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Tuesday, February 27th 2007

Communicating The Differences

It was the second patient during my musculoskeletal physical exam lab. I was the first of my small group into the room where a rhuematology fellow and an older patient waited.

The patient’s fingers looked too short for the hands and deformed. The thumbs were hidden under the palms. During our short time together the full functionality (or lack there of) of the hands became apparent. This was advanced rheumatoid arthritis.

It struck me how absolutely deforming and devastating this disease was.

More than 40 million Americans suffer from ‘arthritis’. What does that even mean? By far when people tell you they have arthritis they speak of osteoarthritis.

From Mayoclinic.com

OA is terrible and can be a debilitating disease but the potential for deformity and functional difficulty (not to mention the systemic manifestations of) rheumatoid arthritis makes it almost seem silly for the public to use the undifferentiated term ‘arthritis.’

It isn’t merely distinguishing diseases from one another which should be a part of patient’s health literacy efforts. I was stunned by this particular patient’s level of dysfunction. I had seen rheumatoid arthritis before, but this was so much worse. How could this possibly be the same disease?

The point is it is often impressive and almost mind boggling how far the courses of diseases, with the same etiology, differ in different patients.

Its been described, and while humorous holds some truth, that half of what you’re learning during the basic science years of medical school is vocabulary. Almost every time I see an actual patient, there’s a profound sense of just how inadequate lay vocabulary is in communicating medical problems. Not that you’d expect more, so this isn’t a criticism.

Really what I wanted to point out in this post is how the level of understanding in patients and even my current understanding (although it is growing) has such a limited perspective. Many disease processes are complex, with wide degrees of severity and multiple ways of manifesting. Often the medical community’s understanding of some diseases is analogous to my own learning process described above in terms of new understandings which lead to new diagnostic criteria, reclassification of diseases, and even new treatment methods. Understanding such is an important part of health literacy with broad consequences, such as helping vaccine opponents understand the rise in autism diagnoses without blaming vaccines.