Language

As was his language so was his life.
Seneca (Roman philosopher, 5 BC - 65 AD)

Our language defines us—our ability to interact with our surroundings is greatly dependent on our ability to translate thoughts into words.  The world of medicine is an environment where communication is paramount and has a long history of being shaped by language.  For a doctor to function he or she needs to be fluent in the parlance of medicine—a complex vernacular composed of Latin, Greek, and syndromes named after lots of dead people.  Furthermore, the doctor needs to be able to converse with colleagues in “medicalese” and then turn around and relate to the patient in language that doesn’t require a Doctor-to-English dictionary (for some caregivers the latter is more difficult than the former).

Even words that are commonly understood by all have meanings that require some degree of translation.  These are terms and phrases that have evolved from the earliest days of medicine and continue to suffuse our language but which may no longer have the same application they once had.  I offer you a few examples:

The practice of medicine.  The term practice in this phrase is an interesting choice for what we do.  Do I practice medicine in the same way my daughter practices piano?  I’ve heard the joke from patients a dozen times: “You’re practicing medicine because you still ain’t got it right, eh doc?”  In a sense this particular definition holds some truth.  I’ll be a doctor for decades but will never perfect my profession—there’s always more to learn and experience. Another meaning for the word “practice” evokes participation in some type of age-old art, similar to practicing alchemy or sorcery.  Plumbers don’t practice plumbing and engineers don’t practice engineering.  To say we practice medicine elevates our vocation above other career fields.  Does this still apply?  In the age where doctors abandon their privately-owned offices and become employed physicians doing shift work can we still say we’re still more than plumbers, electricians, or engineers?

 

Healers.  I’ve never been fond of this term.  I think it’s snooty, highbrow, and arrogant.  I’ve never healed anyone—the best I can claim is that I manage the physiological environment so that patients’ bodies can heal themselves.  Of course, in rejecting this moniker I’m fighting two thousand years of medical tradition.  “Physician, heal thyself,” from the Gospel of Luke, canonizes the concept of the physician healer. The fact that I favor the downgrading of my title from the lofty heights of “healer” doesn’t mean I approve of the ongoing simplification of what we’ve worked so hard to achieve.  As medicine evolved from mysterious conjuring to quantitative science, healer has appropriately descended to physician or doctor.  From there, however, modern medical economics have degraded us further, to health-care professional or to the generic term provider.

 

Delivery.  Doctors don’t deliver babies, mothers do.  At what point did the medical profession lay claim to what mothers have been doing for the better part of a million years?  The term deliver implies that the doctor brings forth or bestows the new life, placing the suffering mother in the role of passive recipient.  Milkmen deliver milk; doctors simply catch the baby when it emerges. (Okay, so I admit I’m selling my obstetrical colleagues short.  They also manage medications, coach patients, and sometimes dive in for emergency surgery.  Thanks to modern obstetrical science, childbirth has gone from a life-threatening medical condition to something where success is nearly guaranteed)

I’ve delivered exactly one baby in my medical career, something I’m hoping to never again do.  I was a medical student and the senior resident was called away for an emergency procedure.  The poor young mother, understandably chagrined that they couldn’t find anyone more experienced than me, did all the delivery work and I mainly made sure the little guy didn’t hit the floor when he popped out.  Somewhere, there’s a 19-year-old young man walking around who has no idea how close he came to suffering from the utter incompetence of his delivering doctor.

 

Residents and interns.  There was once a time many years ago when the newest medical graduates, earning their way into a life of doctorly opulence by paying their dues at the local hospital, would actually live on site.  In the days before pagers and cell phones, young doctors resided (or were interned) at dormitory facilities provided by the hospital.  The new MDs were virtually all men and were frequently required to remain unmarried during their years of internship and residency.  Whenever new grads gripe about their long work hours I try to remind them of the etymology of their title.

 

Attending physician.  This title refers to the doctor of record for a patient and is generally applied to the physician who coordinates the person’s care during a hospitalization.  The term attend, however, is a puzzling anachronism, meaning (according to www.dictionary.com) “to take care of; minister to; devote one's services to.”  Who, in the hospital setting, seems to match this description?  That’s right—the nurses.  Even dictionary.com ignores doctors when they reach for a usage sentence: “The nurse attended the patient daily.”

 

Performing surgery.  This last one is my favorite.  Surgeons don’t do procedures, or complete procedures, or even conduct procedures—they perform them.  This word captures the obvious theatricality that early doctors purveyed as they played god with their scalpels and bone saws.  At one time the operating room was even known as the surgical theater (probably theatre) and often contained tiered rows of seating for captivated onlookers to sit in awe of the talents of the physician.  These days we still perform but do it for less populated crowds (generally only the OR personnel) and I’ve yet to hear of a case ending in rousing applause.

Our language is the product of centuries of storied tradition and may never evolve into the present world of medical reality.  I obviously find humor in some of our older words and phrases but don’t lose much sleep over them; nobody—myself included—really cares that much.  Now, if you’ll excuse me, as a healer and attending physician, I’ve got to get back to practicing medicine and performing surgeries.  Just keep me away from the delivery theatre.