Tuesday, November 01, 2005

Paper 2

How Students Learn to Talk Like a Doctor Even If They Never Play One On TV

Oftentimes, patients wonder whether their doctor is speaking the English Language when they are trying to explain an illness or diagnosis. The doctor is, in fact, speaking, what could be argued, is a dialect of English or a fusion of English and Latin. There is generally a process by which ordinary students acquire the language and presence of a physician. Much of this literacy has its genesis in the classroom and lab of medical school.
On the first day of medical school, students are given a white coat and recite the Hippocratic Oath. They undergo this initiation ritual in order to mark a tangible transition from civilian to the unique world of medical school. Not only are they preparing their academics and ethics for the critical work of medical practice, they are also in the beginning of the process that will eventually make them fluent in medical language (Maher.)
Classes like anatomy require the medical student to remember vast quantities of relevant information. As they dissect their cadavers, this information becomes animated (excuse the pun) and many students experience the thrill of having all the information they learned in high school and college become significant. It is not unusual for students to grow attached to “their” cadaver giving them names and imagining their personalities. Oftentimes, they make their first postmortem diagnosis in anatomy lab. All of the prior academic achievements becomes manifest in the act of tangibly incorporating itself in the form of a real (albeit not live) human being (Maher.)
The process of learning the medical terminology is similar to acquiring the vocabulary of a foreign language. In this case the language is a fusion of Latin and English. In 1066, the Normans conquered the Anglo-Saxons and the predecessor of contemporary English became the language of the servant. The word “Serf”, in fact, has the same origin as “Servant” and “Slave”. The language of the conquered was Angelo-Saxon (Angeloish, the predecessor of English.) The language of the conqueror and subsequent Aristocracy was French. The language of the Clergy and university was Latin (Van Dam.)
During the Middle Ages, medicine as a science was somewhere in its embryonic state. Up until the Eighteenth Century most sick or injured people were treated by local healers, many of whom were women who had acquired knowledge of herbs and folklore. Thus, the language of the banquet table was French where words such as pork, beef, and poultry were manifested. The peasants who labored in the barnyard and kitchen gave us Angeloish words like pig, cow, and hen. The Clergy, who had a monopoly on the Church and university, spoke Latin. Because the clergy held a near monopoly on literacy and formal learning, Latin became associated with literacy (Mareckova, et. Al.)
During the Renaissance, universities began to develop medical colleges and Latin was spoken. Latin eventually became a dead language and the emotional baggage associated with language learned as a child was removed from Latin, giving it the ability to be used as the “Lingua Franca” in the clinical setting of medicine and science (Louden, 127.) A little-known curiosity, that which is commonly regarded as coarse, vulgar, banal words are the words of the people who were conquered by others (Van Dam.) This is why we talk of pigs in the barnyard and pork at the table. We wash our children’s mouth with soap if they say, “shit,” but use of the term, “feces” is respectable. It is used by the doctor when he or she needs to make reference to the product of a bowel movement. Because of its status as the language of academia instead of the language of any people, Latin gives a sterile air to words that are normally charged with sexual or scatological meaning. This mechanism gave rise to the use of Latin in a clinical setting (Loudin, P74.)
I have seen this evolve in my daughter, Jennifer. Jennifer is a Second Year medical student at PCOM. Recently, some of my grown children were over at the house and Jennifer started to discuss a case of uterine and rectal prolapse. I’m considering going to medical school and I was interested in the case. Encouraged by my interest, Jennifer continued discussing the case. Her husband, Kevin, and one of my other daughters, Jessica, didn’t know the definition of ,“prolapse,” and subsequently asked Jennifer to define, “Prolapse.” Prolapse is a condition in which an organ falls out of place. Jennifer offered to show me some pictures that she could access with her student account. Of course, I wanted to see the pictures. Kevin had the sense to stay in the kitchen, but Jessica followed us to the computer for a look at the pictures. In her own words, those pictures ruined her day but Jennifer and I were able to set aside our usual emotional response to a disturbing sight. I believe the Latin clinical terminology helped us to accomplish the emotional distance we needed to learn more about this physical condition (Baker and Maher.)
