Tomato or Tomahto?

We have a saying in CDI, “words matter”, and it is absolutely true.

Over the years I have learned a valuable lesson – words have different meanings dependent on setting and audience. This may seem intuitive, but I had never thought of it happening within a healthcare setting, where in my mind, we all think similarly. I will never forget what happened as a young CDS when I performed an educational session I had titled “Coding Compliance for Debridement”. I had worked diligently on my presentation to depict accuracy, especially given the audience were surgeons. I felt aptly prepared. It started out well, but about ten minutes in, took a very sharp turn! I found myself the target of some very upset physicians. I didn’t understand! I had spoken to the business administrators and the coding manager, and everyone was on the same page, or so I thought. The surgeons thought I was there to talk about coding compliance when performing debridement, when in fact I was there to talk about coding compliance when performing debridement…so…

As you have probably figured out, what the subject meant to them was vastly different than what it meant to me. This represents something called linguistic shaping. You see, the minute they heard the title, their minds thought of procedural coding, bundling payments, and professional fees. What it meant to me, however, was documentation of the procedure, facility coding and capturing the correct DRG. So why am I telling this story? Because it was the first time, I realized that words mattered more than I really understood! The words “coding” and “compliance” unlike a smile are not universal languages; and no one was smiling that day.

Cognitive scientists tell us that language can shape perception. In the land of CDI, and like many professions, we get used to our own language, and use it almost like a tribe to communicate within our circles of comfort. We know that words matter but tend to quickly forget that they are susceptible to interpretation, perception, and setting. This TedX does a great job explaining this.

The linguistic shaping of thought is a concept that we should all realize, especially when educating. When trying to convey knowledge, it is very important to take a step back and understand your audience and perhaps more importantly understand their perception of a subject. Unfortunately, I failed to become knowledgeable about this before my talk that day and lost the trust of my audience nearly immediately – which was detrimental to a positive outcome.

So next time you plan an educational session or talk, take some time to understand this concept more. Know that words we generally throw around daily, such as “coding”, “compliance”, and “audit”, have certain meanings dependent upon one’s setting and perception, and may even hold negative connotations that you may not want to convey. I sure wish I had understood this earlier in my career.

Written by: Jessica M. Vaughn, MSN, RN, CCDS, CCDS-O, CRC

Vice President, Value-Based CDI at Norwood

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