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Patients' perspectives on injuries
  1. N Azam1,
  2. M Harrison2
  1. 1James Cook University Hospital, Middlesbrough, UK
  2. 2Northern Deanery, Newcastle upon Tyne, UK
  1. Correspondence to Dr M Harrison, Northern Deanery, Newcastle upon Tyne, UK; drmarkharrison{at}


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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Communication is paramount in emergency medicine; it is multi-faceted, involving components such as tone of voice, body language and terminology. Vocabulary and language used in a clinical encounter can profoundly affect the understanding a patient has of their presenting complaint. Previous studies have shown that language, the use of jargon and differing terminology can greatly affect a patient's perspective on injuries. A study by Williams et al1 showed that a doctor's choice of vocabulary affects patient satisfaction immediately after a consultation. The aim of our study was to assess the way different terms used to describe a fracture affect the understanding a patient has of that fracture. The perceived severity of the injury and how the patient expects to be treated were also recorded with a view to optimising patient understanding.


A questionnaire was used to gather information in the emergency department waiting room at James Cook University Hospital—a busy level 1 trauma centre. One hundred completed questionnaires were gathered over a 4-month period from April to July 2008 inclusive, a period of time when bony injuries are a common presentation to emergency departments throughout the country. The potential sample size included that number of patients and or relatives who completed a questionnaire during a single clinical presentation at the emergency department in the timeframe previously stated. This time period encompassed roughly 35 000 patient presentations. Inclusion criteria were all adult, English speaking patients attending the emergency department during the aforementioned dates. Exclusion criteria were children and non-English speaking patients.

Patients were asked to record their perceived severity for five different descriptions of a bony injury on a scale of 1 to 10 (1 being minimally problematic to 10 being a very serious injury):

  • A ‘crack’ in a bone

  • A break

  • A fracture

  • A hairline fracture

  • A greenstick fracture.

The study population was also asked in what way they would be expected to be treated for each description of bony injury. There were four choices on the questionnaire, listing the following options:

  • Heals on its own

  • Needs a sling

  • Needs a plaster cast

  • Needs an operation.

Responses were collected via a questionnaire. Statistical analyses using t tests and χ2 tests were utilised to present relationships between the data collected.


Figures 1–5 show the descriptions of the injuries, and the patients' perspectives of severity as well as the treatment the patients expect from such injuries.

Figure 1

‘A crack in the bone’.

Figure 4

‘A hairline fracture’.

Figure 5

‘A greenstick fracture’.

This resulted in an average severity score (mean/median) of 3.28/3 for ‘a crack in the bone’, 6.64/7 for ‘a broken bone’, 4.95/5 for ‘a fracture’, 3.58/3 for ‘a hairline fracture’ and 5.28/5 for ‘a greenstick fracture’.

Table 1 shows results of statistical analysis using a t test on the severity scores, and a χ2 test on the treatment modalities, and allows us to rank the nomenclature.

Table 1

Statistical comparison of severity


This study aimed to show the understanding and expectations for their management of patients presenting with bony injuries to the emergency department. The results show that patients' perceptions of injuries and the possible treatments differ greatly with the different descriptions of these injuries. The patient population found descriptions such as ‘a broken bone’ to be considerably more serious then descriptions such as ‘a crack in the bone’, which were thought to be considerably more benign.

Communication involves many factors of which terminology is one very important aspect. Current literature2 supports the idea that the use of medical terminology may make the consultation more formal. On the other hand the use of lay terms can make the consultation more familiar. The findings in this study show this relationship between the formal and informal. This is especially identified when the lay term of ‘a broken bone’ is used. This creates a statistically significant higher injury score than ‘a fracture’. The results show that there is a very significant difference between what doctors can potentially say and what the patient ultimately understands about the consultation. This can have a direct effect on the management the patient expects from the initial description and diagnosis.

It is important that doctors in the emergency department use terminology that is understood by the patient, as well as emphasising the potential seriousness of the injury. This study shows that patient expectation and understanding vary greatly dependent on what terminology is used. It is possibly better therefore to use informed lay terminology such as ‘a break in a bone’ rather than more formal vocabulary such ‘a fracture’ when discussing the diagnosis and treatment options in the emergency department.


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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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