ORIGINAL RESEARCH ARTICLE
‘THE ACCEPTANCE AND USE OF JARGONS IN CASE HISTORY TAKING: A CROSS SECTIONAL QUESTIONNAIRE BASED STUDY AMONG CLINICAL DENTAL STUDENTS AND FACULTY MEMBERS OF DENTAL COLLEGES IN ERNAKULAM AND IDUKKI DISTRICTS, KERALA, INDIA’
Background: The use of jargons has become very common in health care field, especially in medical/dental records. Although use of standard medical jargons, can be seen as professional, efficient shorthand, the lack of awareness regarding the standard medical abbreviations and incessant and overzealous use of slangs among the health care professionals can act as a barrier in effective communication and understanding among patients and peers.
Objective: To assess the acceptance and use of jargons in case history taking among clinical dental students and dental teaching faculty members of dental colleges in Ernakulam and Idukki districts of Kerala.
Methodology: A cross-sectional questionnaire based survey containing 15 questions to assess the objective of the study was done. The study was conducted among clinical dental undergraduate students, house surgeons, post graduate students and teaching faculty members of five dental colleges in Ernakulam and Idukki districts, Kerala. Results were expressed as a number and percentage of response for each question and Chi-square test was performed for inferential statistical analysis.
Results: All the 549 respondents used jargons in case history taking. About 22.4% of the respondents admitted that they always used jargons and 55.8 % admitted of using jargons only when there was a lack of time. Majority of the respondents (71.4%) learnt the jargons from their colleagues. About 50% of respondents admitted of using jargons in history section and about 32% of the respondents in all sections of case history taking. About 74% were of the opinion that abbreviations should be permitted in case history taking.
Conclusion: This study points out that there is a widespread use of jargons/abbreviations in case history taking among the respondents. There is a lack of knowledge regarding standard medical abbreviations. Although majority of the respondents are comfortable with the use of jargons, majority of the postgraduates and faculty feel the use of jargons should be stopped.
Keywords: Jargon, abbreviations, case history, dental students
Jargon is defined as “the language, esp. thevocabulary, peculiar to a particular trade, profession, or group; medical jargon, plumber’s jargon” All professions use this linguistic shorthand that serves as a means of communication among members but effectively excludes all others(1). It is very useful in a community sharing a common interest as it removes much information redundancy.At the same time, it represents a barrier to those unfamiliar with it.(2) Communication failures created by jargon are especially plentiful and pernicious in healthcare.
Medical/dental records consist of information kept by doctors, health care centres, community health clinics or local hospitals detailing what the doctors or other bodies know about the medical condition and history of patients.(3) They consist of case history, details about medical/dental examinations, treatment planning, treatments done, medications prescribed etc.
Like every profession, the use of jargons has become very common in health care field as well, especially in medical/dental records. Although use of standard medical jargons, in its most positive light, can be seen as professional, efficient shorthand, the lack of awareness regarding the standard medical abbreviations and incessant and overzealous use of slangs, mistaking them for jargons, among the health care professions can act as barriers in effective communication and understanding among patients and peers. Moreover, communication barriers often go undetected in health care settings and can have serious effects on the health and safety of patients (4).
Hence, this study was conducted with an objective of assessing the acceptance and use of jargons in case history taking among clinical dental students and dental teaching faculty members of dental colleges in Ernakulam and Idukki districts, in Kerala.
The study was a cross-sectional questionnaire based survey. The target population was the dental students with clinical exposure (third year and final year BDS), house surgeons, post graduate students and the teaching faculty members of five dental colleges in Ernakulam and Idukki districts of Kerala. A prefabricated validity tested questionnaire that was administered to the target population.The questionnaire was divided into two parts. The first part consisted of questions on personal and professional data including age, gender and designation. The second part contained 15 questions on the acceptance and use of jargons in dental case history taking.Two of the 15 questions were open ended. Informed consent was obtained from the respondents.
The questionnaires were distributed by the faculty members of Department of Public Health Dentistry and house surgeons posted in the department. The respondents were asked to answer and return the questionnaire immediately.
All returned questionnaires were coded and analysed. Results were expressed as number and percentage of response for each question and were analysed using the SPSS Version 17 software. Chi-square test was performed to compare the response in relation to gender and designation and the level of significance was set at p = 0.05.
Among a total of 549 respondents, 24.4% (n=134) were males. About 46.3% (n=254) were undergraduate students, 25.9% (n=142) were house surgeons, 11.3% (n=62) were students pursuing post-graduation and the rest 16.6% (n=91) were teaching faculty members. The profile of respondents is given in table 1.
Acceptance and use of jargons among respondents
The response to questions asked regarding the acceptance and use of jargons in dental case history taking are outlined in Table 2.
All the respondents used jargons in case history taking. About 22.4% of the respondents admitted that they always used jargons and 55.8 % admitted of using jargons only when there was a lack of time. About 62.6% used abbreviations as it saved time and about 49.2% used it as it was easy. Majority of the respondents (71.4%) learnt the jargons from their colleagues and 38.25% admitted of having learnt them from their teachers.
