Making sense out of the language of medicine: cutting out the unneeded harm

Words can hurt !!! but words can aid healing.

This is the point of this blog … getting this right can have a very powerful effect on therapy given and in helping our bodies attempts to heal ………….

“You have crumbling bones”!!

” you have a trapped nerve”

“It is just arthritis, live with it”

These some examples of phrases I have heard said and had my patients tell me they have been told. But you know words that are spoken to us have the added benefit or problem in HOW they are delivered. The voice used, the non-verbal body language that infers things like “caring”, honesty, eye contact these sorts of things that suggest we are trying get the right message to you. Do you get listened to in a way that allows me to reply with the right terms and language that you recognise & understand but still get over the diagnosis (what is wrong) and the prognosis (treatment and expected results) correctly.

Many medical terms can be thought of as “umbrella terms”  for instance LOW BACK PAIN; what does that tell you? it tells you what you told me !!! but what is the cause? … is it ligament, muscle, bone, disc, alignment, “out of joint”, muscle imbalance, postural; ’cause you’re over weight!, is it a major problem, genetic, lifestyle based,does it come from somewhere else (referred pain) kidneys for example. What is most likely it is NOT an either or issue. There will be muscle issues, mobility/stiffness issues possibly nerve issues there will be many INGREDIENTS; the Doctors or Physio’s interpretation may vary depending on the questions we ask, the answers you give, on how you are that day. The process I often think is like dealing with a crime-scene; facts gathered and eventually some suspects or PROVISIONAL DIAGNOSIS can be made. Your condition should change (ideally improve) so the suspects or diagnosis may change to … this is how it is.

Other similar umbrella terms are:-

non-specific low back pain – which translates as ” not sure what it is but it’s not serious and should get better”

Mechanical low back pain – it’s the machinery (muscles etc)nothing serious

Tennis elbow – pain on the outer bony area of the elbow with an ache in the forearm: Probably to do with forearm tendons/muscles. But could be referred.

Sciatica –  shouldn’t be used as “umbrella” term but not infrequently is. Pain down back of leg from a “trapped nerve” (there’s another one!!!) Sciatica should only really be used if the nerve fibres that conduct the impulses up and down the nerve to and from the brain are damaged. And NOT if the outer covering or sheath is pressed or inflamed. Think of an electrical cable if the outer white cable is indented or cut this often has no effect on the connection to the electrical system – its is similar with a nerve.

SO, I guess being honest with patients and taking time to use the right words & the right metaphors that educate, remove fear and promote understanding is vital. I will come back to METAPHORS in later blog. These are useful but may inadvertently not hep as intended. I like them but always check that the patient “GETS IT”; I’ll ask ” can you tell me what that analogy/metaphor says to you “?

Empower though understanding – ” so the problem is ….. and if I do my exercises then …… and should be better in ….so the pain is about protection and healing then……”  These are questions and answers the patient should know. Healing is more likely in this scenario. As against ……” well it could be muscle but not really sure, try these exercises and if isn’t better come back…”

I often ask my patient so what have you been told by the Dr, therapist? the answer is quite often “oh, nothing!!”. This can’t be right all the time – they just haven’t been told anything that MADE SENSE or empowered them.

Medical terms are scary -de-medicalise where possible. If you are the giver of information ask “what do understand from what I have said – I want to be sure I have told you clearly” IF you are the receiver ” so let see if i understand what you have told me….”

This is just short amble into a huge topic, but an important one. I hope you find it useful but as ever – take what sounds like sense & ignore what doesn’t but you never know it might get you thinking.

Thank you: Alan

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