It's a nuclear show and the stars are gone
We are forever presenting patients to our colleagues, almost never questioning the mechanisms and motivations that permeate these oral exchanges-and sometimes send them awry. By some ancient right we assume authority to retell the patient's story at the bedside, not in our own words but in a highly stylized medical code: "Mrs Dalloway is a 51-year-old Caucasian female, a known case of menopausal dysphoria now presenting with intermittent delirium, who complains of paraesthesia and weakness in her right upper limb...She admits to drinking 21 units per week and other problems are..." What is the purpose of this process of reverse alchemy by which we turn the gold of pure speech into the dross of medical jargon? The reason cannot be brevity, as if we are speaking in front of the patient, all that is in bold above could be omitted, or much curtailed. The next easy conclusion to confront is that we purposely use this jargon to confuse or deceive the patient. This is only sometimes the case. There must be deeper reasons for our medicalisms.
We get nearer to the truth when we realize that these medicalisms are used to sanitize and tame the raw data of our face-to-face encounters with patients-to make them bearable to us-so that however sordid or beautiful, however sad or profound, we can think about the patient rather than having to feel for him or her. This is quite right and proper-but only sometimes. We need the illusion that we are treading on well-marked territory when we are describing someone's pain-a problematic enterprise, not least because if the description is objective it is invalid (pain is, par excellence, subjective), and if it is subjective, it is partly incommunicable.
These medicalisms enrol us into a half-proud, half-guilty brotherhood. Proud because we hold the reins of life and death in our hands, and guilty because we are all dragged down by the unstated fear that our cures have never fully evolved from our ancient past of quackery and charlatanism. This is the reason why we are so pathologically loyal to each other and our jargon has the role of binding us into an unbeakable magic circle that ensures that what is unsayable remains unsaid.
The modulations of our voice, the stylized vocabulary, and the casual neglect of logic and narrative order ensure, in the above example, that we take on board so little of our patient that we remain upright, afloat, and (most dangerously) unfeeling, above the whirpools of our patients' lives. So when you next hear yourself declaim in one breath that "Mrs D-is a 51-yea-old Caucasian female with crushing central chest pain radiating down her left arm", take heed-what you may be communicating is that you have stopped thinking about this person-and pause for a moment. Look into your patient's eyes: confront the whirlpool...
I've read this quite some time ago, but I can't seem to be able to make it leave my mind. Because it's true, and the whole of me knows it.
We get nearer to the truth when we realize that these medicalisms are used to sanitize and tame the raw data of our face-to-face encounters with patients-to make them bearable to us-so that however sordid or beautiful, however sad or profound, we can think about the patient rather than having to feel for him or her. This is quite right and proper-but only sometimes. We need the illusion that we are treading on well-marked territory when we are describing someone's pain-a problematic enterprise, not least because if the description is objective it is invalid (pain is, par excellence, subjective), and if it is subjective, it is partly incommunicable.
These medicalisms enrol us into a half-proud, half-guilty brotherhood. Proud because we hold the reins of life and death in our hands, and guilty because we are all dragged down by the unstated fear that our cures have never fully evolved from our ancient past of quackery and charlatanism. This is the reason why we are so pathologically loyal to each other and our jargon has the role of binding us into an unbeakable magic circle that ensures that what is unsayable remains unsaid.
The modulations of our voice, the stylized vocabulary, and the casual neglect of logic and narrative order ensure, in the above example, that we take on board so little of our patient that we remain upright, afloat, and (most dangerously) unfeeling, above the whirpools of our patients' lives. So when you next hear yourself declaim in one breath that "Mrs D-is a 51-yea-old Caucasian female with crushing central chest pain radiating down her left arm", take heed-what you may be communicating is that you have stopped thinking about this person-and pause for a moment. Look into your patient's eyes: confront the whirlpool...
I've read this quite some time ago, but I can't seem to be able to make it leave my mind. Because it's true, and the whole of me knows it.