Supervising Editor: Brian Zink, MD.
I Speak Doctor
Article first published online: 23 DEC 2011
© 2011 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 19, Issue 1, page 114, January 2012
How to Cite
Nestor, E. (2012), I Speak Doctor. Academic Emergency Medicine, 19: 114. doi: 10.1111/j.1553-2712.2011.01244.x
- Issue published online: 17 JAN 2012
- Article first published online: 23 DEC 2011
I was unable to learn Latin or French in high school, had a very poor grasp of German in college, and achieved a passing familiarity with some ancient Greek texts in the graduate school where I got a Master of Divinity degree, years before I earned an MD, but I speak fluent Doctor.
For an emergency physician, that means that the history a patient gives, teased out of the background static, mixed in with family input, separated from the ambient noise, added to the lab and radiology data and the old charts of this patient one has just met can be summed up in 30 seconds to another doctor. Further, it can be translated in a meaningful way to patient and family: mulled over, repeated back, challenged in its details, tweaked, and agreed upon by most parties, to become a plan of action.
I had a predoctor career that involved interpretation to a mixed audience of the ancient texts mentioned above (I am ordained, but then, most doctors think that about themselves), so I am used to divining the entrails, to making the mysteries transparent, and that has come in handy.
Sometimes there are in fact no mysteries, and a simple “Please stop smoking” is all I feel I need to get across. The COPDer, now breathing better on bi-pap and waiting for a bed, nods politely: “Sure, Doc.”
Other times when a family is gathered at a bedside, when a chronic disease has taken a turn for the worse, or new and concerning symptoms have arisen, my skill is called for. Language is always specific to circumstance and adapted to situation, and I find it difficult after close to 25 years to think about diseases in plain English when I am figuring things out. It is after the puzzle has fallen into place (rightly or wrongly) that I find the time to sit and talk: allaying fears or confronting them, interpreting the runes, relaying decisions and refusals, predicting a hospital course, confirming the gravity of the situation, or persuading someone that it is safe for the moment to go home. I speak Doctor, but it can take some time and some effort to close the circle from English to Doctor to English (let alone if Spanish or Portuguese or some Laotian dialect is part of the mix; I know that “tired in my chest” is not the same thing as “chest pain,” but it takes some effort to sort that out). Their question of whether a brain transplant might help a brain-dead family member, and my question to them about the patient’s organ donor wishes, need to be addressed at some length with attention to plain speaking and tragedy and silences and growing acceptance, and I fight to get the time and space for that discussion. That blood test will not change things; restarting the heart cannot be done; an MRI is not magic.
When I retire I might offer my services as a translator to the hospital, which is something I do now for friends and family and friends of friends or family of friends of …, but my sense is that the value of this skill lies in the fact that it is THE doctor, the patient’s doctor, who cares to make clear the unknown, the feared, in language that can be grasped. Learning to speak the obscure language of medicine is an eagerly and early-acquired skill in medical school; learning to speak to patients in their own language of sickness and health, and to hear the questions not asked, the ones that really matter, can take years.