Thinking about the Medical Language

It has been just about a week since I returned from Telluride to Boston. Although the altitude change is welcome, the excitement of the conference is still keeping me awake at night. One such topic is the power and impact of our medical language. We heard a powerful story about the impact of a casual word thrown into a patient’s chart and how that created an anchoring bias that ultimately cost a child’s life — unnecessarily. That story was profound, but I’ll focus on this one aspect of it now. What struck me is my own transformation over the past year. As I’ve really become immersed in the world of medicine — because intern year is nothing if not an “immersion” experience– the language I think in has fundamentally changed. Most of my day is spent either talking about patients to other providers in Medicalese or documenting in the same tongue. So now I think in this strange language, a mix of acronyms with explicit detail. The lines do get blurry though. I’ve been thinking in particular about how many normal colloquial words — like anxious, delusional, confused — have a distinct meaning in medicine. When my patient’s nurse tells me that he is confused, it doesn’t mean he isn’t understanding something and needs clarity. It doesn’t mean that there is a misunderstanding. It means he is not thinking straight because of underlying illness. This gets interesting and tricky when we translate medical English to colloquial English. What is worrisome, however, is when we are flippant with these words. I hadn’t realized the impact that the language I use can have on patients, families, and ultimately the course of a patient’s care. For example, during transitions of care — handoffs between inpatient providers in particular — the new team has a strong inclination to believe what the old team says in their signout. A casual word in that signout — such as “anxious” when you mean that the patient is fearful, or “confused” when you mean that the patient is unaware of the treatment plan, or “delusional” when the patient might just be hopeful — can have an intense impact on the new team’s perception of that patient. We should be aware of the impact of our language but also more clearly train our students about the potency of what we write in a chart.

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