Medical Jargon

Wiki defines jargon as a term that descrcibes the language used by people who work or live in a particular area (such as doctors or Nebraskans respectively). Jargon words are also used by people with a common interest (such as cribbage).

There are benefits to the use of jargon: a standard term may be given a more precise or unique usage among practitioners of a field. This allows for better communication among the members of group.

The major problem with using jargon is that in many cases this causes a barrier to communication with those not familiar with the language of the field (such as patients).

Let's use the term "snow" to develop this concept further. There is a relationship between the geographic area where people live and the need for knowing snow-jargon. For example, in order to survive the harsh Nebraska winter, people must have the ability to effectively communicate around the different terms for snow.

I have lived in the northern Midwest for a good portion of my adult life. I've had to learn these terms in order to be able to survive the winter, stay safe, and prepare for my workday -- nephrologists such as myself have to travel to many hospitals, kidney dialysis clinics, and outpatient clinics in order to provide service -- regardless of the weather. Also, I need to understand these terms in order to make sense of the weather report 6 months a year.

Compare Nebraska to Texas. I spent 2 months in Austin, Texas when I was in high school. I had the opportunity to take AP biology at the University. Its hot! Snow is rare and there is no need to know the 18 Nebraska snow words -- unless you plan to vacation up north!

Here is a short list of the words for snow used in Nebraska:

1. powder snow: frozen precipitation in the form of white or translucent hexagonal ice crystals that fall in soft, white flakes. People who ski prefer powder snow. I think of powder snow as "Rudolph the Red Nosed Reindeer" snow. Same thing as "snowfall" except used in the setting of skiing.
2. sleet: a mixture of rain and snow
3. slush: partially melted snow or ice
4. snowfall: frozen precipitation in the form of white or translucent hexagonal ice crystals that fall in soft, white flakes.
5. whiteout: the failure to maintain visibility in heavy snow. Very unsafe weather in which to drive.
6. hail: snow in the form of pellets of ice larger than 5 millimeters (0.2 inches) in diameter. I have seen softball sized hail. Imagine what a car looks like after being pounded by softball sized hail!
7. crust: this type of snow has a harder crust on top of softer powder snow. We see crust on the road after cars have been driving for a few hours after a snowfall.
8. blizzard: a very heavy snowstorm with high winds. Heavy winds are usually defined as at least 35 miles per hour.
9. ice: water frozen in the solid state.
10. icicle: ice resembling a pendent spear, formed by the freezing of dripping water.
11. dusting: a light sprinkling of snow.
12. flurry: a light, brief snowfall. Not sure, but I think flurries have more snow than a dusting.
13. snowbank: a heap of snow. Snowbanks are created as a result of shoveling snow.
14. snowdrift: a heap of snow as a result of the wind.
15. snowstorm: a storm with heavy snowfall.
16. freezing rain: supercooled droplets that freeze on impact.
17. yellow snow: snow given a golden or yellow appearance by the presence in it of pine, cypress pollen, or anthropogenic material or animal-produced material (such as squirrel potty as my son would say).
18. black ice: a thin, nearly invisible coating of ice that forms on paved surfaces. People can lose control of their vehicles. Four wheel drive vehicles don't help you on ice. Black ice formation is a very difficult situation. Cruise control should not be used when driving on black ice.

People living in Texas have one word for snow:

1. snow: that white stuff we get every few years that our kids find cool, is impossible to drive in, and melts in a day.

So how does this discussion justify the need for medical jargon, and why does this important article fall under the heading of a medical blog? I speak a foreign language called "medicalese" -- the specialized terminology of the medical system. Latin is easier to learn than Medicalise! Medicalise is derived from Latin, Greek, English, and more. The standard medical dictionary has over 45,000 words. In order to communicate effectively, we need to use the jargon we spent 7-10 years initially learning, as well as all the new words that keep popping up.

Another language spoken all over the world that is similar to medicalese is Yiddish. Yiddish is spoken in the United States, Israel, Poland, Argentina, Brazil, United Kingdom, Russia, Canada, Ukraine, Belarus, Hungary, Mexico, Moldova, Lithuania, Belgium, Germany, Australia, France and elsewhere. Someone with knowledge of Yiddish and German in Germany can speak Yiddish to a person in Mexico who can speak Yiddish and Spanish. The German in this case can effectively communicate with the Mexican without having to learn another language.

Let's get back to medicalese. An example of using medicalese is heart failure. There are many terms associated with the condition, and the words we use can get quite complex. Consider the following example:

The patient has New York Heart Association Class IV heart failure with an estimated ejection fraction of 20 percent. He has SOB. He denies chest pain. Moreover, long term sleep apnea has led to pulmonary hypertension, cor pulmonale, and bilateral lower extremity edema. Aquapheresis is an option for this patient, but I think we need to make sure the patient has diuretic resistance first by checking a 24 hour urine collection for creatinine clearance and sodium. I will ask cardiology to calculate the caval index. A greater than 50% variation in inspiration, especially in this setting would suggest decreased effective circulating volume in the setting of total body hypervolemia -- a situation where aquapheresis can do wonders by safely removing water through ultrafiltration while decreasing the risk of acute kidney injury, especially if inline hematocrit monitoring is utilized. In addition, we should consider placement of an implantable defibrillator. Although the patient has chronic kidney disease IIIA, the benefits outweigh the risks because only 10 cc of contrast will be used. We can prophylax with mucomyst....

Still with me? The terms that are understandable may be taken as an insult to the patient without knowledge of how the language is spoken.  SOB is a term to describe "shortness of breath." Also, "denies" is a strong term. A patient reading this chart may misconstrue what doctors mean when this term is used. Using "denies" is a simple term we doctors use to rule out a diagnosis. There is nothing personal here!

Another, better way to say it: the patient's heart is not pumping correctly. A pacemaker might help prevent sudden death. The kidneys are working at 50% of normal so we need to be careful placing the pacemaker. Fluid removal using a machine may be helpful as well. If a person still has swelling in the legs on a high dose of water pills, we can go forward.

In my opinion, the best doctors are the ones who have the ability to communicate in a way that both their colleagues and their patients understand (such as the ability to speak both German and Yiddish). Did you know that "doctor" is from the Latin word "teacher"? That is what the best providers do -- they teach. Both descriptions above are necessary. The cardiologist needs to hear the first explanation; the patient needs to hear the second.