Words We Use

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Our words direct thoughts and feelings. When interacting with patients our word choices shape our views.

During my formal medical training, I naturally desired to support and understand individuals struggling to adjust to a clinical diagnosis. As an eager medical student, I valued learning how another human being makes meaning from their medical condition. However, the training culture eroded my initial inclinations. I vividly recall instructions during an early clinical hospital rotation. “David, go workup the ‘lunger’ in room 208.” The “lunger”, a 38 year old father of 3 small children , was dying from chronic obstructive pulmonary disease associated with hereditary alpha 1 antitrypsin deficiency. The word “lunger” distanced me from the patient’s anguish and courage in this poignant human struggle.

During the first day of internship, the second year resident instructed me to write a note on the “CHFer” (an individual with congestive heart failure) in room 620. Introducing myself, I noticed the patient was too weak to lift a fork to his mouth to feed himself. Yet, the next day upon entering his room, I noted an open window, empty bed and dangling IV. The patient managed the strength to open the window jumping to his death. Later, I learned this CHFer was in his 40’s diagnosed with a rapidly progressive cardiomyopathy. As a motorcycle racer he jumped over large obstacles with his bike just 6 months prior to hospitalization. The last jump of his life represented the act of a once physically active man exercising his final choice. Categorizing him as the CHFer in room 620 completely obscures the meaning of a bedridden, dependent state for this individual.

I worked up appys, hip fractures, diabetics, acute bellies and numerous other “conditions”. Naming people by their clinical states, we condensed and ignored life experiences insulating ourselves from the patient’s “meaning making.”

Imagine, replacing the standard clinical term “work up” with a request to please “understand” the patient in room 208 who is short of breath with end stage chronic pulmonary disease. The improved training culture would embed the medical evaluation within the context of values and meanings for the patient.

Soon, I internalized the pervasive training culture. Shaped by words, I began elevating clinical problems above “subjective experiences.” Years of clinical practice and personal losses provided the humility for me to appreciate the flaws in this viewpoint. Witnessing the courage of patients and families struggling with loss, fear, confusion and vulnerability, while grappling with my own traumatic health crisis, helped me understand the importance of creating a healing environment and experience with patients.

For many of us, who’ve experienced early clinical training within the traditional medical culture, paying consistent attention to clinical needs arises more naturally than attending to the emotional and experiential concerns of patients.

Please use “comments” below to provide examples of words you use or hear that enhance or diminish the experiences of the individuals we support

5 thoughts on “Words We Use”

  1. You have stated beautifully, David, one of the problems in the training of medical doctors. We come in to medicine quite heart-centered, but most of us leave our training quite head-centered. My hope is that training now does a better job of balancing head and heart.

    1. Thank you Bill. I look forward to responses from recently graduated physicians and from leaders of training programs to understand whether and how things have changed. i suspect there has not been significant changes given that the roles models in training our people who trained in our era

  2. We create our own reality positive or other through our thoughts words and intentions. Be the world you dream.

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