Talk like a doctor
By Marc Ringel, MD

      Your doctor looks you in the eye and says, "You have an idiopathic erythematous axillary exanthem." You figure you're a goner. Is there time to call your lawyer about your will? Or should you get right on the horn to the funeral director? Perhaps you ought to head straight for Oregon where you can find a physician who will help you to end your life with a painless prescription.

      But what does this diagnosis really mean? Literally translated: "You have a red rash in your armpit and I don't know what caused it." You rush home to hug and kiss your spouse and kids and then take them all out to a nice restaurant to celebrate your new lease on life. The next day you call the doctor to offer thanks for reviving your spiritual perspective on the preciousness of existence.

      Right! You thank the doctor for scaring the bejesus out of you by using obscure language. Maybe so. Medical language, which is rife with Greek and Latin, conveys some of the same magic as the Latin Mass used to. Nexus readers are likely to be found chanting foreign phrases such as, "nam myoho renge kyo" or "om padme hum," taking solace in the sound of the words without keeping in mind precisely what they mean. People may be similarly soothed, and even healed, by the obscure language of medicine.

      Even though it depends a great deal on faith for its power, medicine is different from religion because medicine is also a science. So medical language can and does serve science by affording its users a higher level of precision than ordinary communication. Let's look at the concepts of above and below, for example. When referring to the body, if I say that one lesion is above another, do I mean with the patient standing, that one lesion is further from the floor than the other? Or is the patient lying down and one owie is higher off the exam table than the other? If lying, is the patient face-up, face down, or sideways? In medical language I can say that one lesion is cephalad, towards the head, to the other. On an arm or leg I can specify if the lesion is closer to the trunk, proximal, or further from it, distal. If it is towards the backside of the body, the lesion is dorsal and if towards the front, it's ventral. Even within the twisted-up intestines, I can specify if a lesion is orad, towards the mouth, or caudad, towards the anus (from Latin for tail). And so on. Medical language, properly used, can hugely reduce ambiguity.

      But what's to be gained by using the word "erythema" for red or "axilla" for armpit? Not much. Unfortunately, much of medical language serves little purpose other than to create a barrier between health professionals and lay people. There is hardly a patient in America who hasn't been baffled by a doctor's language.

I once consulted an orthopedist about my ankle, which I'd sprained badly. He x-rayed and examined me and gave me an explanation of the injury so dense with subspecialist jargon that even I, a family physician, didn't fully understand. I didn't ask the doctor to clarify his pronouncement because I was afraid he might think I was dumb. (As a side note, even though this doctor had struck me as arrogant and distant, my ankle felt a lot better after just his examination and impenetrable monologue, another demonstration of the healing power of touch, knowledge, and maybe also of mystical language.)

      Medical vocabulary is how physicians identify each other. It's sort of like the secret words that Masons use. We doctors speak our own language. Learning that language is one of the most important tasks of medical school. You have to train yourself out of saying "see" because a real doctor will "visualize." Likewise, we "palpate" rather than feel and "auscultate" instead of just plain listen to.

      Just after I started medical school I bought a medical dictionary. No matter what subject I studied, I forced myself to look up every word whose meaning I was even a little hazy about. Since I was learning a new language, I used my reference book as a medical-English dictionary, more for translation than for definition, to decode unfamiliar medical words into English ones that I understood. I appreciated that if I could get inside the language, I could get inside the profession. That same attitude had served me well when I immersed myself in the Spanish language a couple of years earlier during my junior year abroad in Spain. I left there feeling like a Spaniard.

      I can speak medical language-a clumsy, arcane mix of Greek, Latin, English, with a little German thrown in-with the best of them. I take pains to do so when I'm with a new group of doctors as we metaphorically sniff each other's butts to establish our rank in the pack. And my professional idiom can be very useful when I need to be precise, such as describing the x-ray of a fracture to an orthopedist on the phone in the middle of the night so she can help me decide if I should just splint the injured limb, attempt to realign the bony fragments myself, or refer the patient on to her.

      With patients, on the other hand, I take great pains to hold the big medical terms to a minimum. Sometimes I'll write down for them, on my magic prescription pad, multisyllabic words to go along with minor diagnoses. One of my favorites is "malassezia furfur," the fungus responsible for tinea versicolor, a benign skin infection that causes temporary spotty changes in pigmentation-a disease and a causative agent, both with much bigger names than their benign nature merits. I tell my patients (only partly in jest) that it's my command of such big words that lends me the status and income of a physician.

      When you consult a health professional you've got to do better than I did with that orthopedist. You must insist on an explanation, and as much re-explanation as necessary until the doctor strings together enough plain English words for you to understand what's happening to you. Exotic lingo may have healing power, but so does clear understanding.

      If a specialist cannot give you a grasp of what's going on, get your primary care provider to help. As a family doctor, an important part of my job is to make sure that my patients comprehend what's happening to them. I will let a consultant know that if he's not communicating well and cannot mend his ways I'll refer to someone else in that specialty who can make himself understood.

      Forcing people to communicate sounds kind of grim and serious. So as not to end this piece on a downer, I'd like to give you a brain-teaser, wholly composed of words and phrases that I have heard in my years of practice. The object is to match the medical words in column one with their English cognates in column two. There is a key to the correct answers at the bottom. You can be sure that any real doctor would get 100 percent on this test.

 

Match these phrases

Key

1-J; 2-F; 3-S; 4-L; 5-I; 6-K; 7-G; 8-C; 9-N; 10-H; 11-M; 12-B; 13-O; 14-R; 15-D; 16-E; 17-P; 18-T; 19-Q; 20-A