Patient Information vs Healthcare Provider Information: How Label Differences Affect Your Care

  • Home
  • Patient Information vs Healthcare Provider Information: How Label Differences Affect Your Care
Patient Information vs Healthcare Provider Information: How Label Differences Affect Your Care
16 December 2025

Medical Code Translator

Understand Your Medical Terms

Enter a medical code or term you've seen in your records to get a plain-language explanation.

Examples: E11.9, ICD-10, hypertension, diabetes, heart attack

Enter a medical code or term to see the translation

Common Medical Terms

E11.9 - Type 2 Diabetes Mellitus
Hypertension - High Blood Pressure
Hypothyroidism - Underactive Thyroid
DVT - Deep Vein Thrombosis

Why Your Doctor’s Notes Don’t Sound Like You

You walk out of the doctor’s office with a piece of paper that says "Type 2 Diabetes Mellitus, E11.9". You nod, smile, and try to remember what that means. Later, you look it up online and feel confused-or worse, guilty. You didn’t know "E11.9" wasn’t a diagnosis you failed. It’s just a code. But your doctor didn’t say that.

Meanwhile, your doctor wrote down "poorly controlled DM" because that’s what the system asks for. They didn’t mean to make you feel like you’re failing. They just used the language their training and software require. This gap isn’t a mistake. It’s a system design flaw-one that affects millions of patients every year.

The Two Languages of Health

Healthcare providers speak in codes. Patients speak in feelings.

Doctors use ICD-10 codes-over 70,000 of them-to classify diseases. They use CPT codes to bill for procedures. These are standardized, precise, and required by Medicare, insurance companies, and electronic health records like Epic and Cerner. But none of those codes tell you what it feels like to wake up tired every day, to be constantly thirsty, or to fear your next blood test.

Patients? They say things like:

  • "I feel like I’m dragging through molasses."
  • "My legs hurt when I walk, but I don’t know why."
  • "I take the white pill twice a day, but it makes me sick."

These aren’t vague complaints. They’re vital clues. But when they’re not translated into the system’s language, they get lost-or worse, ignored.

What Happens When Labels Don’t Match

A 2019 study in the Journal of General Internal Medicine found that 68% of patients didn’t understand common medical terms. Here’s what they got wrong:

  • 42% thought "hypertension" meant something other than high blood pressure.
  • 61% didn’t know "colitis" meant inflammation of the colon.
  • One patient thought "anemia" meant "I’m weak"-not that their blood couldn’t carry enough oxygen.

And it’s not just confusion. It’s fear. On PatientsLikeMe, a user named "DiabetesWarrior42" wrote: "My doctor wrote ‘poorly controlled DM’ in my chart. I thought it meant I was a bad person."

That’s not just a misunderstanding. That’s trauma. And it’s common.

According to the American Medical Association’s 2022 survey, 57% of patients felt confused by the terms in their medical records. And 32% said they avoided follow-up care because they didn’t understand what was written.

Doctor types codes on screen while translucent patient holds handwritten symptom note in warm light.

Why Providers Use This Language

Doctors aren’t trying to confuse you. They’re trapped in a system built for billing, not clarity.

Electronic health records (EHRs) were designed to make insurance claims faster and reduce paperwork. They’re optimized for efficiency, not empathy. When a doctor types "E11.9," they’re not being cold-they’re checking a box that keeps the clinic paid and the system running.

And time? There’s never enough of it. The average visit lasts just 15.7 minutes, according to the 2022 MGMA DataDive report. That’s not enough to explain ICD-10 codes, answer questions, and still document everything the system demands.

So providers use shorthand. And patients pay the price.

Who’s Trying to Fix This?

Some people are fighting to change this.

Health Information Management (HIM) professionals-certified by AHIMA-work behind the scenes to make sure your records are accurate, complete, and private. But they’re also learning to bridge the gap. They’re trained to translate clinical jargon into plain language.

Hospitals like Kaiser Permanente and Mayo Clinic started something called "Open Notes." It lets patients read their doctors’ notes right after the visit. At first, many doctors were nervous. What if patients panicked? What if they misinterpreted?

The results? A 27% drop in patient confusion. A 19% increase in people taking their meds correctly. And fewer angry calls to the front desk.

Mayo Clinic went further. They built EHR templates that automatically turn "myocardial infarction" into "heart attack" in patient-facing documents. Their pilot program cut patient confusion by 38%.

What’s Changing Now

The rules are finally catching up to reality.

In 2016, the 21st Century Cures Act said: "Patients have the right to see their own medical records." By April 2021, every provider had to give you access-no editing, no hiding. Today, 89% of U.S. hospitals let you read your notes. That’s up from just 15% in 2010.

