Perspectives in Biology and Medicine

MEDICAL LANGUAGE AS SYMPTOM: DOCTOR TALK IN TEACHING HOSPITALS WILLIAMJ. DONNELLY* Language is perhaps the greatest single gift and achievement of the human organism in the natural order. Consequently what we do with language —how we regard it and how we use it—« never indifferent. It shapes our thinking and our attitudes, powerfully and quietly.— Elizabeth Sewell [1, p. 6] The language used by attending physicians, physicians in training, and medical students in large American university-affiliated or teaching hospitals as they talk to one another about their patients is a rich and incompletely explored source of information about doctoring. My casual survey of this language discloses many instances of inhumane, inaccurate , or simply inadequate language. In contrast, the language used for disease and biomedical technology is rigorously up-to-date, highly nuanced, and often precisely quantified. The world of physicians and medical students in teaching hospitals is, to a great extent, like all worlds, defined, expressed, and limited by its language, a language that illuminates disease and technology but consigns to shadow much of the uniquely human in patient and doctor. I believe that there is a major, insufficiently appreciated reason for the sorry state of medicine's language for and about the subject of its activities , the human being: the unexamined assumption that the scientific way of knowing is the only way of knowing anything germane to the doctor's tasks. Our preoccupation with matters of objective fact— whether in morning report, grand rounds, or at the bedside—suggests this. Other clues include our preference for number rather than narrative , insistence on data rather than anecdote, interest in disease rather Work on this paper was made possible by Extended Educational Leave granted by the Veterans Administration Central Office, Washington, D.C. *Edward Hines, Jr., Veterans Administration Hospital, Hines, Illinois 60141, and Loyola University Stritch School of Medicine.© 1986 by The University of Chicago. All rights reserved. 0031-5982/87/3001-0509$01.00 Perspectives in Biology and Medicine, 30, 1 ¦ Autumn 1986 \ 81 than person, and declining interest in the patient's experience. Let us examine the evidence. Consider house staff slang, perhaps the most memorable feature of Samuel Shem's novel, The House ofGod [2]. The decrepit patients who do not get better but do not die are gomers, an acronym, the author says, for "get out of my emergency room." House staff slang is not new. In my own years as an intern and resident at Cook County Hospital, we called such patients "crocks," a word of uncertain derivation, but sounding more mineral than animal or vegetable. Some of Shem's slang seems to have traveled, turf, a verb meaning "to get rid of," as "turf a gomer to urology," is now commonly used by house staff in my medical center. More ominously, and, I think, more important, part of Shem's novel has become a "how to" manual or survival kit for some interns and medical students. For embedded in slang such as turf, buff, and bounce are eminently practical, albeit thoroughly cynical, strategies for expediting (and surviving) some of the work of clinical clerkships and internships. Unlike most house staff slang, turf has become sufficiently respectable to be used in the presence of (although not by) senior medical staff. On the other hand, attendings are unlikely to hear words like "dirtball" [3] or "dump" [4] unless they first somehow signal approval of such invective. Perri Klass, when a third-year student at Harvard Medical School, recently described some new examples of house staff slang [5]. A terminally ill patient is "C.T.D.," or "circling the drain." A patient who dies is said to have "boxed." Klass notes that time and usage soon blunt the peculiarities and atrocities of the medical language she has learned. It becomes professional speech, no longer sounding strange to her ears or coming from her mouth. For the record, not all house staff slang is rude. Some expressions are simply the lively and playful metaphors used by the young of any age. Some residents talk of giving patients "tune-ups" when correcting chronically abnormal blood biochemical abnormalities. Tune-ups may then lead to "good numbers" for, say, blood electrolyte...