Tuesday, January 22, 2008

A word on words

She says no when she means yes
And what she wants you know that I can't guess
When we want more you know we ask for less
Such is the language of love

The late Mr. Fogelberg said quite a bit about communicating with women in "The Language of Love," and most of it rings true. We do our best to get our point across with words that are often inadequate for the task at hand, and chaos (as well as hurt feelings) can result.

The same problem can plague doctor-patient communication. The words physicians use when talking with patients and their families can be frightening, misconstrued, or simply incomprehensible. Similarly, patients often struggle with an inability to describe their symptoms in a manner that allows a physician to adequately understand their complaints. As well, there is ample evidence that much of the discussion that occurs in the physician's office is heard, but not understood --- it sort of floats in one ear and out the other.

The problem for folks on my side of the stethoscope is that there frequently are no other words we can use when talking with patients. I mean, really, say some of these things out loud and tell me they don't come off as weird, impossible, or downright dangerous:

Vein stripping --- that's gotta hurt
Myocardial infarction --- are you describing passing gas in some sort of automobile?
Aggressive debridement of a wound --- oooh, the pictures in my mind are not pretty
Incision and drainage --- ouch
Pancreatitis --- OK, "itis" as in "tonsillitis," or as in "oh my god-itis?"
Aortic aneurysm --- that's a nice, soft phrase; it can't be that bad
Dyspareunia --- as painful to say as it is in real life
Perfusion --- isn't that when you put two "pers" together?
Gangrene --- I know that one from a WWII flick! But didn't the guy die in that movie?
Babinski's reflex --- is that what happens when you get sick watching the ice skating judges award perfect scores only to Russians?
Complications --- such a, well, complicated word
Perforation ---- I bet we're not talking about the little holes in a piece of paper, are we?
Myonecrosis --- sounds like a movie with Bela Lugosi
Rigid proctoscopy --- somehow, I suspect I'm not going to like this very much
Organ of Zuckerkandl --- oh, come on now, this one has to be a joke
Hematochezia --- Gesundheit!
Pneumothorax --- didn't Dr. Seuss write about these guys?
Cholangitis --- if it wasn't for the "itis" part, this sounds like a tropical drink
Achalasia --- is that part of Indonesia?
Lymphoscintigraphy --- scintillating maps featuring nymphomaniacs?
Mediastinitis --- there you go with that whole "itis" thing again
Toxic megacolon --- I'm not sure that I want to hear "toxic" and "colon" in the same sentence

What we've got here is a failure to communicate. This list can go on and on -- Dorland's Medical Dictionary is rather long. When docs talk to each other, we throw these words around casually, because they have real meaning to us and are not some abstract idea. The difficulty for us is to figure out a way to make these words have some real meaning for patients, to ensure that they understand the situation they may be in and what they may be faced with in terms of potential complications.

While that's our goal, I can say with all honesty that it doesn't always come across that way. And as every married man can verify, that's also what happens during those little "kitchen discussions" with our wives. So, the next time you are in a doctor's office, and you think you have heard something you either don't like or don't quite get, make sure you don't act like a wife (or husband -- don't want anyone to think I'm too sexist) --- speak up, ask for clarification, and don't get too upset if we're less than perfect in our communication skills.