And the World Health Organization’s ICD-11, launched in 2022, is the first major classification system to include patient-friendly descriptions alongside clinical codes. For example, "F32.0 - Mild depressive episode" now comes with a plain-language note: "You may feel sad, lose interest in things, and have trouble sleeping."

Meanwhile, the HL7 FHIR standard-used by 78% of major U.S. health systems-is letting EHRs show two versions of the same note: one for doctors, one for patients. Think of it like a split-screen: clinical terms on the left, plain language on the right.

Even AI is stepping in. Google’s Med-PaLM 2 can convert clinical notes into patient-friendly language with 72.3% accuracy. It’s not perfect yet-but it’s getting closer.

Split-screen: clinical term on left, plain language 'heart attack' on right, patient and doctor connect in sunlight.

What You Can Do Right Now

You don’t have to wait for the system to fix itself. Here’s how to take control:

  1. Ask for plain language. After your doctor says "hypertension," say: "Can you explain that in words I can understand?" Most will be happy to help.
  2. Use the teach-back method. After they explain something, say: "So, just to make sure I got it-this means I need to ______, right?" This cuts miscommunication by 45%, according to a JAMA study.
  3. Read your notes. If your provider uses MyChart or another portal, log in after your visit. Don’t skip it. You’ll spot errors, misunderstandings, or missing details.
  4. Ask for a copy of your record. You have the legal right to it. If they say no, ask to speak to the HIM department. They’re the ones who manage your records.
  5. Write down your symptoms in your own words. Bring this to your appointment: "I feel dizzy after eating," not "I have orthostatic hypotension." Let them translate it.

What This Means for Your Health

This isn’t just about words. It’s about trust.

When you understand your diagnosis, you’re more likely to take your medicine. You’re more likely to show up for follow-ups. You’re less likely to panic when you see a strange term in your chart.

And when providers start seeing you as a person-not just a code-they’re better at helping you. Studies show that when patients feel heard, their outcomes improve. Blood pressure drops. Blood sugar stabilizes. Hospital visits go down.

The gap between patient and provider language isn’t going away overnight. But it’s shrinking. And you have more power than you think to close it.

What’s Next

By 2027, experts predict 60% of electronic health records will automatically translate clinical terms into plain language. That’s huge. But it won’t replace the human conversation. It will just make it easier.

The goal isn’t to make doctors stop using codes. It’s to make sure you understand what those codes mean. Because your health isn’t a code. It’s your life.

Why do doctors use medical codes instead of plain language?

Doctors use medical codes because they’re required by insurance companies, Medicare, and electronic health record systems for billing and legal documentation. These codes (like ICD-10 and CPT) are standardized so every provider, hospital, and insurer uses the same language. But they’re not meant for patients. They’re meant for systems.

Can I ask my doctor to explain my diagnosis in simple terms?

Yes, absolutely. You have the right to understand your health. Say something like, "I want to make sure I understand this correctly-can you explain it like I’m not a doctor?" Most providers appreciate the question and will take the time to clarify.

What should I do if I don’t understand my medical records?

Don’t guess. Don’t ignore it. Call your provider’s office and ask to speak with a health information manager or patient educator. Many clinics have staff trained to help patients understand their records. You can also request a copy of your record and bring it to a second opinion visit.

Are patient-friendly notes becoming standard?

Yes, and fast. Thanks to the 21st Century Cures Act and tools like OpenNotes, most U.S. hospitals now let patients read their clinical notes. Many are now adding plain-language translations automatically. Kaiser Permanente, Mayo Clinic, and others have already done it-and seen better outcomes.

How does this affect my treatment?

When you understand your diagnosis and treatment plan, you’re more likely to follow it. Studies show patients who understand their records take their medications correctly, show up for appointments, and report fewer side effects. Misunderstanding medical terms is one of the top reasons for treatment failure.

Is it okay to write down my symptoms before my appointment?

Yes-it’s one of the best things you can do. Write down how you feel in your own words: "I get dizzy after standing," not "I have orthostatic hypotension." This helps your doctor connect your experience to the right medical term. It saves time and reduces mistakes.

Prasham Sheth

Prasham Sheth

As a pharmaceutical expert, I have dedicated my life to researching and developing new medications to combat various diseases. With a passion for writing, I enjoy sharing my knowledge and insights about medication and its impact on people's health. Through my articles and publications, I strive to raise awareness about the importance of proper medication management and the latest advancements in pharmaceuticals. My goal is to empower patients and healthcare professionals alike, helping them make informed decisions for a healthier future.

View all posts

1 Comments

Linda Caldwell

Linda Caldwell

16 December 2025 - 17:28 PM

I used to panic every time I saw a code in my chart. Then I started asking my doc to translate. Now I feel like I’m actually in charge of my health. 🙌

Write a comment