| ||What Your Doctor Is Saying || |
When Your Doctor Is Vague
Last reviewed by Faculty of Harvard Medical School on January 13, 2011
By Robert H. Shmerling, M.D.
Beth Israel Deaconess Medical Center
Among the many reasons it may be hard to understand your doctor is one that may surprise you: Doctors sometimes use terms that are intentionally vague.
There are a variety of reasons for this some better than others but there are clearly times when your health care professional could provide more information, better information, or use clearer terms to explain the situation but chooses not to. Your doctor is likely trying to dole out just the right amount of information in the right way; getting too little information from doctors is a common complaint in this day of rushed office visits, but too much or too technical information is not helpful either.
Why So Vague?
Ideally, physicians make every effort to judge just how much information you want or need and work hard to convey that information clearly. In some situations, though, information is incomplete or imprecise on purpose. Among the reasons your health care professional may choose to be vague are:
- Uncertainty Being vague is one way (though not necessarily the best or only way) to handle the lack of certainty until the situation is more clear. Although full disclosure might seem like a better idea, many doctors prefer to avoid saying they are unsure. They may fear shaking the patient's confidence or be reluctant to acknowledge the fact that doctors do not always have all the answers.
- Stalling for time Your doctor may want to keep open a range of possibilities by using terminology that is vague or over-inclusive until he or she has had more time to review test results, read about the problem in a medical journal or textbook, review it with a colleague or consultant, or simply to think about it. A doctor legitimately may fear that if only one diagnosis or recommendation is made, the patient may not consider alternatives.
- "Efficiency" There may be times when it is quicker to be vague than to explain that there are several possible diagnoses, a different likelihood for each one, a variety of treatment options for each one, and so on. Clearly, there is a cost of this "efficiency": Time saved by not reviewing the leading concerns comes at the expense of the patient's understanding (and sometimes, satisfaction).
- Avoiding worry The most serious conditions may be highly unlikely, so being vague about them may help to limit unnecessary worry. Often, worrying about a condition that is unlikely is worse than the condition you actually have. Your health care professional may be vague only until reassurance can be provided with confidence. On the other hand, many people are worried already but don't mention what they are worried about. Addressing potential concerns, even unspoken ones, is a challenge for even the most experienced physicians.
- Talking in code Doctors sometimes use terms that, while medically precise, may be poorly understood by nonmedical people. There are situations in which health care professionals "talk in code" at least in part to keep the discussion (or the medical record) clear primarily to medical professionals (and vague for everyone else). As mentioned above, not all of the reasons for medical vagueness are as good as others.
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Some Examples of Vagueness
If you are worried about your health or are waiting to hear the results of a test, your doctor's job is to tell you what you need to know as well as what you want to know in a way that you will understand. It's often a tough job to do well and, as a result, the terms the doctor uses may not be not as clear as they could be. Some examples follow:
- Iatrogenic Example: She had to stay in the hospital because of several iatrogenic problems including a rash from her antibiotic treatment and confusion related to her pain medications. "Iatrogenic" means that a condition has been caused by the medication, procedure or other treatment rather than by the original condition. It is a new problem that the person did not start out with but has developed as a result of the treatment. This term is less likely to be understood by patients than "plain English" about complications of medical care. Eliminating or at least reducing "iatrogenesis" is currently a major focus of many hospitals, physicians and other health care providers; speaking clearly about it also should be a priority.
- Lesion Example: There was a skin lesion near the wrist that had the typical appearance of a benign mole. A truly vague term, "lesion" applies to just about any abnormality. It could be a tiny red dot on the skin of no significance, or it could be a tumor seen on a chest X-ray. Doctors may call it a lesion to avoid saying "cancer," especially before the diagnosis has been confirmed.
- Nodule Example: The chest X-ray revealed a small nodule in the upper left lung; further evaluation is recommended. This term is commonly used to describe a lump or small solid tissue detected by imaging tests such as mammograms, chest X-rays or CT scans when its precise nature is uncertain. A major limitation of imaging studies is that they often cannot readily distinguish minor and unimportant abnormalities from serious ones, such as cancer, which may have a similar appearance. For this reason, it is not rare that a "nodule" requires removal or biopsy to figure out what it is. The terms "mass" or "shadow" are similarly vague and may be used in similar situations.
- Suspicious Example: The mole on the upper left shoulder was suspicious for melanoma. This is a term that also applies to imaging studies or biopsies when there is a concern by caregivers of a serious condition (such as cancer). Similarly vague terms suggesting unimportant findings include "insignificant," "unimpressive," or "within normal limits."
- Neoplastic Example: The CT scan demonstrates an abnormality in the upper left lung; possible causes include infectious or neoplastic disease. Technically, this term means anything that has new, abnormal growth and could apply to a range of disorders, from cancer to benign conditions such as warts. Often the term will be used in place of "cancer" if that diagnosis is suspected but has not yet been confirmed.
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The Value of Vagueness
There may be times when you will be glad your doctor is vague. When the chances of a serious problem are sufficiently low, it may be better not to know every possible bad outcome or terminal diagnosis. On the other hand, some people want to know about even the most unlikely diagnoses and minimal risks associated with their care.
With my own patients, I dread the question "What's the worst it could be?" because often my honest answer is not always something the patient is eager to hear and I suspect that once answered, many wish they had not asked. There is such a thing as too much information, and being vague is one way to limit it.
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What's a Patient To Do?
Your doctor is trying to weigh what information he or she thinks it best for you to focus on; consider it your job as a patient to help direct the flow of information. The Internet is a good example of how information requires direction and perspective to be helpful. While a remarkable amount of information about medical matters is readily available on the Web, the 2 million links offered up by a search engine to learn about asthma are probably more than you want or need. Rely on your physician to help sort things out in a reasonable way, including some direction about reliable, outside sources of medical information.
To better understand the (sometimes) vague language of your doctor, here's what you can to do:
- Be a patient patient. Listen to your health care professional. He or she may be just about to answer the question you have.
- Ask for more. If you need more information or a clarification, don't be afraid to ask.
- Ask for less. Tell your doctor if you are getting more information than you want or need. It can be as helpful to speak up when you don't want to know something as much as when you do.
- Be willing to suspend your assumptions. We all make assumptions about our health, our symptoms, our diseases. Keep an open mind, especially if your doctor has an approach or opinion different from your own. Hopefully, your physician is keeping an open mind as well.
- Ask for an "information referral." A trusted website, textbook, medical association or patient-support organization may have all the information you want and need.
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The Bottom Line
There is no single best way for information to pass between you and your health care professional. Some people want to know everything there is to know; others operate on more of a "need to know" basis and rely on their doctors to decide how much information to share. Of course, there is a large group in between those extremes. Ideally, you and your doctor will settle on a style that suits your needs, to identify your "information comfort zone." It usually takes some time to reach the ideal level of information flow. Although there may be times when you are glad your doctor spares you the excruciating details, clearly there are limits to the usefulness of vague language.
If you feel that the information you are getting from your doctor is too vague, it may be a good idea simply to say so. On the other hand, be careful what you ask for if you get more medical information than you really wanted, you may find yourself nostalgic for the vague old days.
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Robert H. Shmerling, M.D., is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.