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The language of medicine

Posted on November 17, 2013 at 5:55 AM Comments comments (0)


Last week I lived the dream. A visit to the library doesn’t sound like much of a dream, but I was off to lay my hands on William Harvey’s original text on the circulation (Ref 1). The importance of this book, marking the dawn of clinical science, had inflated in size in my mind’s eye to that of a mighty tome. In reality it is tiny, like the pocket sized reference books I kept in my white coat pocket as a junior doctor. The librarian warned me that the book was badly foxed, but the discolouration of ageing was not the reason I found it difficult to read – it is, of course, written in Latin. Fortunately, she had the good sense to leave me a copy of the English translation published a few years later.

As a registrar I worked with an academic who devoted his life to anglicising anatomical nomenclature. So, atria became atriums. “We don’t wait for the croci to bloom in spring, do we?” was a typical challenge. The fossa ovalis became the oval fossa (but why not the oval ditch?). It was a bold effort, but one that has (so far) largely failed.

So it’s hardly surprising that Latin is still part of the everyday lexicon of medicine. I occasionally see ‘discharge mané’ written in the notes. (The acute accent presumably to distinguish the Latin for morning from the hair on a horses neck).

Every profession has it’s jargon and I can see how discussions between doctors must seem arcane to the outsider. My own job involves regular meetings with clinical geneticists. It’s like talking with a group of Norwegians - they are perfectly capable of speaking excellent English but when they speak amongst themselves, the language is impenetrable.

But there is a new language of medicine that many doctors struggle to comprehend - management speak. Woe betide those who cannot translate it, you might miss the vital meeting to discuss allocation of junior medical staff, hidden in the email entitled; ‘Human resources: blue sky thinking and horizon scanning event’. In the management speak world we ‘revisit’ places we have never been to. We are given ‘toolkits’ to ‘drill down’ in ‘workshops’ but there isn’t a spanner to be seen. Undefined acronyms (UNAC’s) are liberally sprinkled into the mix. The end result is an indecipherable word salad of mixed metaphors and gobbledygook that is rarely challenged. I once introduced myself at a management meeting as ‘director of cardiovascular enablement and excellence’. Some nodded sagely, no one stopped to ask what on earth I was talking about.

In Harvey’s day Latin was the international language of medicine, an aid to universal communication. Management speak appears the polar opposite. Despite it’s comic absurdity it represents a pernicious and conceited attempt to manufacture a technical lexicon by those with no specific skills. Or am I just picking the low hanging fruit?

Ref

1. Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus, William Harvey,1628, Frankfurt (see it for yourself at www.rarebookroom.org/Control/hvyexc/index.html)

The generals strike

Posted on November 11, 2013 at 6:05 AM Comments comments (0)


Like dinosaurs, there was a time when general physicians ruled the earth, or at least the acute hospital. A consultant’s power and status was proportional to their involvement in the medical take. But the climate changed, medicine became increasingly complex and specialists bred prolifically so now the generalists have become an endangered species.

From the brink of extinction, the society for the preservation of the generalist (aka The Royal College of Physicians), has come up with a master plan. It’s time for the generals to strike back.

Conscious of the impending perfect storm of an ageing population, ever increasing hospital medical admissions and an inability to train sufficient numbers of acute physicians and geriatricians to look after them (REF 1), the RCP set up the Future Hospital Commission (REF2).

Chaired by a retired general physician, supported by a team heavily represented by general physicians and with an operational lead who is professor of respiratory intensive care in a hospital that only admits patients with heart and lung disease (but still identifies himself as a general physician). Their solution to the crisis looming in acute hospitals is ... yes, you guessed it, reincarnate the general physician.

Opinion is divided. Advocates of this proposal point to the USA where a new species of ‘hospitalists’ has been successfully created to fill the void in generalism in their hospitals (REF 3), but this is a country where by and large ‘primary care’ is what patients get from the first specialist they visit. Comparisons are difficult and If we plan to model the new NHS on healthcare delivery systems in the USA, we really are in trouble.

