Language complexity differs between doctors and patients during contraceptive counseling: A mixed-method study

The purpose of this study was to assess differences in language complexity for physician and patient speech and describe differences in speech content and literacy for medical office visits related to contraception. In a cross-sectional, mixed-methods study, we invited clinic faculty, residents, and consecutive patients to participate in simulated clinical encounters. Two investigators independently transcribed the recordings of these encounters. We calculated Flesch-Kincaid Reading Level (FKRL) and Flesch Reading Ease (FRE) scores as proxy measures for language complexity related to physician and patient speech. We also performed content analysis of the office visit transcriptions. Thirty-one of 33 physicians and 51 of 61 patients participated in the study, yielding response rates of 94% and 84%, respectively. Student Independent t-tests revealed differences in language complexity for providers and patients. On average, physicians spoke at an Eighth-Grade (13 to 14 years old) reading level, while patients spoke at a Fourth-Grade (nine to ten years old) level. Physicians gave primary importance to physiologic mechanisms. Patients focused on efficacy and side effects. We interpret the findings from the theoretical perspective of language and culture as inseparable components of communication. Both language and culture communicate, but at different levels of analysis. We explore both dimensions of communication with the same data set. Although this paper is theoretically exploratory, we believe it broadens inquiry of language use in medicine for subsequent investigation.