Level of vocabulary to use with patients

Here's an interesting dilemma I noticed today. How do you talk with patients? Do you use complex medical jargon so that the patient is completely lost? Or do you tone it down to an eighth-grade educational level (supposedly that's the average reading level in the United States?!) so that they can understand it? On one hand, we are accused to being lost in our own ivory tower speaking techno-babble that the "commoners" don't understand - perhaps in an effort to befuddle them and make them believe that we are doing "important things". On the other hand, when we try to use simpler words some patients might feel insulted and patronized. How to choose the right balance?

A good friend of mine was just recently admitted to the hospital for an acute stroke. I won't dwell on the ethics of having someone I know as a patient, but suffice it to say that luckily, as things turned out, I never did round on him nor follow him as a patient. While fortunate from an ethical point of view, this ended up being a detriment in my later interactions with him. You see, they saw some unusual spots in his MRI and wanted to do a slew of additional tests. It didn't help matters at all that, being a very popular guy, many friends and family members were coming by at all hours visiting him. As it turned out, many different family members got only a piece of what was going on, and in the end the poor guy was confused as to what the plan was or why he was even in the hospital! He became to frustrated he ended up having to call up a friend who's another physician at the hospital to try and find out what's going on.

It was at this point that I discovered he was in the hospital, and I had only a brief conversation with him. But it was clear that he was confused as to what he was being worked up for. I managed to track down the resident and told her the issue, and she re-iterated that part of the problem was that she kept explaining things to different people.

Nevertheless, we went back to his room where I stood with the resident who outlined the entire reason for his extended stay and why we were working him up. She used all sorts of technical words and I could see that the poor guy was getting lost. So I waited until the resident left and I asked him if he had any questions. He said he understood most of what the resident said, but the thing that's really concerning for him is why did he get a stroke in the first place, being relatively young for strokes, and what's the odds that he might get another one since imaging showed a history of multiple old lacunar infarcts?

It was one of those rare moments that I felt I could actually help someone as a student - not relegated to simply observing or doing the biding of a resident/intern/attending. I explained the whole diagnostic process to him in detail - starting with the initial MRI findings which were repeated, followed by additional tests including a lumbar puncture to exclude an infectious etiology, and that the fact is we may never know the reason for his stroke. I explained that we were working him up for vasculitis or other hyper-coaguability studies, but I thought that the odds of one of those tests yielding an answer was rather low. We both acknowledged that he's been a heavy smoker (in fact, I just found out right then and there that he had quit for 3 months prior to the stroke - what injustice!) and that smoking cessation probably helped the most in preventing a recurrence more than the anti-platelet therapy they were going to start him on (Plavix).

While I told him that the answer was simply, "We don't know" and we'll likely not know - he seemed to appreciate this much more than the former complete unknown. Sometimes, I guess the fear of the unknown can be great, but understanding helps to alleviate some of the fear even if the final answer still eludes you.

In retrospect, I wonder if smoking cessation was what triggered his stroke? Could his arteries be so accustomed to the nitric oxide present in his blood that the abrupt withdrawal resulted in vasoconstriction and then a stroke? Hmm...an idea for a literature search...