One fellow of the College wrote “I have always believed in seeing a doctor first, specialist second”. Brave talk. I would like to see him shooing away the cardiologist when he is admitted with a heart attack.

So who will become the generalists of the future? Answer; everyone who trains as a hospital physician (Ref 4). If you thought becoming a dermatologist would allow you to escape GIM, think again. Scrap your plans to become an oncologist if you mistakenly believed your future would be spent looking after patients with cancer. You will be expected to do your share. It’s a bit like the task of cleaning out the latrine; very few really want to do it (REF 5), so we all need to roll our sleeves up and get stuck in. So, all physicians will have to be accredited and maintain competence in their speciality and GIM.

However, as a patient your outcome is likely to be better if you are cared for from the outset by a relevant specialist (REF 6). So why not concentrate the acute facilities in a smaller number of hospitals to allow larger teams of specialists (including geriatricians and acute physicians) to provide the front door service for the acutely ill? Unless politicians loosen their grip on the NHS this will not happen. MP’s will instinctively oppose hospital closures in their patch regardless of any health gain that might accrue from doing so. Perhaps dinosaurs really do still rule the earth.


Refs

  1. Hospitals on the edge
  2. The Future Hospital Commission
  3. BMJ 2012;344:e652
  4. www.shapeoftraining.co.uk/static/documents/content/Shape_of_training_FINAL_Report.pdf_53977887.pdf
  5. BMJ 2012;344:e2240
  6. http://www.bcs.com/documents/37E_BCS_Press_release_March2013.pdf

Mandatory Moaning, BMJ 9th October 2013

Posted on October 9, 2013 at 11:55 AM Comments comments (0)



Bibliotherapy

Posted on July 25, 2013 at 6:35 AM Comments comments (0)


I probably shouldn’t do it at my age, but I do love music festivals. Sure, my interest in sex, drugs and rock & roll has been whittled down to two but the eclectic mix of music, poetry, comedy, dance and the outright zany always hits the spot. This year as I strolled around the fields of Latitude in my festival attire and spray on monkey tattoo, I stumbled on an old ambulance, a relic from the 1960’s. At first glance it looked like a scene from one of the medics’ reviews that I remember so well, I fully expected a medical student to explode from the back of the vehicle armed only with speculum, sigmoidoscope and excessive profanity. But no, this is the bibliotherapy clinic - serious business. I booked an appointment and arrived at the allotted time, but like any proper doctors’ surgery they were running 20 minutes late - I understood. Eventually I was ushered into the back of the ambulance by the nurse-receptionist and was greeted by the ‘doctor’ poised like a latter day fortune teller.

The therapist in the white coat (hasn’t she heard?) was Ella Berthoud from The School of Life and co-author of ‘The Novel Cure: an alphabetical list of ailments with their literary remedies. After a potted life history and résumé of my current ailments, Ella gave me a prescription of reading material. No, not an unreadable stack of information leaflets, but 5 novels.

I have dabbled in bibliotherapy myself. I once suggested to a patient keen on homeopathic treatment for her heart disease that she read ‘Bad science’ by Ben Goldacre. She retaliated with ‘Bad Pharma’ by the same author. Touché!

To help me deal with my melancholia, Ella suggested I read Mikhail Bulgakov’s ‘A Country Doctor’s Notebook’. Perhaps reading about a doctor’s life in early 20th century Russia might make mine in the 21st century NHS seem less arduous. As a balm for my spiritual uncertainties; a dose of ‘Quarantine’ by Jim Crace. And the antidote for middle aged medical blues; some scalpel sharp Finnish wit from the pen of Arto Paasilinna in ‘The Year of the Hare’. All of these treatments can be bought over the counter and some are available in tablet form.

This is good medicine; there are no unwanted side effects to worry about and it seems unlikely any harm will accrue from exceeding the prescribed dose. But, as always, you should not take someone else’s medicine for your own self diagnosed maladies. I was warned that “...when read at the right moment in your life, a novel can - quite literally - change it”. So don’t read my books, that’s my prescription. Get your own.


July 25th 2013


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