Student Scene
 Alisa Land Photo by Graham Ramsay |
The Language of Medicine
Wits occasionally describe England and the U.S. as two countries separated by a common language. I feel one might say a similar thing about doctor and patient. As a former English major, I spend perhaps more time than most observing the language of this profession. I find myself uneasy at times with the transition I am making, at an almost alarming pace, from viewing medicine through the eyes of a patient to seeing it with those of a physician.Sometimes I find myself uncomfortable with my voice as a future doctor. I recognize that speaking a common language as physicians gives us a certain bond--a sense of belonging to our own professional guild. Yet I wonder whether the language that enables us to communicate with one another also allows us to distance ourselves from our patients. We can stand at the bedside of an obese patient who has just had surgery and is at risk for a pulmonary embolus and say that "due to his habitus," he will need prophylactic boots and heparin. We may excuse ourselves to the patient: a senior doctor might say, "I hope you don't mind if I talk shop to these training students." But is it really right to have this coded dialogue that excludes the very one most affected by the health issues of which we are speaking?
Against the Patient
The work of the physician involves a struggle against disease and ultimately death--a noble fight, indeed. Yet in the trenches and in our stressed, hungry, sleep-deprived moments, it can feel like a struggle not so much against illness as against the patient who is ill. We might say, "Mr. Jones bumped his pressure overnight" or "Ms. Laurent dropped her sats when we took her off oxygen." It is understood that these adverse events represent a loss for our side. When during rounds, the intern is paged away because "Mr. Smith is crumping," this, too, is a hit. And though we do not mean to blame the patient for this outcome--at least not consciously--we are frustrated all the same. Perhaps we become weary of these patients and tired of being responsible for caring for those we cannot cure.
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Despite the imperfections of the work world we inhabit, perhaps we can find a balance between protecting ourselves and connecting to our patients, considering what we say and why, and remembering that our words have power and shape our relationship with every patient. --Alisa Land |
Or when an IV drug abuser persists in using drugs even while in the hospital, eats before surgery when she is meant to refrain from eating, and hides loaded syringes in her room, who can blame the staff for being frustrated? On the other hand, should we secretly whisper that perhaps she will leave AMA (against medical advice) and save us all the trouble? Does she not also deserve care, even if she is our most difficult patient? On one rotation, in the crush and tumble of stressful early morning rounds, I remember that the physical exam was reduced to saying the patient "LOFD" (looks OK from door). When another patient was in the late stages of metastatic cancer, he was described as "CTD" (circling the drain).
Connecting
It is not that I don't understand the need for emotional distance. If we were to fully consider the depths of fear, pain, and uncertainty for each patient, we would likely be overcome with such emotional noise that we could not do our job as objective clinicians. What is more, we are often so overworked as caretakers that we have too little time to care for ourselves and be nurtured in turn."Blood from a stone!" a surgeon once admonished me as I tried to get a syringe of blood from a patient. Likewise, we, too, can be taxed to a point where we have nothing left to give. The well runs dry. We, too, need a space to process and feel, a time to reflect and grieve for those we have lost, and for our own pain.
Despite the imperfections of the work world we inhabit, perhaps we can find a balance between protecting ourselves and connecting to our patients, considering what we say and why, and remembering that our words have power and shape our relationship with every patient.
We have a choice about how we practice medicine. I have seen physicians who communicate with great gentleness and compassion, who listen to patients share their stories in their own words. I have watched the way this interaction offers a window through which doctor and patient can connect--two human beings searching together for solutions. If the disease proves too strong or complex for a solution, this same language of caring creates a relationship of trust that can prove more comforting than medication for those facing death.
I believe our own mortality remains something we ponder too little in medicine. Running far and fast in our high-powered careers, we may hope to beat it at last. Yet if we acknowledged the frailties that we ourselves possess, perhaps we would better appreciate those of our patients, and in doing so, create a bond of understanding instead of distance between us.
--Alisa Land, a third-year medical student at HMS
The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.