The Keyword Effect: A Grounded Theory Study Exploring the Role of Keywords in Clinical Communication

Objectives: Keywords, also known as “buzzwords” or “trigger words,” serve as memorable descriptors to associate physical findings with specific diagnoses. These terms, such as “target lesion” and “steeple sign,” liken a physical or radiographic finding to a nonmedical comparator as a means to elicit an associated diagnosis. Keywords permeate medical literature and clinical conversations. However, the potential for miscommunicating critical information exists and the impact of keywords on communication-related medical error is unknown. We explored the use of keywords and how physicians perceive their use in their clinical communication as part of patient care. Methods: With a grounded theory approach, semistructured interviews were completed in 2016 to 2017 with a purposive sample of 15 resident and attending physicians working in one pediatric emergency department, where clinical conversations occur frequently between providers of different specialties and levels of training. Constant comparative analysis for emergent themes was conducted. We identified key themes and examined their relationships to theorize how keywords affect clinical communication. Results: We identified three major aspects: 1) keywords belong to the culture of medicine, by which providers connect with each other using specialized terms that imply a shared experience and knowledge base. This culture encourages keyword use. 2) By encapsulating a pattern of clinical findings into one word or short phrases, keywords allow for convenient, efficient communication of both diagnoses and of thought processes between providers. 3) Keywords, however, may mislead; if incorrectly applied to a given clinical situation, they may be misinterpreted by the receiver, or they may introduce bias to diagnostic decision making. Conclusions: More than simple descriptors, keywords can communicate entire diagnoses and activate illness scripts between providers. Also, keywords are integral to the culture and language of medicine. However, providers should be aware of the potential negative effects of keywords in clinical conversations and must balance the demands of efficient and accurate communication with the potential for miscommunication and error.