(My search for a lingua franca.)
What I love about medicine is that it is, in one sense, just another culture. It is a world of operational definitions. The ability to accurately describe an injury or procedure may be likened to gaining proficiency in a language. I remember learning French and pushing myself in order to express myself — to communicate. The desire to share ideas was so great that I had to learn; not just what to say, but comment dire. We learn so much just as building blocks, to simply come to the table and be a part of the conversation. I am in pursuit of fluency. In practice, there is the need to speak to a colleague and the need to speak to a patient. One skill I felt that I was learning third year was the ability to communicate with my attending–to utilize doctor talk. On the other hand, lest we become too comfortable, there is the paramount need to communicate with the patient. “You’re getting a dobhoff because you’re not stable enough for a PEG.” Who understands that statement? The people I hang out with do (and secretly, I’m so impressed with myself that I’m finally putting some of this surgery stuff into my permanent memory). Deep sigh.
Recently, I watched a man improperly land with his foot inverted. He heard a snap or a pop and it immediately started to swell. Afterwards, he had good range of motion, could bear weight, had good dorsalis pedis/posterior tibialis pulses and had no bony tenderness. I told him a fracture was very unlikely. I also told him that I thought a rupture of a ligament or tendon was highly likely because of the things I described previously and the immediacy of the swelling he experienced. He looked at me and said, “When I hear the word ‘rupture’ I think of bombs blowing up.” I thanked him for the feedback — yes, I used the word feedback. In my mind, many words presented themselves as options — avulsed, torn, and ripped. I think I said something about the grades of ankle sprains i.e. the distinguishing factors between merely stretching a ligament, partially tearing it, and fully (I so want to say rupture again) tearing the ligament. Why does “rupture” seem like the perfect word to me, but such a horrible word to him? I’ve been in doctor land a long time I guess.
Is there a middle space?
Is there a medical language that has the precision of doctor language and the ubiquity of a pop song? The pop song reference was not chosen to suggest “annoyingly everywhere;” I chose it to suggest something readily accessible to the public and neatly fitting into the public’s schema. It should be a language that uses tangible images so that we can make meaning together — with ease. I’m afraid such a language does not exist.
All of this turns my thoughts to the very definition of a professional. The term professional denotes a person who corners the market on a certain service or knowledge base. That is why there is credentialing. What if I wake up tomorrow and say, “I feel legal today. I’m going to open up a shop and take clients to defend their rights”? Hopefully only a small group would be fooled and quickly some governing body would stop me. There are exams and licensing bodies. All of this so that I can wave a paper and say I have a certain kind of knowledge — I’ve proved it by devoting myself to study, passing these tests. You can trust me to perform said skill. I have rights and responsibilities. But I digress.
There is a quote, attributed to Einstein, that says if you cannot describe it simply you do not understand it well enough.
I ardently desire this skill.
I still remember my cardiologist, Dr. Towne, taking a picture of a heart off his wall and marking on it with his pen to explain Wolf-Parkinson-White to the sixth grade version of me. I’m no electrophysiologist, but his explanation of atrioventricular reciprocating tachycardia still sticks with me. Instead of drowning in details, I want to have a command of pathophysiology, pharmacology, plan, and prognosis. One day.