A Noteworthy Suggestion

Plus: What's the language of medicine?

Author

Kyan Lynch
October 06, 2024 • Estimated Reading Time: 8 minutes

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Thank you! Back to our regularly scheduled programming.

As always, this week’s Newsletter is in SOAP note format:

Subjective: The Language of Medicine

All physicians share a language. And I don’t mean English.

It’s the pause before delivering a life-changing diagnosis.

The furrowed brows at conflicting test results.

The subtle lean forward to say “I’m with you. You have my complete attention”.

But, in the United States, fluency in this universal language isn’t enough.

Like it or not, we judge our physicians by their ability to communicate - in English.

So, what does an international medical graduate (IMG), visiting scholar, or immigrant physician do if they’re not fluent in English?

And what can we do, as medical educators, to ensure our trainees are set up for success?

Fortunately, there are people like Amanda Mull in the world.

Amanda is an English Communication Coach for doctors and surgeons.

My main goal is to help doctors enhance their communication skills so they can develop better relationships with their patients and colleagues.

Amanda Mull, TEFL, MA
What does communication coaching entail?

Amanda covers a number of tricky topics:

  • Verbs used in medicine that can be sources of confusion or mistranslations from other languages, including: take, make, give, administer, check, and draw.

  • Phrasal verbs like "follow up," "bring up," and "find out".

  • English/American idioms like:

    • "to run in the family”

    • "to come down with something”

    • “an elephant is sitting on my chest”

    • “a scratchy throat”

    • “my arm is asleep”

    • “to wean someone off medicine" 

  • Pain descriptors, like "dull pain," "knife pain," and "nagging pain," among others, along with the English terms for the pain scales used on patients in US hospitals.  

  • Patient-friendly language, such as “heart attack” instead of “myocardial infarction”

The doctors I’ve worked with around the world often express in our initial meeting that they are self-conscious when communicating with their patients in English

Amanda Mull

After working together, physicians feel more confident and comfortable:

“Mastering the English language to feel comfortable with your patients and colleagues is not easy if you have not lived in an English-speaking country for a long time. With Amanda you can get it.”

Carlos, Urologist and Fertility Specialist in Spain/ US

“[S]he is not only an English teacher. With her classes she also gave me other skills to help me improve (I hope) as a doctor, to appear more human and closer to my patients.”

Josep, Emergency Room Doctor in Spain/ Dubai

To learn more and get in touch with Amanda, email her at [email protected]

Have you referred a trainee or colleague to an English Communication Coach for doctors?

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Objective: Noting Progress on Progress Notes

When I was in third grade, my teacher asked: “what do you want to be when you grow up?”

Like many of my classmates, I said: “I want to be in the clinical documentation hall-of-fame”.

That’s a lie. Obviously.

No one is called to write clinical notes.

But love ‘em, hate ‘em, or begrudgingly accept ‘em, notes are an integral part of modern health care.

They serve three main purposes:

  1. Documenting what was and was not done during an encounter for medicolegal and billing purposes;

  2. Creating a record of the patient’s status at a specific point in time;

  3. Informing current and future caregivers about the clinician’s thought process, reasoning, and plan.

If you’re going to spend ~2 hours a day writing them, why not add a fourth: trainee assessment and development.

Here are 3 validated tools you can try out to give learners feedback on their notes:

  • Revised-IDEA Assessment Tool

    • Superlative: 🏆 Best for Clinical Reasoning

    • What It Does: The Revised-IDEA tool evaluates how well trainees synthesize patient information during admission, focusing on clinical reasoning, diagnostic thinking, and decision-making. It breaks down notes into four key areas:

      • Interpretive summary

      • Differential diagnosis

      • Explanation of reasoning

      • Alternatives.

    • Sample Question: "Does the differential diagnosis reflect a clear, evidence-based reasoning process considering the patient's presentation?"

    • Grading: The Revised-IDEA tool uses a Likert scale (1–5) for each component, where 1 indicates limited understanding, and 5 shows a comprehensive and accurate diagnostic approach.

    • Key Teaching Point: Encourage trainees to connect the dots between patient history, physical exam findings, and clinical decision-making in a structured, evidence-based manner.

  • RED (Responsible Electronic Documentation) Checklist

    • Superlative: 🏆 Easiest to Implement

    • What It Does: Addresses the most common EHR problem behaviors (copy/paste, unnecessary information, outdated results, etc.), following a SOAP Note format

    • Sample Question: "Has relevant new information, like lab results or imaging, been incorporated into the note?"

    • Grading: The RED Checklist uses a simple Yes/No grading system for each element (e.g., “Did the student update the diagnosis based on new test results?”).

    • Key Teaching Point: Keep your notes updated and accurate.

  • P-HAPEE (Pediatric History and Physical Exam Evaluation) Tool

    • Superlative: 🏆Funniest Name

    • What It Does: Designed specifically for pediatric admissions, P-HAPEE digs deep into history-taking and physical exams for younger patients.

    • Sample Question: "Describe the patient’s developmental history and integrate this with their current clinical condition."

    • Grading: P-HAPEE uses a 5-point Likert scale to evaluate sections like history, physical exam, and developmental integration. A score of 5 means the student nailed it, while lower scores show areas where they missed critical information or context.

    • Key Learning Point: It forces students to think about how a kid’s developmental milestones (or lack thereof) play into the current diagnosis.

Do you routinely give structured feedback on trainees' notes?

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Assessment: Quick Quiz!

⏪Last Week’s Question:

Which learning theory categorizes learning outcomes into cognitive, affective, and psychomotor domains?

Answer: Bloom's Taxonomy categorizes learning outcomes into the cognitive, affective, and psychomotor domains.

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