{"id":48931,"date":"2020-10-30T11:11:33","date_gmt":"2020-10-30T10:11:33","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=48931"},"modified":"2020-10-30T11:11:33","modified_gmt":"2020-10-30T10:11:33","slug":"doctors-and-patients-two-nations-divided-by-a-common-language","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/10\/30\/doctors-and-patients-two-nations-divided-by-a-common-language\/","title":{"rendered":"Doctors and patients: two nations divided by a common language"},"content":{"rendered":"<p><span style=\"font-weight: 400\">There is an oft repeated misconception that anaesthetists choose their specialty because they can\u2019t communicate with conscious patients. This is demonstrably untrue. Take the average anaesthetic assessment on the morning of a routine day case list. We must find out what we need to know about the patient, tell the patient what we think they need to know about the procedure, answer questions about what they want to know (usually something quite different), and finally persuade them to trust us, literally, with their lives\u2014all in the space of less than ten minutes. We do this successfully every day.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">However, we know that the opportunities for miscommunication are vast. Think about some of the words we use. \u201cTopical\u201d, to the average politically aware citizen, does not mean something you smear on your skin to make it numb. It means something outrageous a politician said on the news last night. \u201cLocal\u201d has nothing to do with anaesthesia, everything to do with their neighbourhood. \u201cRegional\u201d brings to mind, in the current fevered climate at any rate, the differences in covid-19 lockdown arrangements between north and south.<\/span><\/p>\n<p><span style=\"font-weight: 400\">It is horrifying to look through clinical notes from the last century, when doctors would routinely write phrases like \u201cThank you for referring this nice old duck.\u201d We have improved. It is no longer acceptable to insult our patients. However, we are still careless with some of the clinical shorthand we use. We still occasionally talk of a \u201cmissed abortion\u201d, which must sound to a vulnerable and possibly sad patient as if she is being accused of trying unsuccessfully to end her pregnancy. We talk about \u201ctrial of labour,\u201d or, worse, \u201cfailed trial of labour,\u201d which suggests to the patient that she has been tried and found wanting, and the resulting caesarean section is in some way her fault.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Words and diagnoses, which to us sound relatively benign, can be terrifying to patients. To the doctor \u201clesion\u201d means anything or nothing\u2014an all-purpose word to describe something abnormal. It\u2019s probably the word Humpty Dumpty had in mind when he said, \u201cWhen I use a word, it means just what I want it to mean\u2014neither more nor less.\u201d To many patients, it means \u201ccancer.\u201d Worst of all, though, is \u201cheart failure.\u201d As anaesthetists, we encounter \u201ca touch of cardiac failure\u201d frequently in elderly patients. Not a problem. Usually, easily managed with a judicious combination of diuretic, fluid management, and careful monitoring. To the patient the term \u201cheart failure\u201d means precisely that\u2014actual failure of the cardiac pump, with inevitable consequences. It is a term I try not to use, especially preoperatively.<\/span><\/p>\n<p><span style=\"font-weight: 400\">To misquote George Bernard Shaw, doctors and patients are two nations divided by a common language. To quote him correctly, he also said that all professions are conspiracies against the laity (he didn\u2019t like us much). We certainly can use jargon to obscure, and that is a conspiracy, but all the evidence shows that working in partnership with patients produces better results. The English language is a powerful tool. Like all tools it should be used with care.<\/span><\/p>\n<p><i><strong>Anna-Maria Rollin<\/strong>, Honorary Consultant Anaesthetist and former Vice-President, Royal College of Anaesthetists.<\/i><\/p>\n<p><em><strong>Competing interests<\/strong>: None declared<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>There is an oft repeated misconception that anaesthetists choose their specialty because they can\u2019t communicate with conscious patients. This is demonstrably untrue. Take the average anaesthetic assessment on the morning [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/10\/30\/doctors-and-patients-two-nations-divided-by-a-common-language\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":44015,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-48931","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Doctors and patients: two nations divided by a common language - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/10\/30\/doctors-and-patients-two-nations-divided-by-a-common-language\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Doctors and patients: two nations divided by a common language - The BMJ\" \/>\n<meta property=\"og:description\" content=\"There is an oft repeated misconception that anaesthetists choose their specialty because they can\u2019t communicate with conscious patients. 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