Tuesday, October 29, 2013

Congitive Load

Healthcare is tremendously complex, but I sometimes wonder if we are suffering needlessly from complexity that we can do without.  And if you think technical standards are fraught with unnecessary complexity, acronyms and specialized language, the language of healthcare providers itself can be very confusing to the patient.

One of the classes I am taking this year is The Practice of Healthcare.  The text is a 1200 page tome called "The Essentials of Pathophysiology", and we use it to help us understand what clinicians must do for each of 10 cases addressed over the term.  The "Essentials" indeed, because the complete work would consume 4-5 times that in paper.  Fortunately, I have the electronic copy, which greatly improves my ability to find what I need.

Many of the other students in my class are clinicians in training or in practice, and this material is not quite as daunting for them.  I find myself struggling with the reading, having to stop and look up a term about 4 times on each page.

But in the process of doing so, what I have learned is that for many of these terms, there are simpler ways of explaining what these terms mean.  I understand the origins of many of the terms, and can routinely parse the meanings of them (but still look them up to be certain).  The words I seem to have the biggest problems with aren't the nouns (after all, engineers invent new nouns routinely), but rather the adjectives.

So I wonder, is it really necessary to say ventral and dorsal, or could we say front and back?  Is distal the best adjective or would far do?  And others like afferent and efferent, did we really need to have a word be able to be changed to its opposite by substitution of a single letter.  Would not transmitting and receiving be more readily understood?

How much of a physicians cognitive load is impressed upon him or her by the complexity of a secondary terminology that duplicates the function of words we already have and know?  Could that could be improved?  (And I also ask myself that same question about technology, but that has been less of an issue).

I'm afraid as I learn more that I might slip into the same pattern of language use.  I try to be diligent in my responses to translate the medical language into the English I already know, and avoid the use of three, four and five letter acronyms in my responses.  I now understand the short hand, but unless I respond in "my own" language, I'm not actually certain I understand the answer I just gave.

The next time I hear a clinician complain about my technical babblety babble, I'm not sure how I will respond.  I certainly have a better understanding of how they feel, but I think I just might explode on their own (ab)uses of language.


  1. This is what they teach at colleges aren't they? You need to make sure stuff like that is.

  2. I would argue that professional jargon can actually reduce cognitive load when physicians communicate with each other or take in information - after the pain of learning it has subsided. As soon as a physician hears afferent/efferent, he already knows that the rest will probably concern nerves or nerve impulses. Not so with the more general receiving/transmitting. Ventral/dorsal hint the listener that you are talking about anatomical body structures, as do distal / proximal, anterior / posterior and so on. These terms help information parsing by giving more specific hints on what is being talked about than general English terms. They are also universally understood across language barriers. Of course all of this only pertains to information exchange between professionals, and as care has been moving in a more patient-centerd direction, so has the use of terminology. At least we don't need to know Latin anymore ;).

  3. After the pain from learning subsides is the telling point in your message. Does the learning need to be so painful? Would it not work better to use plain English when that language would serve, and so communicate the same thing. Of course there would be pain in transition, but your argument that transmit/receive would not convey the same meaning in a medical context doesn't fly. The learning that you get is what provides that meaning, after all. Not the unfamiliarity of the word.

  4. I agree that learning should not be made any more painful than absolutely necessary. New terms should be explained and not just used as if they were obvious to everyone. In medical curriculae, the anatomy course (which usually precedes pathophysiology) takes care of a large part of introduction to medical terminology. If somebody just needs a basic conseptual understanding of e.g. nerve signal transmission, there is probably no need to introduce specialized terms.