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Pediatric neurologist Paige Kalika discusses her article, “Learning the language of medicine: from student to fluent physician.” Paige compares mastering medicine to learning a language, from grasping basic vocabulary like anatomy to becoming conversational during clinical rotations and fluent in residency. She highlights the challenge of translating complex medical jargon into plain English for patients, emphasizing that true fluency lies in effective communication. Paige offers actionable takeaways, urging aspiring physicians to immerse themselves in specialties and refine their ability to connect with patients clearly and compassionately.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Paige Kalika. She’s a pediatric neurologist, and today’s KevinMD article is “Learning the language of medicine from student to fluent physician.” Paige, welcome to the show.
Paige Kalika: Thank you so much for having me. I really love your website, the articles, everything. It’s a pleasure to be here.
Kevin Pho: Well, thank you so much for writing and for coming on. Now, for those who don’t know you, just share a little bit about yourself and then talk about the article that you wrote on KevinMD.
Paige Kalika: I’m a pediatric neurologist, which means I see babies, children, and adolescents for any disorders of the nervous system—headache, epilepsy, developmental delay, autism, ADHD, all these things. I’m an academic physician, which means I work at a med school. I work with med students, residents, fellows, so I work with a lot of trainees, a lot of learners.
As I was seeing all my patients and as I was working with my learners, I realized one of the biggest problems that everyone had was talking to patients—not being empathetic or being kind or having bedside manner. Those are different things, which we also need to learn. But our patients and their families weren’t understanding what we were saying because medicine is a language.
I realized this, and this is something that occurred to me as I was driving on my commute, which was at that point pretty lousy, and I had a lot of time to formulate this idea: We learn medicine in much the same way that we learn a second language. We go to school, we learn the basics, we learn the vocabulary, and the vocabulary is, of course, all of our fancy technical words. But it’s also the concepts—our physiology, pharmacology, microbiology, biochemistry—and we build on that. We’re building on the concepts, making these words into phrases, phrases into sentences, and sentences into paragraphs. We’re building this whole language in our minds, and it all makes sense.
I like to joke—and I’m sure I’m not the only one—about “the real Krebs cycle” being learning the Krebs cycle, forgetting it, learning it again, forgetting it again. But the thing is, we do learn it. Even though we have to relearn it every time to remember the details, it’s still in there, and we build on it. We understand everything that’s built on that foundation. That’s what we carry with us when we talk to our trainees and when we talk to our patients and their families. Our trainees are learning the language also, so we’re teaching it to them, but our families don’t have that background for the most part. When we start rattling off our jargon, they get lost; they get confused. Sometimes they’ll ask questions, other times they just shut down and figure they’ll Google it later or ask their friends, or just give up.
One of the most important things we can do as clinicians is to take the time to translate back from medical jargon into plain language. I have to say plain English, but I work in South Florida, so plain Spanish, plain Portuguese—whatever language the patients are speaking. We have to be able to communicate these very complex concepts in clear language.
One of the things that prompted me on this was back when I was very early in my career. I saw a very cute little girl for evaluation of epilepsy seizures. So, OK, not a big deal. I know how to do that. I explained the diagnosis: I explained, oh, we’re going to do this test and that test, we’re going to start this medicine, we’re going to start Keppra (levetiracetam). And the father asked me a very simple question: “What does the medicine do?” I was taken aback—he really wanted to know the mechanism of action of Keppra? OK. I did my best to explain it, and he listened. He was very kind, but I could tell it was going over his head. To be fair, it had been a while since I’d taken my boards, so I probably wasn’t explaining it as well as I could have. At the very end, he just smiled and said, “Yeah, I once spoke to a doctor who said that the mark of someone who truly understood was someone who could explain it to a layman.”
That really made an impact because I realized he didn’t want to know what the Keppra was actually doing on a biochemical level. He wanted to understand what it meant for his daughter. That’s not the same thing as understanding exactly what the medicine is doing in her body. He wanted to understand the concept behind it: The medicine is protecting her from seizures. I like to tell parents now—after having had that experience—I’ll say, “OK, the medicine works like an umbrella. This is not how it works in real life; there are no seizure waves raining down on you from above. But imagine seizure waves raining down on your child from above. If they hit your child, she might have a seizure. So you hold up your umbrella—the medicine is your seizure umbrella. The medicine protects you from the seizure waves. As long as you’re taking the medicine, it’s harder for the seizure waves to get through and make a seizure happen. If you stop taking the medicine, that puts holes in the umbrella, and the seizure waves can get through. But sometimes, even when you’re doing things perfectly—taking the medicine exactly the way you’re supposed to—sometimes the rain gets through anyway. We’ve all been out in big storms where the rain is splashing up and getting our feet wet no matter what we do. That happens sometimes, but we’re still better off with the umbrella than without it.” People seem to appreciate that because they want to know what the medicine is doing on that conceptual level. So I picked up a bunch of “scripts” that I use for my most common conditions, and that seems to help my families understand what’s going on.
