4 minute read
Mind Your Language: The Need for Precision in the Vernacular of Medicine
Richard J. Cunningham, MD
I’m sure many of us during our long and arduous training have been told we have a true “doctor’s handwriting” when others catch a glimpse of our rushed and indecipherable script. While the electronic medical record has made the notoriously illegible penmanship of physicians less relevant than in years past, I ponder why what we write has not received as much scrutiny as how we write it.
From our early years memorizing the mind-numbing details of the electron transport train and Krebs cycle to the many hours reviewing signs, symptoms, and differentials, the humanities have often suffered at the expense of medical education and the way doctors distort, contort, and at times abuse the English language is perhaps the best example of this. “To endorse” is defined by the American Heritage dictionary as, “To express approval of or give support to, especially by public statement.” If so, why would any patient ever “endorse nausea and vomiting?” Yet, many of my colleagues use this word daily when relaying that a patient replies in the affirmative to a myriad of questions; “The patient endorses chest pain, headache, history of hypertension, drug use, etc.” (I myself was at one time guilty of the exact same transgression). That is just the tip of the iceberg. “Room air” is redundant as the FiO2 inside or outside a room is exactly the same. I’ve been reprimanded on ICU rounds for presenting: “Cardiovascularly, the patient is hemodynamically stable.” Cardiovascularly? What Frankenstein have I created? Though I often employ the old adage “the patient is a poor historian”
myself, let’s not forget that a historian is a compiler or writer of a chronicle. Does that make us the poor historians? Finally, I’m sure we all as emergency physicians can agree that the emergency department was never just an “emergency room.” I personally find some of the ways we physicians bend and twist our malleable language as infinitely charming. “Bolus” is not a verb, but the phrase “Bolus ‘em with X, Y, Z!” rolls off the tongue like no other. I enjoy saying, “He’s satting in the 80s” the same way I enjoy casually replying, “I’m doing pretty good.” I know both are wrong, but some of the fun of language comes from its flexibility. Though grammatically abhorrent, colloquially these loose applications of the rules of English bind us together and make a heavy job a little lighter. One misapplication of the English language in medicine however, has come from outside our own. The term “Provider” has insidiously crept into the mainstream language of health care. Invented by bureaucrats, applied by administrators, and passively accepted by many, the term implies that we as physicians “provide” our patients a service. If so, does that make a patient the consumer? Or, perhaps worse, a customer? At a particular community hospital I spend time at in my residency, the screensaver on every computer lists the non-profit health systems company values, among them is “customer-obsessed.” Medicine may indeed be at times more art than science, but should it be a business?
To call us “providers” also blurs the distinction between physicians and other health care professionals. While I personally know and enjoy working with many non-physician practitioners, to label us all as “providers” implies a false-equivalency and ignores the vast gap in education and training between us. Language matters. To ignore such is to ignore reality.
References
1. https://www.ahdictionary.com/word/search.html?q=endorse 2. https://www.aaemrsa.org/current-news/infographic-what-it-takes-to-makea-doctor
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