About half the number of respondents used jargons in history section and about 21%, in clinical examination. However, about 32% of the respondents used abbreviations in all sections of case history taking (personal information, history, clinical examination, diagnosis and treatment). Although, only one half of the respondents opined that they were aware of the standard medical abbreviations, about 65% claimed that they used standard abbreviations only. About 60% of the respondents admitted that they were comfortable with case history with abbreviations and only 10.4% had a discomfort in using abbreviations whilst recording case history. More than half the number of respondents felt a difficulty in understanding abbreviations written by others.
However a vast majority of the respondents (74%) were of the opinion that abbreviations should be permitted in case history taking.
The jargons used by the respondents are given in Table 3
DISCUSSION Clearly, the world has become “smaller” due to the use of information and communications technologies.Effective communication requires the parties involved sharing a clear understanding of the various definitions and parameters about which information (and data) are being exchanged – in other words, are we talking about the same thing?
Here, language and, in particular, jargon, plays a key role. Even assuming that all parties have a reasonable command of a common language – for example, International English – the same words may have significantly different meanings to people from different parts of the world.Jargon is an abbreviated form of language that encapsulates tacit knowledge.(2)
As medical students, house surgeons, and residents, we pick it up from our peers and from attending physicians who should know better. We hear it at lectures and conferences. We read it in journals and textbooks. Eventually, we become inured to it, and we no longer recognize how ugly it is and how often it impairs effective communication.(5)
Medical jargon is often justified on the grounds that it constitutes a kind of medical shorthand, allowing more efficient communication when time is short. These examplesillustrate that jargon is often less informative.(5)
Although studies assessing the impact of jargons used by health care providers on the patients have been reported in the literature, not even a single study was found in the available electronic literature that assessed the impact of use of jargons among the health care personnel. As stated above, with the world becoming much smaller and with great developments in the field of communication, there needs to be uniformity in recording and reporting of medical data. Although, there exists a definite set of standard medical jargons, there is a serious lack of awareness regarding the same and there is a prolific use of abbreviations in case history taking, mistaking them for standard medical jargons. This often can result in a lack of effective communications among the colleagues and patients. With case history deserving a great importance as a medical record presently, uniformity needs to exist in documentation of medical records. Hence this study was conducted to assess the use of medical jargons among dentists and their impact on the peers.
A very significant observation in this study was all the 549 respondents of the study used jargons in their case history taking. Moreover, only 56% of the respondents admitted to using jargons only when there was a lack of time. This habit is significantly greater in students compared to house surgeons and faculty. This highlights the fact that use of jargons/shorthand has become an integral component of writing for a significant proportion of the population. The growing and overzealous use of short messaging service and social media may have a significant role to play in this regard. This has in fact become a current topic of concern. Various researches conducted in this regard (6-8) indicate the influence of texting on English language. Although the results are debatable, there is a clear preference for the present generation to use abbreviations over full forms everywhere. Thus the observation that about half the number of respondents use jargons as they find it easy. Over 70% admit learning these jargons from their colleagues which is again matter of concern. Yet another important observation is that about 65% of the respondents believe that they use standard medical jargons only. However, in reality, as per this study, vast majority of the jargons used are not standard jargons. Moreover, an institution-wise comparison of the jargons used by the respondents, reveals that there a definite variation among the institutions in the same geographical area. Even more important is the fact that there were abbreviations, the use of which was restricted to a single institution, which the respondents in the neighbouring institutions were unaware of, clearly ascertaining the fact that these abbreviations are created according to one’s convenience. This accounts for the lack of uniformity in the jargons used, as reported. Ironically, only c/o, h/o and w.r.t among the abbreviations reportedly being used by the respondents can be described as standard medical jargons (9).
It is a noteworthy point that, over 60% of the respondents use jargons in recording patient’s personal information and history section. Guidelines in case history taking indicate that that these sections demand the use of a language which the patient can comprehend. (10) With case history record serving as important legal evidence in medico-legal cases, uniformity needs to be strictly maintained in its recording.
Furthermore, in spite of about 55% reporting a difficulty in understanding the abbreviations used by their colleagues/students, a response which is significantly greater among faculty members. About 60% feel they are comfortable regarding case history with abbreviations. This is significantly higher among undergraduate students. However, majority of the post graduate students and faculty members opined that they were comfortable with case history without abbreviations. Although about 50% of the respondents claim that they are aware of the standard medical abbreviations, it was found to be false. This indicates that there is lack of adequate knowledge regarding the same. Most importantly, with about 85% opining that there is no need to stop the use of abbreviations, there is a clear reflection of the attitude of the respondents towards the same. A statistically significant difference in this regard between students and faculty members reveal that faculty members opined regarding the stop of use of abbreviations.
This study thus throws a light on an issue which demands a serious action. Furthermore this study warns us that this practice is leading to damage to the use and purpose of medical recordkeeping, which can have a serious impact in the long run.
With lack of awareness being one of the most common reason for this observation, efforts to improve the awareness by incorporating the same in the curriculum can be recommended. The faculty members have a major role of play in this regard by ensuring that the students record the case history without abbreviations/jargons.
This study points out that there is a widespread use of jargons/abbreviations in case history taking among the clinical dental undergraduate students, house surgeons, post graduate students and faculty members in dental colleges in Ernakulam and Idukki districts. There is a lack of knowledge regarding standard medical abbreviations. Although majority of the respondents are comfortable with the use of jargons, majority of the postgraduates and faculty feel the use of jargons should be stopped.
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