Speaking to patients about concussions: Does our terminology impact recovery outcomes?

Issue: BCMJ, vol. 60, No. 1, January February 2018, Pages 8-10 Letters
By: Sarah Fraser, BSc Alexander D. Wright, PhD Paul van Donkelaar, PhD Jonathan D. Smirl, PhD

Perception is a subjective phenomenon and, when it comes to medical conditions, it is clear that each person has their own perception of their ailment.

Perception is a subjective phenomenon and, when it comes to medical conditions, it is clear that each person has their own perception of their ailment. Notably, the perception can be positive or negative and can have an immense impact on a patient’s adherence to treatment, recovery, and associated outcomes.[1-3] The association of a patient’s mindset with their clinical outcomes has been demonstrated in a number of conditions, including myocardial infarction, rheumatoid arthritis, type 2 diabetes mellitus, chronic kidney disease, head and neck cancer, and mild traumatic brain injury (mTBI).[1,2]

Importantly, it has been suggested that perception may be shaped by the terminology clinicians employ to describe the illness.[3] Whereas the terms concussion and mild traumatic brain injury are often used interchangeably in the medical community, the clinical appropriateness of the nomenclature continues to be debated.[4] The terms may convey altered messages to patients, and it has been argued that only concussion communicates the transient nature of impaired neurological function.[4] A negative illness perception in mTBI patients results in increased risk for persistent symptoms, and the term concussion, in contrast to mTBI, is strongly predictive of earlier hospital discharge and earlier return to school.[2,5]

Frostholm and colleagues[6] suggest that discussions with patients about their ideas of an illness could help resolve misconceptions and reduce the risk of health problems developing into chronic conditions. Despite the lack of consensus, the potential influence of terminology on patient expectations and outcomes should not be underestimated. Reiterating these concepts to medical trainees, in the context of mTBI and the conditions listed above, could be an important intervention to counteract negative illness perceptions and thus improve outcomes. 
—Sarah Fraser, BSc
MD Candidate, UBC Southern Medical Program, Class of 2019
—Alexander D. Wright, PhD 
MD Candidate, UBC Southern Medical Program, Class of 2019
—Paul van Donkelaar, PhD
School of Health and Exercise Sciences, UBC Okanagan
—Jonathan D. Smirl, PhD
School of Health and Exercise Sciences, UBC Okanagan

References

1.    Petrie KJ, Jago LA, Devcich DA. The role of illness perceptions in patients with medical conditions. Curr Opin Psychiatry 2007;20:163-167. 
2.    Whittaker R, Kemp S, House A. Illness perceptions and outcome in mild head injury: A longitudinal study. J Neurol Neurosurg Psychiatry 2007;78:644-646. 
3.    Weber M, Edwards MG. The effect of brain injury terminology on university athletes’ expected outcome from injury, familiarity and actual symptom report. Brain Inj 2010;24:1364-1371. 
4.    McCrory P. What’s in a name?? Br J Sports Med 2001;35:285-287. 
5.    Dematteo CA, Hanna SE, Mahoney WJ, et al. “My child doesn’t have a brain injury, he only has a concussion.” Pediatrics 2010;125:327-334. 
6.    Frostholm L, Fink P, Christensen KS, et al. The patients’ illness perceptions and the use of primary health care. Psychosom Med 2005;67:997-1005.

Sarah Fraser, BSc, Alexander D. Wright, PhD, Paul van Donkelaar, PhD, Jonathan D. Smirl, PhD. Speaking to patients about concussions: Does our terminology impact recovery outcomes?. BCMJ, Vol. 60, No. 1, January, February, 2018, Page(s) 8-10 - Letters.


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