On calling a spade a spade

aFall 1996

PHYSICIANS USE cryptic abbreviations, snobbish cliches (it is never "before," but always "prior to"), and sundry ungrammatical, unintelligible abominations. Nevertheless, our Medical/Dental Staff proposed—and approved—that henceforth a patient shall be called a patient, not a "client or a "customer"; and, likewise, that a physician shall be named just that, instead of "health care provider," "medical care deliverer"or any other ill-suited forms of nonsense in current use.

Now the success of this proposal was not owed to a sudden surge of love of linguistic purity among doctors, but to the troubling suspicion that language is deliberately being misused to shape a new, and presumably erroneous, mode of thinking. "To undermine a culture," a revolutionists’ tenet asserts, "you must first attack its language." As managed care replaces the traditional styles of medical practice, the ideas and methods of industry are being gradually introduced into the hospital and so is a whole terminology ("zero defects," "productivity," "provider" and so on).

American medicine benefits from adopting the raw-boned, unforgiving self-scrutiny and efficient practices of the business world. But no amount of improved productivity or buoyancy of the bottom line should obscure the fact that the assembly line is not the patient’s bedside; that quality and outcome cannot be measured in the same way for manufactured products and for children enduring pain, affliction or illness; and that physicians must not feel compelled to prefer the study of business over that of human suffering and its alleviation.

Aside from the value of words as ideological weapons, we applaud the proper use of words simply for the sake of clarity. It is not true, as some argue, that "patient" sounds patronizing. There is no flavor of condescension in this word. Its Latin root, pati, to suffer, is in "passion," used to signify the sufferings (the passion) of Christ. The O.E.D. defines a patient as someone with the capacity to endure with composure, and who is lenient toward others or toward his own ills. Far from having a patronizing connotation, the word carries a compassionate, even admiring, undertone. Other acceptations are "one who suffers from bodily disease," "the inmate of an infirmary or hospital," and one who "undergoes the action of another," i.e., a correlative of "agent." Any of these meanings is appropriate and well-suited for our ordinary use; clearer than (therefore superior to) the bastardized expressions that have been proposed in its stead.

Tropes, euphemisms, and barbarisms, attempt to restore the dignity and upgrade the status of the oppressed. The old become "senior citizens," garbage collectors become "sanitation engineers." The intent is laudable, but the aim is not always achieved. The effect may be the opposite of that sought: the new expression sounds jeering, or preposterous. The medical profession is in a difficult pass and needs to think clearly. Changing words such as "patient" and "physician" for expressions full of ambiguity will only increase the confusion.

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