The use of Latin, as opposed to the use of vernacular languages, gave the knowledge of even medical vocabulary the essence of privilege because the only way people could learn Latin was through formal tutelage rather than in a naturalistic setting. The only way people acquired this specialized literacy was through the social gatekeepers. For centuries this was the privilege of white European males (Ehrenreich and English.) This stratification created a divide between the folk practitioners, who were frequently women, and the products of the universities who were exclusively men. Women who had knowledge outside that of a housewife were often held suspect. In fact, many, if not most, of the women accused of witchcraft were midwives and herbalists (Erenreich and English.) It is not surprising that the result of these persecutions was the rise of maternal and infant mortality as well as epidemic plague. While the folk practitioners were being suppressed the doctors, who were the products of university education, were being immersed in Latin and developing specialized nomenclature and abbreviations. Since Latin carried no emotional baggage from anyone’s culture those privileged to know it were free to dialogue in an increasingly clinical manner.
The development of Latin as a language of medicine and science allowed the publication of scholarly papers that could be read by people regardless of their native language. This ability to dialogue and share research in a (at that time) fast pace is partially responsible for the explosive evolution of medical science that has not slowed its pace to this very day (Mareckova, et Al.) I belong to a discussion group called “The PA Forum.” “PA” is shorthand for “Physician Assistant,” a midlevel practitioner who holds a master’s degree. Sometimes the PA’s in the forum give those of us who are students real cases to diagnose. In one thread, for example, an experienced PA offered us an opportunity to diagnose a challenging case that he encountered as an Emergency Room PA. “50 yr old male without prior significant medical hx or risk factors admitted for lower gi bleed of unk etiology X3 weeks. h+h 11/33, nl abd ct with 3hr contrast.” The thread continues in this fashion. Much of this is medical shorthand that is necessary when communicating quickly. “Hx is history, GI, is gastrointestinal (your gut.) Etiology is the cause, h+h refers to heart rate and nl abd is, I believe, normal blood count (PA Forum, Sept. 28.)
In some regards, English has replaced Latin as a universal language but it could be argued that English has assimilated Latin nomenclature and vocabulary and synthesized it to create a specialized language with deep structural roots in Latin. These structural roots have become dynamic with the transition from scholarly works being written in Latin to the present practice of writing scholarly works in the English language. English has a way of assimilating the best qualities of other language traditions enabling the writer to be precise and expressive at the same time.
One skill expected of a good doctor that is almost exclusive to the medical field is the ability to translate the specialized language of medicine and interoperate it in lay English for patients. This skill begins in medical school when students role play clinical situations with actors who play patients. Jennifer recently informed me that she just performed her first rectal exam. Of course, we were amused. I asked her if the students performed the examination on one another. She said, “No, there is a traveling troupe of professional assholes from Johns Hopkins.” Needless to say, it was a challenge not to spew my drink! I was laughing heartily as my imagination took a turn toward pondering what members of this troupe placed in the “occupation” part of their tax forms. Much later, as interns, students get to learn how to incorporate “bedside manner” as they work as apprentices under the watchful eyes of attending physicians.
After the arduous process of studying medicine, young doctors will emerge with the specialized language of medicine at their command. The ability to speak medical English with ease and fluency is an essential tool in their repertoire as skilled healers. As such, they will bridge the gap between an ancient dead language and the dynamics of English in a unique fusion manifested in medical literacy. Their time in residency harkens back to apprenticeships and mastering the linguistics of medicine is one of many skills new doctors develop under the tutelage of their attending physicians. These specialized language skills allows the physician to quickly and accurately convey his or her thoughts to colleagues and allows patients to feel confident that the doctor possesses the very skills and wisdom they need in order to be or stay healthy.


At 10:55 AM, Anonymous Anonymous said...

I like your depth. I am a chiropractic physician and went through a very simular journey and found your view and commentary perfect


Post a Comment

<< Home