Kevin Pho: Now, how does it get back to you that patients in general aren’t understanding a lot of what their clinical staff says? Do you get surveys, feedback—how does that get back to you?
Paige Kalika: A lot of times they’ll tell me themselves. A lot of times it’s very flattering: “Oh, I never understood this before I spoke to you.” Of course, I love to hear that. But a lot of times I see it when I’m with my trainees, because I figure that the best way to learn is to do. I’ll try to model as much as I can, but then I’m like, “OK, you talk to the families. I’m here standing beside you, supporting you. I will jump in if you need me, I promise.” And I’ll see them talking, and I’ll see the expressions on the families’ and patients’ faces glazing over. They get that look—I’ve been on the other side of that look, like when I’m in a complicated calculus class: I’m not sure about these variables, I’m not sure what’s going on. You can tell. Sometimes I’ll give the trainee some time to course-correct, and other times I’ll try to slide in.
Yes, we get feedback. We have our beloved Press Ganey scores—which, again, usually these days I’m very pleased and flattered to see that people are understanding me. But when I see other people sharing them, it seems to be a common complaint. It’s so easy for us as doctors—as clinicians—to slip into the language we speak to each other, because this is an efficient language. If I say, “Oh, I see nonspecific FLAIR hyperintensities on the MRI” to another neurologist, they know what I’m talking about. But then I have to sit there and try to explain this to a parent. That sounds terrible. And then I have to say, “No, no, it’s not that bad.” But the parent says, “What does it mean?” It means “bright spots” on the brain. “Oh my God, bright spots, that’s terrible!” No, no, really, it’s nonspecific. “What does nonspecific mean?” It doesn’t really mean anything; it just means it’s kind of there, probably not bad. This language can be very intimidating, but for us, as fluent speakers, it’s so easy and so clear that it’s hard for us to remember what’s normal language or common usage and what isn’t.
Kevin Pho: Now, what are some of the root causes of why you think there is that communication disconnect? Is it simply a lack of training? Is it, as my daughter says, a skill issue? Is it time pressure? What are some of the reasons why you think that disconnect exists?
Paige Kalika: I think it’s a bit of everything. There’s always going to be some people who like to sound smart—hopefully not too many; hopefully we’re learning better than that. But, yeah, we’re in a rush. We’re hurrying, and we slip into the language that it’s easiest to explain this in. But I think a lot of it is a skill issue because we’re not taught this. We’re taught medicine, we’re taught the concepts, we’re taught how to treat. We’re even getting better at learning bedside manner. This is not exactly the same as bedside manner, although of course they’re related.
I was thinking about it recently, and I decided for myself that bedside manner is making sure that the patient feels heard, and this kind of effective communication is making sure that the patient hears you. There’s a lot of back and forth, because sometimes we’ll be speaking with patients who have a strong medical or scientific background, so we can speak a little more “medical.” But even then, we still need to be careful, because when we’re talking about our own medical issues or our children’s medical issues—even if it’s our own field—it’s hard, because we’re not processing as a clinician; we’re processing as a patient or as a parent. That’s a very different thing. This is why we don’t treat our own family members (or we shouldn’t), because we can’t relate to them on that purely clinical level in the way we need to when we practice medicine.
Kevin Pho: What are some of the tips that you give the trainees when it comes to communicating medicine in plain language?
Paige Kalika: The most important one is to stop and listen, because we tend to go off on long tangents because it’s efficient—”Let me pack all of this information into one run-on sentence.” No. Speak slowly, speak clearly, speak in shorter sentences. Think about it, respond. If you’re going to use jargon—I tell the parents this, too—I’ll say, “I’m going to say this in ‘medical’ first, and then I’m going to translate it for you.” That way, if they happen to look at that scary MRI report later, they’re not going to freak out because they’re seeing unfamiliar language. They’ll say, “Oh, she said that word and she explained it. I may not quite remember what it means, but I remember it wasn’t that bad.”
