Reflections on the Vocabulary of Medicine

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What I noticed the First Time I Saw Patients on Rounds as a Medical Student

MFisch.BayArea_clinic.jpgOn a rainy weekend, I spent a few minutes looking through an old photo album with my kids. Tucked away in a folder within one album were letters that I shared with my parents during medical school. My mom, who died of lung cancer in 2006, had saved these letters.

One letter was written to a wonderful physician and mentor who allowed me to go on infectious disease rounds with him on a Saturday morning for the very first time, during my first month in medical school when everything was about book learning. I found a "thank you" letter to my mentor, Dr. Barry Farr, dated Oct. 27, 1986. In the second paragraph of my letter, I wrote:

I want to share with you some of the things that I learned on Saturday that I otherwise would not have known. I think that this may be interesting for you because it seems that physicians (and other medical students) do not always remember exactly what they did and didn't know when they were first-year students.

In the ensuing paragraphs, I listed seven categories of my observations. Topic six was about vocabulary:

I realized that my ability to understand what was going on hinged on my familiarity with the vocabulary. One way to categorize the vocabulary might be as follows:
a) Anatomical vocabulary (i.e. fourth metatarsal)
b) Vocabulary of disease (i.e. osteomyelitis)
c) Vocabulary of clinical medicine (i.e. nosocomial, iatrogenic)
d) Current jargon (i.e. "LCM," "PTC")

As you may recall, I think that one of Yogi Berra's quotes may apply here (if adapted to medicine). He said something to the effect that "Half of baseball is 50% mental." This can be adapted to read "Half of medicine is 50% vocabulary."

The following week after finding this old letter, a colleague, Dr. Daniel Epner, shared with me his correspondence with Dr. John Mendelsohn, M. D. Anderson's president, regarding his reflections on health care reform. Dr. Epner wrote:

... Many challenges that we face on a daily basis that we think of as biomedical, technical or logistical issues are essentially communication issues. For instance, I hypothesize that we can improve care tremendously and avoid uncomfortable and futile interventions at the end of life by implementing improved communication protocols and procedures that focus on discussions of goals of care throughout the spectrum of illness. ...

The key point from Dr. Epner is the focus on goals of care and attention to the topic of physician-patient communication. Nevertheless, the vocabulary of medicine itself is one part of the challenge in communication, and it is all too easy to forget when we, in health care, didn't understand all of these words (as I noted to Dr. Farr after my very first rounds).

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