Medicalese and isolation

I recently had breakfast with an American ex-patriot who moved to Central America. At that time, 20 years ago, she spoke only survival Spanish.  Her language skills allowed her to order food, pay for a purchase or get directions, but lacked the detail and subtly to communicate complex thoughts, ideas or feelings. The hardest part of the relocation became social isolation, even when surrounded by others in animated conversation.  She became profoundly depressed, and it was only when she was able to overcome this hurdle, learn to speak Spanish so as to give and receive emotional support, that she committed to stay in her new, no longer foreign, home.

It occurs to me that healthcare suffers the same problem.  When we become ill, we are not only in pain or weak or simply frightened, we are sent to a place, be it doctor’s office, radiology suite or hospital, where everyone speaks another language, the language of medicine.  This adds to our feeling of confusion and loss a dimension of social isolation.  We assume that the conversations around us are about us, and that what is being said is bad.  We believe that the bizarre words we hear are designed to cover up or convey grim news. We not only have no control, we are socially isolated.   Dehumanized, alone, even when surrounded by others in animated conversation, we become depressed.

We all know that “medicalese”,  i.e. “You have inflammatory hyperplasia without primitive dysplastic changes of the z-line, negative of Barrett’s degeneration,” verses “humanese”,  i.e.  “you have mild benign stomach irritation,”  can result in confusion and poor compliance with medical recommendations.  In addition, not using a patient’s primary language, be it English, Spanish or Greek, causes more chaos. If you do not understand what is happening it is hard to know how or why to fix it.

However, the observation that receiving healthcare in an atmosphere of medical language isolation can lead to depression, makes clear language health teaching critical.  I think experienced and gifted doctors realize that good education relieves part of the emotional burden of fighting disease.  Often at the end of a consultation when the patient finally understands what is happening, they will say, even if the news was not “good,” that they feel much calmer and less frightened.  While a significant part of this reaction is that they regain some element of control, I suspect much of that relief is the chance to communicate and receive emotional support via a language they understand.

The lesson for me is that by the simple act of speaking “Patient”, not “Doctor” I can emotionally help my patients.  This not only empowers the patient and family with information, it relieves feelings of isolation. This inclusive approach to care is critical and should be basic to every medical interaction.  It is exciting to understand that something so simple, so basic, so natural, can go so far.


  • Stephanie Klein
    As a nurse undergoing radiation for breast cancer, I received minimal education from the techs and rarely saw the doctor. This came to a head when I broke down crying, fearful that they were going to surgically implant radioactive rods in my breast. I thought I read something about this and made it much worse in my frightened imagination. They actually laughed at me for thinking this. I was told that because I was nurse they assumed I knew exactly what was going to happen to me. I had only worked in Labor & Delivery and only knew about birthing babies! From that point forward I have requested that all providers speak to me as a lay person and not assume I know what they are talking about. Conversations start out simple and eventually get to the appropriate level based on my questions and level of understanding. Thank you for your insight!
    • James Salwitz, MD
      Boy you have really touched on what for me is a sore subject ... the idea that medical professionals are already experts and therefore can be given care with modified or minimal teaching and support. When a nurse or a doc is ill, or their family is in trouble, they are as needy as any other patient. I trained at the breast cancer section of the NIH and almost half of my own patients are fighting breast cancer, but when my mother had breast cancer in the setting of myeloma I really appreciated being walked through the decision tree by her oncologist. When we are patients, we are patients and not health care experts and should be allowed to assume that complex emotional role. If any thing because of what we have seen in our careers and the anxiety that can invoke, increased support and education is needed. Thank you very much for reminding us of this key concept. jcs
  • Back in the day--way back--I was a nurse. It was a means to an end, really. My plan was to be trained as an LPN, work for outrageously great money, and put myself through college to become an OR nurse. Well, it put me through college and then I graduated with a degree in Historical Studies and American History and went on to work in the academy. A little off course, but I did get through college! All of this to say that having that foundation (though the finer points are eroded) I am able to converse with my doctors in a way that allows them to generally speak their language until I have to ask them to explain. And I am not so intimidated by the culture, I see the difference when my mother and sister are faced with medical emergencies and they turn to me for the translation when the doctor leaves the room. And it allowed me to be a fierce advocate for my brother when he was so critically ill before he died. The time a physician takes to translate his/her words as they speak is minimal and the payoff is priceless to the patient. As one doctor once told me: No one cares how much you know until they know how much you care. Great post!
    • James Salwitz, MD
      Thank you very much for the comment... much appreciated, especially given the source. I guess in the end it is indeed all about trust and that is hard to gain when the patient cannot understand what you say. jcs
  • Lizabeth Santomauro
    So true! I resent when a health professional speaks "above" me, and I leave an office with more questions than answers. It's as if they have to prove that they've had more schooling, are smarter than me, and instead of leaving the office feeling empowered, I feel dis-empowered with a prescription in hand, wondering what side effects and masking of the root of the problem, the medication will have on me. Fortunately, I am only on medication for high BP, and nothing else thus far. Thanks for your compassionate, informative weekly articles.
    • James Salwitz, MD
      It seems to me that someone (i.e. a doctor), who can speak only one language (i.e. medicalese), is definitely not smarter than someone who can easily translate from medicalese to clear instructional English. When doctors fail to communicate clearly, not only does it hurt the patient, but probably shows the docs to be no where near as intelligent as they may wish to believe. Thanks for the feedback, jcs
  • Communication requires both parties to understand each other. Watch any Brit com on PBS and you realize you are probably only catching about half of what is being communicated even though you speak the language- you don't get the accent or the idioms or cultural references that contribute to the humor Lack of communication also occurs when doctors "profile" a patient. A recent article in the NY Times illustrates what harm is done when doctors and other healthcare staff make erroneous assumptions based on a person's mental health diagnosis. But the same errors occur if a patient is "profiled" by race, sex, sexual orientation, age, insurance status, etc. Doctors need to listen to the patient not profile them, Prejudging colors what you hear and see and diagnose and then treat. Learning to maintain an open mind takes practice but it will improve the outcomes for your patients.
    • James Salwitz, MD
      Well said. Thanks for the comment. I am not certain that we say loud enough or often enough to medical students, "suspend all judgement here." jcs
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