous experience of not being sure what a test result meant; eight of these specifically mentioned not understanding what the doctor had said. Eighty three of the sample understood “positive” and “negative” in relation to a test result in the same way as a doctor, nine got them the wrong way round, and eight were unable to decide which was right.
The word “haemoglobin” was not understood by 38 of the sample, and none of those questioned realised that the phrase “the haemoglobin was a bit low” meant that there was nothing wrong. Suggestions of what it meant ranged from “anaemia,” “something to do with the blood,” and “lack of iron” to “diabetes,” leukaemia,” and “haemophilia.” On direct questioning 63 of the sample said that they would be worried by this statement.
The response to the phrase “she's small but normal” was more difficult to interpret as many of those questioned said that it had been said of their child. Only 13 would be worried by this statement.
These words and phrases were used in an artificial way, in a fairly small sample, but the results serve to remind us that we need to be vigilant about the words we use and try not to create unnecessary worry. Reassuringly, many parents spontaneously commented that they would ask the doctor if they didn't understand.
References
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