BlakeCharlton.com

How Doctors Speak

“Blake,” you say to me, as you are often apt to do these days, “I can’t understand a single effen thing my doctor says.”

I can sympathize.

“And it gets worse when two of you guys are talking to each other. Hard enough to understand one white coat but then another of you walks in the room. That happens, and you start talking something that sounds like Ancient Greek humping a can of alphabet soup: this patient presents with AMS, scleral injection, and hyperalimentation likely secondary to cannabinoid use. I mean, what the hell does that mean?”

It means your doctor thought you were high.

“I was, but that’s beside the point. Why couldn’t he just say it in plain English?”

You know, it’s funny you should ask that, because I was just about to write a self referential, semi-dramatic blog post about it.

“Wait, how did he know I was high?”

Are you still high?

“No. I resent that question. And why didn’t the doctor just say he thought I was high?”

Maybe he didn’t want to call you out on being a pot head. Medical jargon really is a strange dialect of English. If feeling cynical, you might argue that we speak it to exclude people from our profession and our patients from understanding. In college a sociology professor lectured us on—

“So scleral injection means getting high?”

It means you had red eyes.

“What the HELL, man. The word ‘eye’ isn’t even in that.”

You’re still pretty high, huh?

“You’re not answering the question.”

The sclera is the white part of your eye, and ‘injected’ means that the vessels were ‘injected’ full of blood and so were big and red.

“Huh.”

So, I was saying, medical jargon may have a dose of exclusion in it. All professions develop their own argot. Police officers ‘apprehend a perpetrator’ while the rest of us ‘catch the dirty mofo.’ But, in medicine at least, I think there’s a greater point to our strange language.

“So, when he said cannabinoid use, he meant I was, like, smoking cannabis?”

You’re really not helping the stereotype of Northern Californians.

“Touchy.”

Can I go on?

“Last one. What’s AMS?”

Altered Mental Status, acting intoxicated. He needed to use a vague term because he didn’t know if you were acting whack because you were high or drunk or you had just woken up form a seizure or something else weird.

“Huh, you don’t say. Anyway, so about the funny doctor talk. There’s a point to it?”

Some of its historical: when people discover something, they want to give it a new name to show how new it is. During the Renaissance, classical European languages were thought to be more precise, more scientific. So most of the knowledge that was codified back when it was fashionable for straight men to dress in tights and wigs comes from Latin and Ancient Greek. Anatomy and physiology are the best example of this (biceps brachii, hypovolemia, latissimus dorsi ) but macrostructure of tissue and cells (nucleus, nucleolus, mitochondria) and many signs, symptoms, and diseases (nausea, tuberculosis, gastritis) are also examples.

“So when the doctor said I had hyperalimentation…”

You just aren’t going to give up on that, huh?

“Is hyperalimentation, like, dangerous?”

No, man, it just means you had the munchies.

“I so had the munchies.”

If I pay you, will you let me finish my take on how doctors speak?

“What if you bought me Taco Bell?”

Anyway, it was common practice-dating all the way back to when it was necessary to chisel them onto stone-to reduce Latin phrases to acronyms (e.g. and i.e. and all that). Medicine did the same thing. So ‘Nihil Per Os’ nothing by mouth, became NPO, or ‘Pro Re Nata,’ as needed, became PRN. Now, hundreds of years after male physicians stopped wearing the aforementioned tights and wig (But I’m from San Francisco, baby, so if you’re feeling that look, I say do it big!), they no longer learned Latin and Ancient Greek. However, they could still reduce things to acronyms. So when they first discovered “Non-Steroidal Anti-Inflammatory Drugs” they became NSAIDs. “Selective Serotonin Reuptake Inhibitors” became SSRIs. And that’s just scratching the surface; the names of genes look like computer code that’s dragged across a cheese grater.

“I think Ancient Greek humping a can of alphabet soup was better.”

Maybe, but I haven’t gotten to my point about why it may be a good thing to use this language.

“So…Taco Bell is out of the question?”

I hate you.

“Whoa, no need to go all House MD on me. You can finish your point. So why should doctors speak in gobbledygook?”

Illness scripts, my friend. Illness scripts. To some extent the clinical presentation of a disease is like a play.

“A play as in, like, Hamlet?”

As in like Hamlet.

