A few weeks ago, I was describing my team’s discharge plan to the patient I had been following all week. We had found an anterior mediastinal mass on imaging, and the pulmonologist wanted to follow-up in a week after immunohistological staining came back. I told him we felt he was now stable, and that we would like him to follow up with the lung doctor as an outpatient within the week.
He asked me if he should return to the ER to get his appointment.
Noooo, I told him, the ER was the last place I wanted him to revisit. It was two days prior, utterly short of breath and with a lung full of fluid that he had barely walked into the ER before he was admitted to our medicine service. He said he didn’t want to go there again either. We verbally orbited each other until finally he asked, “What is outpatient?”
A few weeks later, while on holiday break, my aunt asked me what a resident was, and did they have their MD? My parents asked, what is internal medicine, and isn’t all medicine largely internal anyway
I am two and a half years into this training, and yet already am disremembering what it is like to not have had this schooling, to be a non-medical student. I hear the talk, read the talk, try to write the talk, and then, suddenly, I am walking the talk. To my patients’ and my own confusion. It must be what it is like to join the Marines, or live in a highly religious sect — they strip down all you know, and they build their new flock back up, using the same learned code and rituals, rights and responsibilities. Instead of “citizens“ or “gentiles“ or “Muggles,“ we call the non-initiated “patients.“
I was consistently annoyed as a first-year medical student when lecturers used comically and needlessly medical terms — did they categorically need to use the word “tachycardic“ instead of fast heart rate? It was, in fact, adding a syllable, and significantly worsening our comprehension. Lecturer after lecturer would liberally use jargon and then the all-confusing acronym, not knowing we were far closer to a layman than a professional. In one breath a pulmonologist spoke of RV, FEV1, FVC, the cardiologist of LVEFs, LAs and PMIs.
It was only a few months into my medical school career that I started donating biannually during Wikipedia’s funding drive — I couldn’t have survived these classes without Wikipedia-ing every third word on the slide.
And yet now, two and a half years later, my vocabulary has metamorphosed to a stunning degree. I catch myself saying “hypertension“ instead of “high blood pressure.“ I hear myself speaking sentences littered with medical jargon in front of patients — my medical thoughts now flow most naturally in their medical linguistic domain, it seems — and I have to backtrack my way to the realm of common language and straightforward words.
It scares me how these two years have transmuted my speech and I only assume my thinking, too.
A part of me is excited by how much I have absorbed. Medicine has created a specific language to describe ailments, medications and symptomatology. It is important to accurately define and label a patient’s consciousness as lethargic, obtunded or somnolent. Radiologists must precisely articulate the location of their findings. Clarity and specificity are vital.
And yet, it’s been shown medical students become worse communicators through their years in medical school and are less able to understand patients‘ overall views on their health. In reviewing thousands of live and taped doctor-patient sessions, physicians consistently use medical terms patients don’t understand and patients do not clarify either, due to intimidation and fear of looking uneducated. Up to half of patients leave a doctor’s office unsure of what information was exchanged and what actions they were instructed to take to better their health.
The studies go on, and get more depressing: docs are distinctly poor listeners and explainers, patient interviewing has become embarrassingly abbreviated, and now less that five percent of a visit is used to even transmit information from doctor to patient. It’s an overwhelming and grim topic that speaks forcefully to the skeleton of what the “art of doctoring” has become, and more broadly to what is rewarded throughout premedical and medical training and to the devaluation of talk, which occurs mostly in primary care physician offices.
For all this training affords me, I worry about what it takes away. I hope I can hold on to how unsettling and uncertain it is to be unwell and not to know the details of the diagnosis, if there is even a clear diagnosis to be made at all. That I may remember that things that seem so clear and self-evident to me may be obscure and peculiar to others. That the words I now know are my own narrow area of soon-to-be proficiency, and I couldn’t follow a lawyer discussing a bank merger, or a plumber discussing pipes, any more than they could read a CT scan.
Or in other words, as I become a doctor, I hope I become equal parts translator and educator. For what good is this information stored inside me if no one knows that I am talking about.
Pleural Space looks at the experiential curriculum of medical school, the many things that are taught and learned that aren’t listed in a syllabus.