In the 1940s, the idea that our thoughts could be determined by our language came to the forefront with work led by Benjamin Lee Whorf and his mentor Edward Sapir. Their general concepts became the basis of ‘Linguistic Relativity’ — the idea that language affects our essential cognitive processes. While this makes sense intuitively (we think in a certain language or for the more linguistically savvy multiple languages) the extent to which this is true is still being explored and characterized across our 7000+ existing world languages.
An article by Lera Boroditsky a former Stanford professor of Cognitive Psychology in 2011 points out many of her research findings in this domain. A fascinating example of individuals whose language requires reference to the cardinal directions reveals that their thought process in categorizing, organizing and understanding their world requires constant orientation to direction while speakers of other languages could not tell you east from south.
These ideas have always fascinated me in the realm of medicine where a sublanguage has emerged within other languages to seamlessly communicate medical information. This makes sense. Why frequently describe that a dehydrated woman feels dizzy and faints everytime she stands up when we can convey cause and effect in one or two words? The medical dictionary, however, extends into an area that is less recognized, less critiqued and as a result more dangerous. In our non-medical terminology we have picked up phrases passed down from those around us to describe our interactions with patients, frustrations with the healthcare system or even to discuss the world that happens outside the hospital or clinic walls. We have picked up a language that makes it difficult to communicate with people who don’t speak it and continues a cycle of elitism and distance from those we hope to serve.
I found myself in a patient’s hospital room last week trying to explain a 10 item ‘problem list’ I was assessing daily for progress. Regardless of the complexity of his case, explaining the simplest of concepts such as why I couldn’t let him eat (‘we think you have an obstruction’) was riddled with jargon, abbreviations (‘PO intake’) and confusion on both of our parts. It is not because I intend to talk over my patient’s heads. It is because the amount of time spent writing a note, dictating a note, presenting a case, ‘running the list’, and giving verbal orders is 90% of a physicians day. Going back to speaking without these terms the other 10% of the day requires turning off my primary language, which is shockingly difficult to do. When I see a physician do this transition smoothly, I am impressed. It is a skill grossly underemphasized in our educational approach by a system aimed to teach us how to talk amongst ourselves. We, subsequently, forget how to talk with others.
Our thought and cognitive processes are intricately tied to this language. In many ways I think it underlies our difficulty in creating physicians who are simultaneously ‘creatives’ because no matter where we train we are taught to communicate in the exact same way. This language I’ve discovered is hard on patients. Our terms involve dismissal and pretend to be polite: a ‘difficult family’ is code for ‘I really wish they would leave’, ‘AMA’ means a patient did not agree with us, ‘poor historian’ (one of my least favorites) is said about every single patient during every single presentation. We’ve forgotten that a sick person doesn’t have the capacity (or access to their electronic records) to recite every detail of their illness. They either ‘endorse’ or ‘deny’ our questions demonstrating perhaps an underlying mistrust of all patients when it comes down to securing information.
I believe that not enough attention is paid to how we present and communicate information in the medical field. The terms we use to be consistent and objective instead represent a subjective interpretation of our medical world we have adopted — and thus underlining thought processes. Acknowledging and breaking from these patterns will help our newest physicians emerge creatively in their approach to patient care and their ability to relate to those outside of medicine.
Photo Credit: Draws by dohkoo