“Are _you_ high?”

No, I’m not.

“Because that would be pretty ironic if you were.”

Look, you’re the one who’s high.

“I might be, but you’re the one comparing diarrhea to Shakespeare.”

Diarrhea isn’t a disease; it’s a sign of a disease. Diarrhea isn’t like a play; it’s more like an actor who might be in many different plays. For example, it might appear in “infection of the intestines” or “excessive caffeine use.”

“To poop or not to poop, that is the question.”

Okay, feel free to never do that again.

“Whether ’tis nobler in your end to suffer the slings and arrows of outrageous feces, or take Imodium against a sea of troubles and by opposing, end them.”

You are, just, so proud of yourself right now, huh?

“Ah’yup. You may carry on now.”

Thanks so much.

“No, really, how are diseases like plays?”

So when learning about diagnosis, we learn how certain signs and symptoms tend to appear in a given set of diseases, how they progress, and when and why patients with these diseases ‘present’—which is a fancy way of saying ‘come to medical attention.’ The tricky thing is that a single disease might present any number of different ways even though they all have the same cause. In the same way, a single play might be performed in many different ways even though they all use the same script, or parts of the same script. Take Hamlet: he might look like Laurence Olivier in tights or Ethan Hawke in a business suit and ski hat with earflaps reciting the “to be or not to be” soliloquy while walking around a Blockbuster. But they’re both the same character.

“It is not humanly possible to hate Shakespeare so much as to put that soliloquy in a Blockbuster.”

No, really, look it up on YouTube.

“Aren’t you going to link to it?”

Don’t screw with the sixth wall, man. This post already has enough trouble.

“Are you sure you weren’t stoned when you came up with this analogy between drama and disease?”

Promise I wasn’t, and let me finish. So we can recognize Laurence Olivier and Ethan Hawke because we have the script for Hamlet. So we recognize the words. But imagine if we didn’t have the script, if we had to watch all the movies and then try to guess what the script might be like? That’s what diseases are to diagnosticians: productions of a play without the script. And in the clinic you have to figure out what play it is. So when creating these almost Platonic “illness scripts,” physicians were trying to recreate the script of a disease. And a disease’s script was clearly written in a language that wasn’t anything they spoke, so they tried to mash up Latin and Greek and acronyms and English all to create a language that more closely approximates the hypothetical language of disease.

“I mean, if you were stoned when you came up with—”

Bloody hell, this shit again?

“Lemme finish. If you were stoned when you came up with this disease/drama idea and then accused me of being stoned, would that be dramatic irony?”

No, Alanis, that’s not ironic, it’s just bad luck for you.

“Like rain on your wedding day?”

Bad luck.

“Like a black fly in your chardonnay?”

Unless you dedicated your life to designing a wine glass that would repel black flies and then during the IPO of your created company lifted said glass in a celebratory toast only to discover said black fly, it’s not ironic.

“Well that’s what she meant then, huh?”

GAHHHH!

“Your head turns a lovely shade of purple when you’re infuriated. But that vein that’s pulsing; that thing, kinda freaking me out.”

You know, you’re not real.

“There’s no need to be vindictive, man. I was just trying—”

No, you’re purely a figment of my imagination. And given that I can hear you even though you’re not real, this clearly means I’m experiencing a hallucination.

“Where are you going with this?”

And, I’m an author. This means I suffer from a fixed delusion that I at some point might be able to make a living writing books.

“This is not a friendly—”

And everything has been so crazy for the past week that I missed my usual blogging schedule, meaning I had disorganized behavior.

“This is really beginning to harsh my mellow, man.”

So, auditory hallucinations, fixed delusion, and disorganized behavior are three of the ‘positive symptoms’ associated with psychotic disorders.

“That can’t be a good thing to say for your self esteem, man.”

And, I’m writing out the script of our conversation. So, now, we can be clear about what you are.

“YOU’RE NOT MY FATHER. NOOOOO!”

Calm down, Luke Skywalker.* If you’re the embodiment of my psychosis then you’re the embodiment of my illness, and if you’ve been written out in script form, you are my illness script!

“So is that ironi—” *POOF ALL GONE*

Physician (or medical student) heal thyself!

*Holy shit, my spellchecker recognizes the word ‘Skywalker!’ For serious?