Medicalese and the art of translation

As a school student, I had the opportunity to learn several languages.
 
One of the joys of this is being able to translate my thoughts into other languages, which I found helped me clarify what I meant to say.
 
Later, as I went through medical school, I noticed that I was learning a new dialect. Not exactly a language, but very different to mainstream English. I was learning medicalese, which mainly uses a Greek and Latin vocabulary to precisely describe what English cannot.
 
In English, a black eye can encompass bruising, orbital fracture, skin abrasions and ocular injuries
 
In medicalese, a periorbital haematoma means one specific thing.
 
The challenge, of course, comes when we have to explain medicalese. The process is doubly difficult because patients often have their own language and vocabulary – finding concepts that make intuitive sense to them is a key part of medicine.
 
Patients are working to grasp just what it is that is happening to them. If what is happening is hard to describe, they may borrow quasi-medical language from the internet, TV, books or friends.
 
The trick, I have found, is to not confuse patient language with our own dialect, and to not enforce the use of medical terminology. Instead, doctors and patients need to actively work to translate for each other.
 
Every GP will have heard a version of a story about ‘broken’ body parts, ‘stopping’ of limbs or the whole body, or any number of nebulous symptoms.
 
What I hear in these stories is this: ‘Doctor, I have had a very difficult life and every so often I become overwhelmed and immobile’.
 
What I have had to learn is to translate my response from medicalese back into language that is understandable to the patient, using acknowledgement, reframing, self-help and a gentle placebo effect.
 
I might say:
 
I understand that you have had a very difficult life and that this has injured you. I understand that you are taking some medication for this injury and that this has only helped a little, which is why you came here today. What we need to do is to work to harness the power of your mind to heal your body, especially as the medication has not worked completely.

I would go on to talk about relaxation, positive imaging,  sleep hygiene, positive self-talk, diet, and starting and incrementally increasing an achievable exercise regimen, including relationship counselling if appropriate.
 
If they ask me about prescribing other medication, I would suggest that we try the basics first and see how they respond to that.
 
Understanding a patient’s language is directly connected to how well you know them and how often you see them. I might only see a patient for 10 minutes, once a month. But if that relationship has been there for more than 10 years, you build that understanding.
 
In my experience, people find it easier to explain their suffering in terms of physical rather than emotional injuries.
 
That means we have to really listen to exactly what they’re talking about. What works? What makes it better?
 
If they say nothing, we ask, what’s happening in your life? What are your experiences? Get them to tell their story. Active listening is a powerful treatment.
 
I have had a number of patients over the years who have been very sceptical that childhood sexual abuse is detrimental to the victims. As I got to know them better, I started to make sense of this puzzle. In almost every case, each of my patients had been victims of childhood sexual abuse themselves. In their denial of the severity of the abuse, they were denying that they had also been victims.
 
It is the same for patients who would dismiss issues regarding physical punishment of children. I have had patients tell me they were whipped until they bled, and that it didn’t affect them at all.
 
But it had, of course, in ways that were not always visible to the patient themselves.
 
To untangle these puzzles, we GPs have to learn to go beyond the initial words and get to deeper truths, to what is really going on. To listen to what our patients really mean, rather than just what they say.
 
New doctors dread having patients come in with undiagnosed pain and an atypical presentation, or when someone is tired all the time. I believe we should avoid getting hung up on the lyrics and listen to the music instead.
 
One of my teachers once told me to always distrust the obvious, at least until you had verified it. Far too often, the obvious is not what is really going on.
 
General practice is no place for the feint-hearted. The mark of a good GP to be able to see the complex in what seems simple and the simple in what seems complex.

active listening jargon medicalese