Stop talking about language, clinicians

Just about every day, my Twitter timeline sports new examples of how language matters and suggestions of new solutions to newly found language issues. Except that by far most of the problems identified have nothing to do with language. I’ve wanted to write this post for some time – it’s about quasi language problems.

The quasi-language problems became very clear to me with a tweet about a woman who ‘heard voices’:

For so long she had had to, as she explained, “pretend” that she “heard voices”, to get “the doctors” to take her seriously. Her bombardment by silent forces without language, she quickly came to realize, did not count, were not real enough. Were not “real voices.”

At first sight it appears as a language problem – the woman had to adopt a particular phrase in order for her experiences to be taken seriously. Simple? No, not all. In fact, the issue is about access to communication and the ability to tell her story and for that story to be heard. Only in such a way can we cater for all patients, also those who do ‘hear voices’ and want to construct their experience as such.

In other words – in order to make sense of what is described in the tweet, it’s much more useful to see the issue not in terms of language and replacement of one phrase with another, but, rather, as an issue of whether and how I can communicate with a clinician in a way which is useful for me. Moreover, this recasting also allows us to see the communicative role of the clinician and their part in opening and maintaining the channel of communication, as well receiving and communicating along it.

For those who are not very happy with languaging things, you recast in medical terms. Rather than language, see it as an issue of person-centred medicine.

The second example of quasi-language problems came from another tweet in which the author advises their conference audience to mind their language. And so, the author says that a message like:

If you need to contact me outside of office hours, you can email me….

is unfriendly, while a message such as:

I welcome you to contact me outside class and student hours. You may email me….

And I just despair. I really wish psychology stopped offering such simplistic advice, as if a message always has the same meanings and connotations, regardless of who sends it to whom. So, ignoring the interesting contrast between ‘can’ and ‘may’ which, in my view, makes the messages much more complex, let me offer a couple of comments. First, if the first message is sent by a respected and well-liked person, it is likely to be taken as more friendly than the second message if it is sent by someone generally unapproachable and unfriendly. And this is really not rocket science, nor does it require any particular understanding of linguistics to understand it. And so, second, we come to understanding that there are many ways in which we can be friendly and nice to students. It is also considerably better to offer advice about forming relationships rather than offer ‘linguistic advice’ which, I am sorry to say, makes no sense at all.

I actually have a personal third comment. Personally, I would never choose the course run by the person sending the second message. This is because it rings false. I am yet to meet anyone who ‘welcomes’ more overnight emails from students, so, I just don’t trust a person who says it. The message is so syrupy, it’s nauseating. Also, if someone chooses a course on the basis of the contact message, I think they should stop and do much reflecting….

The final example of a linguistic non-problem comes from a recent BMJ blog. Abraar Karan is admonishing his colleagues for the language they use to speak of their patients. So, you shouldn’t speak of the ‘pancreatitis guy’ or ‘the heart failure lady’! Dr Karan calls these ‘transgressions of language’, making an argument about dehumanising people. He continues the argument by quoting an account of a medic who called a morbidly obese patient a ‘whale’. And I almost hear you think – if this is not about language, what is? I’m afraid it’s not – talking about language offers an easy way out of the problem.

Let me ask you the following question. Is it possible to be disrespectful and dismissive of a patient with the use of purely professional language? I hope it’s easy to agree that it is. Using words your patient doesn’t understand, speaking too fast, modulating the tone of the voice, the doctor’s choices of dissing me are just about endless. Will Dr Karan care to ban all of them? Believe me, you can’t, there will always be one which you will not think of.

So, instead of denouncing someone who says ‘the pancreatitis guy’, how about writing a blog about respecting the patient? You know, like, urging your colleagues to be respectful. Because this is what it is about. You could, for example, start by asking them not to type while I talk to them. No language is involved, and believe me, every time I see it, it boils my blood. I haven’t told any doctor to stop (you know, even I am somewhat scared), but I am close.

Also, it’s really hard to tell your colleagues that they are disrespectful, isn’t it? Look what happened to the #doctorsaredickheads thread. Many of your colleagues really pushed back. Imagine what they would do to you, if you wrote: ‘We must respect our patients’. It doesn’t bear thinking, does it?

But let’s consider the issue from the other side. Is the phrase ‘pancreatitis guy’ necessarily disrespectful? What if I chose to describe myself as such. It really doesn’t require leaving the realm of what’s possible to consider that I might say something like:

Hi, I’m the pancreatitis guy who was referred to you.

And then, when we meet again, the doctor, with a broad smile says:

Ahhh, the pancreatitis guy!

Have I been de-humanised? No, I have been remembered!! And you must understand that what we say has context. And I have repeated it so many times, I weep when I have to do it again!

I want to finish with two last points. First, I really wish clinicians stopped worrying about ‘language’. Most ‘language problems’ you have have nothing to do with language. They are to do with your attitude, your communication, or, more generally, what kind of doctor you are. And references to language mostly serve to obscure the issue. So, stop talking about language!

My second point is this. If I think you respect me, that you listen to me, if I have a good relationship with you (like I had with this Eastern European medic who might be gone after Brexit), I will forgive you your language. I really will. In fact,  I will not even care about it. So, stop talking about language. Start talking what kind of doctor you are. Yes, it’s considerably harder.

 

2 Comments
  1. A powerful piece, as always, and making an important point. But is it a case of “either/or” (attitude not language)? For example, here’s the extract from a real consultation that I often quote (from Eliot Mishler’s work):

    Patient: It’s one spot right here. It’s real sore. But then there’s like pains in it. Ya-know how…I don’t know what it is.
    Doctor: Okay…Fevers or chills?
    Patient: No
    Doctor: Okay. Have you been sick to your stomach, or anything like that?
    Patient: [Sniffles, crying] I don’t know what’s going on.

    The doctor’s attitude is rubbish, obviously – but it is irrelevant to point out that he also misses an important language cue in the words “I don’t know what’s going on”? Such language often hints at fears about serious illness and death – and even doctors with generally good attitudes routinely tune out from them, as one can see regularly in videos of consultations etc? So I would argue: 1. Yes talk about attitudes, but don’t ignore attention to language as well 2. sometimes learning about language helps doctors identify that their attitudes weren’t as great as they thought, and start to work on these.

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