“Immune system” is not for everyone

blog blocksI read a post this week from a group that disseminates a range of information about Health Literacy, Communicate Health.  On their website they state that they’re “dedicated to designing better health information.”  They say they have a “crush” on health literacy.

This week they blogged about  “How to Explain the Immune System”. Since I’m always on the prowl for innovative ways to write and illustrate complex health and science, I dove right in.

The blog essentially states that if a reader/patient isn’t in a situation to really need to know the term “immune system” then just don’t use the term.

So, instead of this:

The medicine you get during chemotherapy can weaken your immune system (the system that helps your body fight infections). When your immune system is weak, you’re more likely to get sick — and it can take longer for you to get better. 

You could write this:

During chemotherapy, your loved one is more likely to get sick — and it can take longer for them to get better. 

The bottom line: Teach the term “immune system” to readers who will be hearing it often and skip it with those who won’t. 

switchboard operator


Dear Communicate Health Blogger, 

Are you really saying you advise that we should decide what readers need and when we can,  use only words/language that people already know?

Is it that the big words are hard to say?  Take up too much line space?  Expendable? TMI?

If this is true, it doesn’t seem like a big leap from deciding to leave out the technical words, especially for poorer readers.  They would get the “dumbed down” version of health, science and how their bodies work, while the rest of us would continue to, well…become smarter, know and understand more. Perhaps even be healthier?

As a linguist and reading expert, I really don’t know of any sound human language development, cognition or reading theories that would support your advice. Even at the earliest ages and stages readers/listeners are faced with words they don’t know – they employ the universal strategies of skipping and guessing. We’re pretty hard wired for this kind of thinking. In fact it’s one of the main ways we learn.

And, just checking again, are you really saying that the developer of the health material decides what the audience needs to know?  Isn’t that so very 20th century – don’t you think?

If we followed your guidance, I simply can’t think of how we’d ever foster and achieve more equitable access to knowledge and the information commons in our society.







3 replies
  1. Juan Lopez
    Juan Lopez says:

    I agree with Jessica in that there are situations where using ‘doctorspeak’ may do more harm than good, particularly in the scenario she presented where a Chinese-born elderly woman may have died as a consequence of not fully understanding her discharge instructions. I also, however, agree with a lot of what Chris is arguing for in the piece, because I think that there is no better way to ‘educate’ than to ‘immerse’ the audience. I personally believe that, at least among those who speak the language, the medical information administered should never be dumbed down for certain groups. If the very same medical community that fights against poor health literacy is the one that is propagating it, then we will never get anywhere in turning those numbers around.

  2. Jessica Llamozas
    Jessica Llamozas says:

    As a nurse, I may have to agree with some of the advice that Communicate Health is offering although they used a terrible example.

    I realize that we have to assess our audience and understand their health literacy level before explaining health information. In the ER people come in with complaints of chest pain everyday. When someone comes in with chest pain we immediately do an electrocardiogram (EKG) and check a troponin. Troponin is a protein released when there is cardiac damage.
    So when a patient comes in with chest pain I assess their level of health literacy before explaining the procedures. I have to admit I do dumb down the information if I don’t think they need (or want) to understand it. Are they at an age or have risk factors for a heart attack? If so then I need to explain the procedures and use medical terms. What if they are a healthy 27 year old or an 85 year old with dementia. Why say EKG or electrocardiogram when that might confuse or scare them? Instead I say we are going to take a picture of your heart and we are going to check blood work to make sure you are not having a heart attack.

    Everyday I am astonished by the questions I get asked by my patients and their family members and how little knowledge of basic health some of them have. As a health professional I have to know when I can (and have to) dumb down the information and when I have to really step in and educate. And what is more important that I teach them the medical terms or that they fully understand the concept? I believe that if I can do a good job at teaching the concepts they are more likely to stay healthy.

    I will never forget a patient I had when I worked on the oncology unit. She was a newly diagnosed mandarin speaking Chinese woman that had been receiving treatment with us for about a month. I remember the day she was being discharged she was so happy to finally go home. I remember spending hours going through discharge instructions using a phone interpreter and an in person interpreter. I went over all of her medication, explained neutropenia, how the treatment was going to make her extremely vulnerable to infections, the importance of follow up, situations and foods to avoid etc. During discharge I took the time to explain everything to her and she said she understood. A month and a half later she acquired an infection that brought her back to the hospital and she passed. How did my colleagues and I fail her in teaching her about her disease and risks? Did we get too caught up with medical terms? Did we focus too much on trying to explain neutropenia and white blood cells when instead we should have been more straightforward? If we left out saying “your white blood cells are low and cannot fight infection right now” and said, “if you do X you will die” would we have been more successful with our teaching?

    • Nevila Bardhi
      Nevila Bardhi says:

      You bring up a good point about communication needing to be simpler Jessica. This is especially true in the medical/nursing practice. However, with what I grasped from the info Chris provided, the Communicate Health was referring to simplifying written material for readers and patients. As we all know when something is written, it suddenly becomes “official” engraved in a record that might never cease to exist. Therefore, using simplistic language would simply be impossible. When it comes to health, we rely on experts ie. PHD and MD’s to be credible sources (besides using YouTube and Google) but by using the actual terms in writing we are actually educating the public to understand more because we might compel them to look up a term or refer to a dictionary (as Chris suggests). I am not talking about going straight to the physiology of things and confuse our public with troponin, epinephrine etc. but simple terms like immune system, infection and hygiene are in my opinion, necessary to communicate effectively. The case you described is very sad, and I feel sorry, but written communication sometimes if it is simpler, it would be unnecessary to be written in the first place.
      Thanks for your comments.
      P.S Perhaps the interpreters did not do a good job in transmitting what you told them too (spoken communication can be tricky)

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