What a Difference a Few Letters Make

01.21.11: Why it's important to ask questions.


• One patient insisted she wanted her episiotomy before her epidural. We assured her, she’d really like it better if we did it the other way around.

• Another said she had a good epidermal with her first baby and wanted another one this time. Her nurse told her she had a lovely complexion and we’d try to get her a great epidural too.

• My patient was adamant. She didn’t want to have anything to do with an epididymis. Unfortunately, it was too late.

• A diabetic patient was relieved she didn’t have “keystones” in her urine. Her husband had keystones and he said it hurt worse than his bullet wound.

• One patient’s biggest fear was that she might pass fetal matter when she pushed. I told her lots of women push out a little fecal matter and not to worry about it. We’d make sure she was perfectly clean.

• A patient brought her grandfather with her when she went into labor. She said he had “old-timer’s disease” (Alzheimer’s) and no one was available to watch him at home. When the patient needed to push, we parked the old gentleman at the nurses’ station and reassured him he was right where he needed to be.

These little mistakes happen all the time and frankly, medical professionals get a kick out of them. Medical terminology is confusing, even to professionals. We curse the geniuses that created such complicated lingo that the difference between two completely different medical terms is one consonant or vowel. Take for example these frequently confused words:

• An episiotomy is an incision that’s sometimes made between the vagina and rectum, at the time of delivery to make extra room for baby to get out.

• An epidural is a type of anesthesia that makes labor an almost pain-free adventure. If you need an episiotomy, you’ll probably appreciate having your epidural first.

Epidermal means, “having to do with skin, AKA epidermis.”

• And epididymis? Part of the male reproductive system responsible for sperm production. I’m impressed the patient had this one in her vocabulary, because most of us wouldn’t know an epididymis up close and personal. Since she already had intimate experience with somebody’s epididymis, there wasn’t much we could do to in the maternity unit to avoid that.

• “Keystones?” The diabetic patient’s urine didn’t have any “ketones,” a byproduct of fat breakdown that sometimes indicates trouble. Her husband apparently had “kidney stones,” small rock-like calcifications. When passed from the kidney down the ureters to the bladder, kidney stones are said to hurt worse than labor. I have no idea if they hurt worse than bullet wounds.

Fetal means having to do with a fetus, as in “baby.” Fecal, on the other hand, means “poo.” Pushing tends to involve both.

• I think it makes perfect sense to call Alzheimer’s disease, “old-timer’s disease.” I mean really, it’s mostly old timers who get it.

While these little errors are cute and kind of funny, they’re prime examples of the importance of communication in accessing and administering medical care. Little mispronunciations indicate a lot about patients’ understanding of what their medical team is doing to them and how well staff is communicating. It gives staff an opportunity to double check: Are we taking into consideration their patient’s primary language, level of education, culture and familiarity with medical terminology? Are we considering a patient’s learning style, stress level and family?

Medical errors can cause serious problems. One study published in the Journal of the American Academy of Pediatrics says on average, each clinical exchange involves 31 medical errors, most of which are errors of omission (the stuff that’s not said, the questions not asked, the explanations not made). This can have serious health impact, especially when the patient is expected to follow instructions, take prescriptions, perform certain medical procedures, follow-up on tests, etc.

Sometimes, communication problems occur because medical staff is overworked. With three other patients waiting for pain medication or breastfeeding help; a nurse may not spend enough time on a thorough explanation of how to use the breast pump. We’re not slackers…we’re understaffed. When a patient tells us, however, “I don’t get how to use this thing,” we stop and make that patient and her question our priority. Help us out here, folks. Ask the questions.

Among the biggest challenges care providers face are language barriers. Millions of Americans have limited English proficiency. They might bring a family member to translate, but that’s pretty inefficient. We need a professional medical interpreter. A professional won’t squirm when asked to translate: “Do you have anything coming out of your vagina?” Or “When was the last time you had sex?” Ask the same question when the patient’s mother-in-law is translating and you might not get a straight answer, that is, if she even translates the question. Countless times I’ve rattled off a 15-word question only to have the super uncomfortable, red-faced, friend-of-a-friend’s 8-year-old brother refuse to translate or reduce my 15 words to two sounds. Worse yet is when the translator answers the question without ever translating it to the patient.

It’s all about communication. Let your medical care providers know what you need to know. Ask those questions. Don’t be afraid to tell us when you don’t understand. Believe me, when I go to the doctor for something unrelated to women’s health, I don’t always know the difference between my PVCs, CMPs or LMNOPs either.

Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to labornurse@fitpregnancy.com and it may be answered in a future blog post.

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.