A few months ago, we had an opportunity for one-on-one time with standardized patients (SPs): the trained actors that are well-versed in how us medical school fledglings should and shouldn’t be performing physical exams. It was a laid-back, non-graded session wherein we could ask for advice and even have the SPs walk us through exactly what we should do. So, when it came time for the abdominal exam, I asked my SP, “Okay, is this where I auscultate before pal …”
“Ask-ull-what?! No no no, you don’t say that. I am a patient. I don’t know what that means. Why would you use words a patient doesn’t understand?”
Although I understood (and agreed with) her point completely, I was mildly irritated. In the week prior to that session, I had been corrected for listening and not auscultating. Since this exercise was part of our clinical skills course, I honestly thought I’d earn another stink-eye if I didn’t use the proper lingo again.
Fortunately, the awkwardness of that session had peaked a mere 30 seconds into it, so my poor word choice didn’t make it any worse. What it made me realize, though, was that this was going to be the first of many of the most difficult concepts to learn in medical school: the ones that won’t be found in any clinical skills session or USMLE review book.
As a former linguistics major, seasoned patient, and expert waiting room accomplice, I have always understood quite well the language barriers that exist between doctor and patient (and no, I don’t mean those that arise from thick accents). But I have to say that, even a year in, it’s exceedingly difficult to switch gears from medicalese, which is desired and arguably mandatory in the classroom and on the wards, to the language that the human beings we treat actually use.
Just the other day, without even thinking, I asked a patient at one of our free, student-run clinics if he had hypertension. Pathetically, it wasn’t until I received a look that might otherwise be elicited for me having three too many eyebrows that I thought to blurt out “high blood pressure” instead.
From a linguistics standpoint, there is a somewhat logical explanation: The sterile dialect of our long-coated superiors is not only the standard for precision and professionalism, but it’s also the language in which we learn everything. Just like how people tend to count in their first, native tongue, no matter how fluent they are in another, those in the medical field stick to the words with which they were taught medicine.
It was esoteric terminology that first disenchanted me with the study of linguistics, and here it is again, wedging itself in the growing divide between physician and patient. This hardly surprises me, though. I have access to hundreds of biochemistry practice problems, but I can only hope for plenty more brutally humbling exchanges with patients.
Granted, it does take some additional brainpower and time to generate a clear translation for patients, but aren’t we all accepted to medical school because of our (sometimes irrational) tendencies to go the extra mile, especially when it comes to helping others?
And even if our LCME-approved, “Patient as a Person” PowerPoint presentations could effectively teach us how to translate between the grammars, would anyone really listen to them? Or would we all tune out in favor of counting the number of cytokines we haven’t memorized yet?
I recognize the need for a streamlined and standardized language when diagnosing illness, but I don’t understand why we are all so quick to forget the words we learned before medical school when healing people.
After all, it is pretty silly to use such a fancy word for making sure we hear lunch sloshing around our patient’s belly.
Allison Goldberg is a medical student.
