A few months before I applied to medical school, I came across a book in the library called “Attending: Medicine, Mindfulness, and Humanity.” As an aspiring physician, I was drawn to the latter three words in that title. I reached for the book and skimmed my fingertips across the embossed word, “Attending.” Whatever did that mean?
About a year later, I found out. Only this time, I was listening to an impassioned speech welcoming me to the medical profession. A neatly folded, and blindingly white, short coat sat in my lap. It was my white coat ceremony, and the Dean of Admissions had just used the word “attending” in a context I’d never heard before — as if it were a noun. And as if I’d become one someday.
Words like this were swiftly and nonchalantly lobbed my way over the next few years. I’d surreptitiously try to define them on my phone during conversations, worried about seeming naive or ignorant if my peers or supervisors realized that I didn’t know what something meant.
“What are rounds?”
“Define triage”
“Who is an intern versus a subintern?”
What is most remarkable is that all of these words are not inherently clinical, scientific, or medical. They’re words I could define for you, but in different ways. After all, I had been an intern at a startup before. And I’d certainly been to a triage center before. Despite that, my mind was left trailing behind during conversations. I often felt silly or dumb, which caked onto the already rampant imposter syndrome that I was facing as a burgeoning clinician, trying to learn and retain so much information. Luckily, most lecturers in our didactic curriculum recognized this, and sought to be as clear and explanatory as possible.
Once I entered the clinical space, I found that the real world of patient care cannot slow down for novices. The frequency of new words and meanings skyrocketed, now including abbreviations that were pervasive in clinic notes or hand offs that I’d blearily try to interpret at 4:30 AM.
“52 y/o F with PMH of HTN, DM2 and HNPCC…presented with BRBPR…now POD2 s/p APR for lowlying CRC”
I didn’t know what rounds were until I embarked on them for the first time with my colorectal service team of no less than a dozen, but rounds proved even more challenging to navigate than reading patient notes. Residents muttered abbreviations and terms faster than I could scribble them down in the corner of the sheet where I’d written my own patient presentation script, in case I got nervous and couldn’t remember it.
“NAEON. Stable Is and Os with UOP 400 back 250 back 300. One BM overnight. Pain controlled on PCA. Encouraged IS and OOB. Will DC foley today. SCDs and SQH for prophy. No other issues or changes.”
Of course, by the time you understand how one specialty communicates, you move on to another. By the time you grasp the series of abbreviations and terms that are most used by neurologists, for example, you rotate over to the world of ob/gyn. All of a sudden, “cervical” and “fundus” have vastly different meanings.
Language is important. It’s how we find meaning and make connections with those around us. And, in an environment of training, it’s how we learn the science of medicine and develop our communication as healers. As a medical student, being able to understand jargon is essential; without knowing it, you lose efficiency or the ability to mesh with your colleagues, which are critical when you have to prove yourself to your superiors.
Over time though, as you are further enmeshed in the world of clinical medicine, picking up new words or abbreviations comes easily. So smoothly in fact, that you don’t even realize that the way you speak or comport yourself (even in casual situations) might have shifted slightly. Maybe you use the word “unremarkable” or “acute” more often, as I do. Harmless, subtle changes.
But what happens when this habit bleeds over into the way we speak to patients?
One day, I remember counseling a patient during a primary care visit and discussing their levothyroxine and atorvastatin and nonchalantly said, “If your labs are healthy, we’ll keep your levo and statin doses where they are.” I would’ve continued to prattle on had their blank, confused look not given me pause. I quickly realized my mistake, and restarted the conversation, using patient friendly language.
I was pretty unsettled by this event. Wasn’t it only a few months ago that I, a person in medicine, felt confused? The pace of learning in medicine is so rapid, and the content vast; as trainees, we are immersed in medicine. And, as we eat, sleep, breathe, think, and do medicine, the divide between us and the general layperson begins and widens. We forget what it’s like to have minimal understanding of human physiology. The typical baseline of knowledge of medical terms seems higher. We can’t unlearn the nuances of healthcare and sometimes feel that our patients should feel as casual about it as we do.
Since this personal realization, I err on the side of casual terms and over-explaining to my patients, with a tone of respect to avoid any element of condescension. I think about my immigrant family for whom healthcare still seems foreign; and I think about myself in that bookstore.
As we grow into more confident and seasoned physicians, let us not forget how little we knew or how scared we were when we first entered medicine. And let those memories guide our empathy and communication with patients who might also be uncertain or nervous as complex medical conditions and terms are thrown their way. Let us attend to the needs of our patients, in all ways.
Kavya Davuluri is an MD/MBA candidate at the University of Michigan.
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