language barriers

Monday, January 28, 2013

Only after watching the Pro Bowl can one appreciate the speed, power and violence of a regular NFL game.  Playoff games showcase the teamwork that is required to win a championship, but it is the preseason where individual passion is seen, not only for the love of the game but also to secure a spot on the roster. Preseason action is more ragged because of lack of communication. Players and coaches learn new systems, languages and playbooks. The Pro Bowl has the same affliction with players and coaches from a dozen different teams trying to learn to speak others’ dialect. Language barriers are a real issue in medicine as well, with each specialty having its own terminology and slang, making communication a constant issue.

It takes the first years of medical school to learn the basic language of anatomy, physiology (normal body function) and pathology (when stuff goes wrong). Becoming fluent in medical speak requires time at the bedside, talking with patients, examining them and then translating the findings into the appropriate language.

Knowing how to speak orthopedics and describe a fracture on an x-ray can help the orthopod visualize what the bones look like and whether a break can be treated by casting or by an operation. Open v. closed (used to be called compound v. simple)? Displaced v. anatomic? And if displaced, is it angulated, deviated, rotated, and shortened? And of course, the relationships of the bone parts need to be described. There is no front/ back in medicine, but there is anterior/posterior or ventral/dorsal…same thing but different words. Hands and feet sometimes use different descriptive words, not to be difficult but because descriptions begin with the anatomic position, imagine the Vitruvian man. Explaining where the thumb and little finger are is easier if you use bone references instead of medial (inner) or lateral (outer).

Neurologists have a language all their own as descriptors for things that can go wrong with the brain, spinal cord and peripheral nerves. They are physicians who are elegant when it comes to the minutiae of the physical exam, trying to decide if the exam is consistent with a structural problem in the brain, like a stroke, or a functional one, like a migraine. Functional is a bad word though. The real world would think it to mean that there is a problem with the function of a body part, but psychiatrists use the word to mean that the cause of symptoms is psychogenic, or all in the mind.

General surgeons have their own slang and much of it has to do with deciding whether a patient has a surgical abdomen, meaning that a condition exists that needs an operation. Should there be inflammation within the abdomen, guarding may be found, describing the tensing of abdominal wall muscles when the abdomen is palpated (felt or in the south, mashed on). Guarding may be voluntary, the patient thinks it will hurt so tenses the muscles in anticipation of pain, or involuntary, where the muscles reflexively tense themselves because of the underlying inflammation. Rebound tenderness occurs when the peritoneum, the sac that contains the abdominal organs becomes inflamed. Pressing on the abdomen and then quickly releasing the pressure, causes intense pain because of peritonitis. Patients can give clues whether they have rebound by complaining that bumps in the road while driving to the hospital caused pain…same mechanism, the peritoneum was shaken. Calling a surgeon and describing involuntary guarding and rebound usually means that surgeon will be making a trip to the bedside to decide if an operation is needed urgently or emergently.

And how can we forget ophthalmologists who write in hieroglyphics to described eyes and follow each term with numbers decipherable only to them. Only they could develop words like hordeolum, chalazion, xanthelasma, pinguecula and pterygium to confuse and confound medical students, interns and non-ophthalmology doctors.

The lesson to be learned is that all doctors don’t speak the same language. When a family doctor calls a specialist to ask for help, the language of the specialist needs to be used and it often requires a trip to the anatomy book or dictionary to translate the patient’s situation to a colleague who isn’t in the same room. Common terminology allows everybody to use the same playbook and deliver quality care. Mistakes can happen when doctors don’t understand each other and just like in football, enough mistakes and suddenly your spot on the roster is gone.

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