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Jack Smith

The language has been so doctored it has become the disease of the medical profession

March 21, 1985|JACK SMITH

Two thousand years ago Hippocrates wrote:

"Those things which are sacred are to be imparted only to sacred persons; and it is not lawful to impart them to the profane until they have been initiated in the mysteries of the science."

And ever since then doctors have been talking in tongues, excluding their patients from their diagnoses with a sacred language rooted in Greek and Latin.

In a recent issue of Verbatim, the Language Quarterly, Dr. Stephen E. Hirschberg enlightens us on this: "The theory here is that a polysyllabic, preferably Greek-rooted diagnosis will flabbergast the patient and deter embarrassing follow-up inquiries. 'Mea culpa' is not in the doctor's vocabulary; rather, 'Your illness is aitrogenic,' induced by a physician; or 'It is a nosocomial infection,' acquired during hospitalization.

"Similarly, loath to concede his imperfection, the doctor rarely says, 'God knows.' Diseases are not of unknown cause. They are 'idiopathic,' 'agnogenic,' 'essential,' or 'cryptogenic.' Your doctor may declare, for example, 'You may have idiopathic (we don't know why) thrombocytopenic (but you're short of platelets) purpura (and you have purple blotches from bleeding into your skin and mucous membranes.)' This sort of name sounds erudite, and the sufferer may find it somehow reassuring that his ailment at least has an imposing title, albeit no known cause and perhaps no cure."

Of course most of us have been doctored enough to know that a skinned knee is an abrasion, contusion or ecchymosis; heartburn is pyrosis, boils are furuncles, and an itching is pruritus. The common cold is acute rhinitis with rhinorrhea (runny nose), sternutation (sneezing), cephalagia (headache) and pyprexia (fever).

Hirschberg concedes that there are some "perfect" medical words--words that express concisely and unambiguously symptoms that are well-known to patients but describable only in long vernacular phrases. Borborygmi , for example, is "the audible rumbling or gurgling sounds produced by movement of gas in the digestive tract"; knismogenic , "causing tickling"; paresthesia , "a tingling, pins and needles feeling"; formication , "the sensation of ants crawling on the skin."

Evidently this disease of the medical profession (sesquipedalian loghorrhea) is much worse in the colonies than in mother England. Writing in the distinguished British medical journal, the Lancet, A. S. D. Spiers of the Department of Medicine, Albany Medical College, Albany, N.Y., notes that the differences between British and American English are multiplying, in and out of the medical field.

"It is not widely known that the rules of correct English usage are virtually identical in the U.S. and the U.K. The idea that there are major differences in correct usage has arisen because in the U.S. there is very little respect for the rules, probably as a result of the (now declining) liberality of the educational system. It is permissible to write correct English but the writer should be aware that this will always identify him as a foreigner."

The gap is especially noticeable in medicine, he says, where American doctors seem much more inclined to isolate themselves from the generality of citizens by the use of an arcane jargon.

"In the U.S., sick patients are deaphoretic, vasoconstricted, tachycardic, and have decreased mentation; when they are better, they ambulate. To suggest that they might be sweaty, pale, with a fast pulse and confusion, and able to walk when improved, is almost considered professional misconduct. Indeed, a student may be corrected for saying 'bruise' instead of ecchymosis or 'yellow' instead of xanthochromic. A senior individual may not be openly corrected but is sure to be thought a crude fellow for using such basic terms. . . ."

Spiers notes that the euphemism is much employed by American doctors--not so much to ease the impact of facts on the patient as on the doctor himself.

"It began in a small way; patients expired and nobody ever died." Much progress has been made since; a patient who abuses the doctor is "adopting an adversarial relationship." The best example comes from a government document in which, after careful research, it could be shown that "adverse patient outcome" meant death.

Spiers observes that this tendency of elite or ruling classes to talk in tongues has always been a part of their isolation and mystique. "The Normans seldom communicated in Saxon. The U.S. Government rarely communicates in English. Examples are myriad, but the one I like best is 'portable reusable hand-held inscribing device.' This is Pentagonspeak for 'pencil.' "

Spiers notes certain aberrations in the American language generally, not only in medicine; for example, the proliferation of the apostrophe, which turns up in signs offering to sell tomatoe's and potatoe's, and in patients with renal stone's; also the demise of the adverb, one example being that nothing is ever done regularly anymore, only on a regular basis.

I can't blame doctors for using jargon in their charts and papers; in their conversations among themselves; so do football coaches; why waste time making everything elementary when you're talking to enlightened colleagues. Shortcuts save time and eliminate ambiguity.

But sometimes patients need translations.

After my recent life-saving stay at the County-USC Medical Center, I got hold of a copy of my charts. Understandably, they were written mostly in abbreviations; but with the help of my daughter-in-law, a registered physical therapist, I figured most of them out. One word puzzled me.

It said that after I came up from emergency to intensive care, I was cold, pale, clammy and had no pulse. Also, it said, I was cyanotic.

"Cyanotic," I asked her. "What's that?"

"Blue," she said. "It means you were blue."

Wouldn't you rather be blue than cyanotic?

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