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What’s New in the Patient Safety World

January 2023

Hearback Is More Than Just Hearing Back



We often talk about the importance of “hearback” in aviation or in the OR or other medical situations. But hearback is also important in our communications with our patients. Hearback is much more than simply having someone repeat back what you said to them. It is ensuring that the intent of the communication was understood.


We’ve given examples where aviation accidents have occurred because a person issuing a warning failed to make sure that the target of that communication understood the gravity of the situation. We’ve noted that our use of some medical terminology may be confusing in the OR, particularly in multicultural settings. But, if we can confuse other clinicians with our medical jargon, what do we expect when we use it with patients?


A recent study looked at patient understanding of medical terms we use (Gotlieb 2022). Gotlieb et al. surveyed 215 adults about some common medical phrases may lead to confusion among patients affecting health outcomes.


A 13-question survey with a mix of open-ended and multiple-choice questions assessing jargon understanding of common phrases used in medicine was administered. The full survey and contextual comments can be found in the supplementary materials to the Gotlieb article. Note that some of the questions had been used in previous studies demonstrating that patients may have difficulty understanding some medical jargon. Some questions were “dual” in that one was in jargon, the other in non-jargon. Respondents were asked to indicate if they felt these statements indicated good news, bad news, or they were unsure.


Some examples of the questions are:

“We are halfway through your chemotherapy treatment and your tumor is progressing.”

“Your urine tests are back and there were bugs in your urine.”

“You will need to be NPO at 8 am.”

“You are to have nothing by mouth after 4 pm.”

“Your nodes are positive.”

“The findings on the X-ray were quite impressive.”

“I am concerned the patient has an occult infection.”

“Have you been febrile?”


Most respondents (96%) knew that negative cancer screening results meant they did not have cancer. However, fewer respondents knew that “your tumor is progressing” was bad news (79%) or that positive nodes meant their cancer had spread (67%).


Significantly more respondents correctly interpreted the phrase nothing by mouth compared with the use of the acronym NPO (75% vs 11%), respectively. The authors suggest we should actually be using the phrase “You should not have anything to eat or drink”, which is more in keeping with everyday language where “by mouth” is not commonly used.


98% correctly understood “blood test shows no infection”, but only 87% understood the jargon phrase “your blood culture was negative”.


Interestingly, only 41% of respondents correctly interpreted “neuro exam is grossly intact” as good news. The authors speculated this might have been because the word “gross” more often means “unpleasant” than “in general” in common usage.


Few respondents accurately understood the questions that required a free-text response. Only 29% correctly interpreted “bugs in the urine” as intending to convey a urinary tract infection, 9% knew what febrile meant, and 2% of respondents understood the phrase “occult infection”.


The authors did look at factors like age, gender, and educational level but did not come to any firm conclusions about the impact of these on understanding of many of the jargon terms.


The bottom line is that we need to be very careful with the medical terminology we use with our patients and avoid medical jargon where possible. More importantly, we need to make sure our patients clearly understand what we are saying. Asking them, in a non-condescending manner, what they understood from our communication is both appropriate and necessary. The problem is even more serious and complicated when we communicate with them regarding medications and dosages, as highlighted in many of our columns on “numeracy”.



Some of our other columns on health literacy and numeracy:


June 2012                    Parents' Math Ability Matters

May 7, 2013                Drug Errors in the Home

November 2014          Out-of-Hospital Pediatric Medication Errors

January 13, 2015         More on Numeracy

August 2017               More on Pediatric Dosing Errors






Gotlieb R, Praska C, Hendrickson MA, et al. Accuracy in Patient Understanding of Common Medical Phrases. JAMA Netw Open 2022; 5(11): e2242972






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