Patients Frequently Overestimate Their Comprehension of Common Mohs Micrographic Surgery Terms: A Cross-Sectional Survey

November 2021 | Volume 20 | Issue 11 | Editorials | 1252 | Copyright © November 2021

Published online October 26, 2021

Peter Chow MDa, Brett C. Neill MDb, Edward W. Seger MD MSa, Spyros M. Siscos MDa, Jace J. Rickstrew MDa, Ian Graham BSb, Anand Rajpara MDa, Thomas L.H. Hocker MDa

aDivision of Dermatology, University of Kansas Medical Center, Kansas City, KS
bUniversity of Kansas School of Medicine, Kansas City, KS

Background: Patients who understand their diagnosis and treatment are more likely to be satisfied with their care and more compliant with treatment. Dermatologic surgery is a specialized field with associated jargon that many patients may not understand.
Objective: The aim of the study was to assess patient understanding of dermatology medical terminology.
Methods: This was a single-blinded study conducted with patients 18 years and older from an academic dermatology clinic surveying patients on 12 terms that are frequently used in dermatologic surgery. Participants rated their level of confidence in their understanding of each term using a 5-point Likert scale, followed by explaining the definition of the term. 3 blinded physicians graded each participant’s definition using a 5-point scale of accuracy of understanding, designed to mimic the Likert scale.
Results: A total of 200 respondents completed the survey (96% response rate). The average term perceived understanding was 3.90 ±0.66, the average term accuracy was 3.26±0.93. Patients overestimated their understanding 44% of the time, and underestimated their knowledge 17% of the time. The terms with the lowest respondent confidence were the terms secondary intention, Mohs, and flaps. The terms with the lowest respondent accuracy was secondary intention, defect, and Mohs surgery.
Conclusion: There is a gap in knowledge in commonly used dermatologic surgery terms among patients. Certain demographics appear to be more at risk for not understanding medical jargon or overestimating their understanding of terms. Obtaining these patient demographics may help to identify patients needing additional education regarding dermatologic surgery.

J Drugs Dermatol. 2021;20(11):1252-1254. doi:10.36849/JDD.6174


Patient satisfaction and outcomes are impacted by an inability to understand medical jargon.1,2 Further, patients often don’t understand, or overestimate their understanding of dermatology terminology.3-5 Comprehension during Mohs surgery is important as patients are alert during the procedure and uncertainty may increase anxiety levels. Moreover, lack of comprehension may impact adherence to post-operative recommendations and worsen clinical outcomes.


An institutional review board-approved survey was conducted to assess patient comprehension of commonly used terms during Mohs surgery. Patients 18 and older were recruited from an academic dermatology clinic to complete a brief in-person survey which assessed comprehension of 12-terms. Each term was presented in a sentence for context. Participants rated their level of confidence in understanding each term using a 5-point Likert scale and then defined the term (5 denoted as extremely confident). Three blinded physicians graded each definition using a 5-point scale (termed “accuracy”, 5 denoted as completely accurate). Student t-tests were used to identify associations between patient confidence and physician-graded accuracy of understanding (P<0.05 considered statistically significant). Fisher exact tests were substituted when parametric assumptions could not be verified.


Two-hundred respondents completed the survey (96% response rate) with an average age of 57 ± 20 years. Sixty percent were male, 90% white (3.5% black, 3% Asian, 2% Hispanic, 1.5% other) and 62% had a college degree (Table 1). The average patient confidence in Mohs terms was 3.90 ± 0.66, the average term accuracy was 3.26±0.93. Patients overestimated their knowledge (reported a confidence score higher than the physician graded accuracy score) 44% of the time. The terms patients were least confident in included secondary intention and Mohs surgery. The terms they were least accurate with included secondary intention and defect (table 2).

College educated patients were more confident (3.98 ± 0.70 vs 3.76 ± 0.70, P<0.001) and accurate (3.34 ± 0.98 vs 3.01 ± 0.91,