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‘No, not really.’
The first time you hear this exchange on an intensive care unit, surrounded by people who are intubated, on triple inotropes and/or profoundly septic, it’s a bit puzzling. Not sick? I mean, they don’t exactly seem to be in radiant health….
But of course, that’s not quite what we mean. ‘Sick’ means ‘unstable’. It means ‘liable to get worse and die in the next few hours’ or ‘currently requiring rapid escalation of treatment’. Just being on organ support doesn’t cut it.
‘Poorly’ is even worse. Before I went to medical school, ‘poorly’ sounded almost cosy, suited to the kind of ailment that might be dealt with by means of a hot water bottle and a nice glass of warm milk. Now I know that if someone is ‘pretty poorly’ when I start a night shift, there’s a good chance I’ll be signing their crem form in the morning.
Lots of words have a subtly different meaning in medicine. First of all there’s the obvious jargon – ‘neoplasm’ for ‘cancer’, or ‘supratentorial’ for ‘psychological’. Then there are the words which are used in ordinary language but have a different meaning in medicine, words such as ‘acute’ or ‘stomach’.
More interesting, though, are those little turns of phrase which don’t occur in any medical textbook, and sound quite ordinary, but have specific resonances when used among doctors. Take ‘good-going’ or ‘sporting’. Both sound benign, even playful, but in medicine they both mean ‘severe’ or ‘dangerous’. ‘Good-going pulmonary hypertension’ means prompt intervention is needed; a ‘sporting CRP’ is probably over 300.
‘Brave’ is another one. Far from ‘courageous’, treatment decisions described as ‘brave’ may well actually border on the unacceptably negligent. When the consultant at morning handover tells the night registrar, ‘That was…brave’, it certainly doesn’t feel like a compliment.
There are also a number of strange little expressions used to describe patients’ progress. ‘He dropped his blood pressure’ always sounds faintly accusatory to me, as though the patient had done something mildly reprehensible like dropping his trousers. And doesn’t ‘went off’ sound like something that happens to food left too long in the fridge?
Most of us understand that we need to translate medical jargon into comprehensible, everyday language when speaking to patients or relatives. (Not all of us: I remember an elderly man, told he needed an ERCP, asking the surgical registrar ‘What’s one of them, then?’. ‘It’s an endoscopic retrograde cholangiopancreatogram,’ answered the reg, and went blithely on with the consent form.) It gets more complicated, though, if we haven’t noticed we’re using jargon in the first place. The fact that words are short, Anglo-Saxon and easy to spell doesn’t always imply their meaning is obvious.
By the Secret Doctor. Read the blog and follow @TheSecretDr on Twitter and on Facebook
That was a very interesting and relevant article. Thank you!
Beautifully written !
I never realised some of these words has other meanings within medicine, might listen out for them if I have to return to hospital any time soon. As I'm not working in a hospital or GP practice, I've forgotten most of my actual medical words that I learned at college a few years ago. The only one I remember is atrial fibrillation because I have a friend who has that.
I have stumbled over this before: Politely apologising to the parents of a child who needed clerking by explaining that I was seeing "a sick patient". Their pyrexial 3 year old with tonsillitis seemed pretty sick to them.
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