"Aphasia" is the loss of the ability to produce or comprehend language. The first day of med school is typically a period of aphasia for the young Medi. He or she enters a world in which obscure terms become common parlance, and the terms flow freely from the mouths of experienced practitioners. This lack of knowledge, this pseudo-aphasia, is of course a necessary part of the learning process, but learning to speak in medicine is unlike learning any other language in the world.
One of the most challenging aspects of learning medicine is learning how to speak the language. Although I have learned to speak in many abstract languages over the years (English, Spanish, Hindi, programming languages, social languages), learning "medicalese" has proved to be quite daunting. The breadth of the vocabulary nearly matches a modern spoken language. The time in which one has to learn the language is brief, relative to other languages. The words are complex and not always easily related. The presence of multiple synonyms and eponyms (using a person's name to describe a disease) complicates the picture. Yet, somehow, after a few years, we as students slowly begin to make sense of the terminology and begin to take ownership of the medical words we produce.
However, one soon comes to see that learning the language to the point of comprehending it is only the first step of the challenge. Even the challenge of producing the terminology is eventually conquered. Yet, just as the medical student feels comfortable conversing with colleagues and peers, the student realizes where the true challenge lies in communicating medical ideas: the patient.
Today, I saw a patient in clinic. The Hispanic woman had a history of seizures for which she had recently had a brain scan. She spoke only Spanish, but her Spanish flowed easily as she described her situation. My Spanish is the kind one receives after 6 years of classroom education. I could generally follow her, but my mind had to stay ever alert, lest I get confused on a word that was not in my limited vocabulary.
One of her questions during the visit was whether she would find out the results of the scan. I had read the results prior to calling her into the room. The MRI of her cerebrum showed medial temporal sclerosis among other findings, which we believed was potentially due to head trauma in her childhood and a cause of her seizures. Had she spoken English, I feel my instinct would have been to read her the report. However, the additional language barrier gave me pause. I sheepishly told her that I would discuss with my attending and return with the results.
My attending also only spoke English. Even if we had both been fluent in Spanish, I suspect we would have had a difficult time explaining the lesion to this patient. I could have called a Spanish interpreter, but what would I have told him to tell her? While I might be capable of spouting out "temporal lobe abnormality" and "gliosis," how could I convey what this meant in plain terms to the patient? Still, something had to be said. After returning to the room with my attending, I showed the patient her MRI on the computer screen and had the attending describe it in English, while I tried my best to explain in Spanish. After doing so, the look on the patient's answered the question I was about to ask: "Entiende Usted lo que estamos diciendo?" (Do you understand what we are saying?). Her chagrined "No" probably embarrassed me as much as it did her. I attempted again, and this time she acceded to understanding. Yet, I fear, she understood only to the level that there was a problem in her brain, but I failed to convey the more complex picture that actually existed.
Why is this so? Of course, medical training creates an educational gap between physician and patient. But, this does not explain the entire situation. Medicine seems to cling to its roots as a descriptive field. In fact, the use of eponyms can be viewed almost as an act of hubris, of ownership, a researcher securing his place in eternity by attaching his or her name to the afflictions of his or her patients. Fortunately, medicine has trended away from the use of such eponyms, but they still litter the landscape. Another issue is the multiplicity of names for the same disease. While this may reflect the evolution of understanding over time, or independent discoveries, it seems that we as a field revel in being able to spout off the 5 names for a syndrome. We use language as a measure of skill and competency of our peers and colleagues. We also use language as a shield, protecting us from the inquiries of our patients, obscuring the knowledge we have attained.
The sad part is that often our shield appears as a weapon to our patients. Our patients enter the foreign land of the hospital and are bombarded by the foreign tongue of medicalese. We have now transferred our medical student aphasia to our patients, who are able to neither produce nor comprehend this "medicalese" we speak. When they ask for clarification, we often either intentionally use technical language to describe the situation so that we do not waste time by truly clarifying what is going on. Or, we are so caught up in presenting all our medical knowledge, that our eyes turn inward, reading what is kept in our memories, instead of looking outwards, and seeing the confusion and eventual submission. The patient learns to simply accept what we tell them instead of truly understanding their condition. However, without true understanding, the patient can never fully take charge and ownership over their condition. One can only hope that as we move forward as medical students, we shall remember to listen to ourselves speak as our patients do, and learn to use our language not as a weapon but as a light to enlighten the patient and enrich their lives.