Do your best to break it down into common language, and ask for feedback. Don’t be afraid to say, “Do you understand me? I know we talked a lot. I know this was complicated and there’s a lot going on. What else do you need me to explain?” Then I also tell my families—and I tell the trainees to do this—”Let me write it down for you.” I call them my “cheat sheets.” I have cheat sheets for a lot of things, and I say, “Here, read this later, because I know as soon as you leave, half of this is going to fly out of your head. I know it happens to me. These are the important points; this is what you need to do. If it’s not clear, call me or send me a message through the patient portal—everyone loves to message me through the patient portal—and we can always go through it again.” But when it’s written down for them, it seems to help, because it prompts them, and then I’m sure everyone goes and Googles things and finds scary things, and they come to me with those scary things. But I tell them, “If you find something scary, tell me. I promise if we’re going to panic, we’ll panic together, but we’re not going to panic, because we’ll have a plan and we’ll go through it.”
Kevin Pho: Now, it sounds like this is a pretty important skill that needs to be taught better in medical school and residency. Obviously you work in an academic medical center, so are these students and residents not formally taught how to communicate in plain language? Is this something they just need to learn based on the models that they see in their clinical rotations?
Paige Kalika: I think things are changing. I know that my medical school changed the curriculum a few years back to be much more integrated, much more holistic. The medical students are going out into the clinical world much earlier. I’m getting these medical students when they’re still “babies”—what I used to call an MS1 or MS2. Before, I didn’t see med students until they were MS3s or possibly MS4s. Now these brand-new medical students are out there seeing patients. There’s a big push to have them working with patients much earlier. I think that helps, because when we spend those first two years locked in a classroom learning all of our language—learning our jargon—we forget, and we have to relearn later how to speak to actual people. This way, if they’re learning the jargon and the language as they’re actually seeing patients, they’re putting it into practice. I do think that’s helping, and I think I’m seeing a shift in my med students. I think I am.
Kevin Pho: What do you say to those busy clinicians? Everyone, of course, is time-pressured—in primary care, we have five to ten minutes to see patients, and sometimes communication is not at the top of our list of things to do. How do you advise those time-pressured physicians to still communicate clearly despite everything else they have to do in that visit?
Paige Kalika: That is so hard. I feel for everyone. This is why I’m not doing primary care—I’m not smart enough to know everything, do everything, communicate everything, and boil one entire complex human being down into a 10-minute visit, if you’re lucky to get 10 minutes. It’s hard. I would say, in your copious amounts of spare time—I know that doesn’t exist—try to make your cheat sheets. I know my most common conditions, so I was able to take some time to write it down. If you’re in primary care, you know you’re going to be seeing people with diabetes, hypertension, hyperlipidemia—all these things—over and over all day. Take a few minutes, write it up in plain language: “This is what you have, this is what’s going on, these are the most common interventions.” Again, it’s hard. I don’t know how anyone fits all of this into one tiny visit. I’m very spoiled; I usually have an hour for new patient visits. I realize what a luxury that is.
But do your best to say, “This is the 30-second summary of what’s going on. Here is what I have for you, written down. Take a look at it. If you have questions, check back in with my office. Tell me what the questions are, and either I’ll address it or hopefully, if you have good support staff, my team will assist you.” I don’t have a great answer otherwise, other than to say the system is very broken, and it’s very hard to provide appropriate care like this. I know everyone’s out there doing their best, and I hope we see some positive change soon, because we’re all feeling very, very squeezed.
Kevin Pho: We’re talking to Paige Kalika. She’s a pediatric neurologist, and today’s KevinMD article is “Learning the language of medicine from student to fluent physician.” Paige, let’s end with some take-home messages that you want to leave with the KevinMD audience.
Paige Kalika: For clinicians, do your best. It’s not going to be perfect, and that’s OK. Over time, you’ll figure out more effective ways to communicate, and it’s going to change over time. My communication strategy certainly has. I know that ten years from now, I’ll look back and think, “Wow, I wasn’t that great then, either,” but we’re evolving, we’re growing, and our patients appreciate it. So do your best with it. Don’t beat yourself up, and always leave space for your patients and their families to ask questions. Even if it’s just 30 seconds at the end of the visit, try to give them that space. They’ll remember that, even if they don’t have a question, they’ll appreciate that you gave them the opportunity.
Kevin Pho: Paige, so much for sharing your perspective and insight, and thanks again for coming on the show.
Paige Kalika: Thank you so much. It’s a pleasure to be here.