On learning a new language
Taking intro Spanish leads me to reflect on health care lingo
My husband (Arthur) and I plan to spend next year, when he has a year-long sabbatical, in a few places where he has colleagues, and coincidentally those colleagues all live in Spanish-speaking countries. In preparation for our travels, I decided it would be fun to spend this year learning Spanish. I mean, why not? I signed up for Elementary Spanish at our local community college and the class began in September. It meets every Monday night for three hours—perfect. The best part: I can walk there from my house and sometimes on the way home I stop at our neighborhood pizza place and grab a slice. I feel like a college student! It’s fun, but taking Spanish has also led me to think more about the language of health care, how integral that lingo is to caring for patients, and how medical jargon relates to patients’ stories—or doesn’t.
My Spanish is still so basic that I don’t have anything interesting to say about the language or how it differs from English, but taking elementary Spanish has led me to consider language learning in general. I took French in college and still have some basic knowledge of it. I learned German in Germany through the Goethe Institute and became, as they say, “functionally fluent” by the end of three summers. Alas, I’ve lost a lot of both languages, although often when I’m trying to think of a new Spanish word, the French or German one will pop into my head instead. Neuroscience research on the brain shows that language use occurs in specific parts of the brain called the “language network.” I’m guessing that learning Spanish activated my language network and the foreign language part is full of French and German so they populate the blanks in my fledging Spanish.
Thinking about my confusion of Spanish, French and German helps me understand that learning health care jargon did not activate the language network in my brain. Instead, the proliferating and ubiquitous abbreviations in health care stimulated the “danger” and “safety” networks in my head. The importance of using the right acronym or notation was first brought home to me in nursing school when we were given a “Do Not Use” List. The specific list from the Joint Commission—the body that accredits hospitals—includes the following prohibited abbreviations and notes, an explanation of why they’re confusing and therefore dangerous, and the recommended replacement:
IU (International Unit)—Mistaken for IV (intravenous) or the number 10 (ten)—Write "International Unit"
Q.D., QD, q.d., qd (daily)—Mistaken for each other—Write "daily"
Trailing zero (X.0 mg) & lack of leading zero (.X mg)—Decimal point is missed—Write X mg and 0.X mg
We also learned not to write cc for cubic centimeters because it could be easily misread when written poorly and were told to write “mL” instead. The abbreviation “hs” could mean “at bedtime” or “half-strength,” and for obvious reasons was also prohibited, though “hs” would still occasionally show up in written orders for nightly medications.
As a new nursing student I understood that using non-confusing abbreviations and terminology really mattered for keeping patients safe, but once I began working as a nurse I discovered that the possibilities for confusion were not limited to a few acronyms. One day as I was training on the bone marrow transplant floor, my preceptor told me a patient was being sent for TBI. I looked at her with surprise bordering on shock and she in turn looked puzzled at my confusion. “We’re sending the patient for a traumatic brain injury?” I asked. The lightbulb turned on in her head and she laughed. “No. Total Body Irradiation,” she explained.
Chemotherapy regimens have their own acronyms and there are a lot of them—three whole pages in fact on one online link I found. As oncology nurses, it was our job to double-check all orders for chemotherapy. At times that required us to decipher the acronym for the regimen and the dosing of each drug, since neither the name nor the dose was standardized. I remember using a website called chemotherapyregimens.com, which oddly enough is now for sale. The three-page list of acronyms includes regimens I remember giving, including BEACOPP (BEAC back in the day), which stands for bleomycin + etoposide + doxorubicin + cyclophosphamide + vincristine + procarbazine + prednisone. Your guess is as good as mine as to how that collection of medications got abbreviated as BEACOPP. The list also includes “7+3” for idarubicin and cytarabine—the standard treatment at that time for patients with a new diagnosis of AML (acute myelogenous leukemia). You’ll notice that the “7+3” “acronym” consists of numbers instead of letters. And that’s not confusing at all…
Medical television shows are notorious for physicians saying, “Get me lactated ringers, STAT,” but no one I ever worked with in the hospital ever said STAT out loud. It means “right away,” and in emergency situations the urgent need for…whatever would be so obvious that broadcasting that need by saying STAT loudly would be incongruous and unnecessary. However, orders would get written with “stat” and that was supposed to communicate urgency. Sometimes it worked and sometimes it didn’t, depending on the need and how busy the person or place receiving the order was. “Lactated ringers” are a kind of IV fluid used in operating rooms and it’s doubtful anyone would be shouting for them when a patient needed urgent support. More common fluids would be “NS” for normal saline, or “half normal” for half the usual sodium concentration. “D5,” for dextrose, might also be included in the fluids, as in “One liter half-normal saline with D5.”
There’s a power to knowing what all the abbreviations and technical language mean and that’s why it sounds cool when TV doctors yell things no one working in health care would actually say. There’s drama built into the words and acronyms and there’s a whole lot of specialized language. As students, nurses and doctors learn the different parts of the human body and the important chemicals that keep the body working. We also learn a multiplicity of diseases and many many medications, most of which have at least two names. And then there’s everything else. Acronyms for staff alone can overwhelm new clinicians and uninitiated patients and their family members: NP for nurse practitioner, PA for physician assistant, PT for physical therapy, RT for respiratory therapy, and PCT for patient care technician (formerly aides), to name a few.
But all that lingo, fun as it is to riff on it, doesn’t add up to a real language, and that’s an important distinction to make. I supplement my Spanish class with the Duolingo app. It’s enjoyable to use and has taught me a lot, and after I’d used it for about a month I suddenly grasped that I was learning an actual language spoken by real people all over the world. That is, I was not learning random new Spanish words for car, street, house, store, boy and girl. Those words are part of a complex web of nouns, verbs, articles, pronouns and prepositions that have been used to produce great novels and movies as well as give voice to the lived experience of billions of humans.
The distinction between a language and lingo matters because while Spanish (or any language) can be used to tell an intelligible story to anyone who understands it, the same cannot be said of medical jargon and technical language. That’s in part due to the lack of standardization and the expansive possibilities for confusion (TBI vs. TBI), unlike the consistency of meaning in real languages. But more importantly, because medical notations are about facts and details they cannot form a whole narrative of patient suffering. Patients live their illness experiences; they embody their own sicknesses. The language of health care can translate a patient’s symptoms into long latinate phrases and express treatment in multiple abbreviations and potentially confusing drug names, but none of that captures the essence of the patient’s narrative, which in its most fundamental form consists of, “I’m sick. Can you help me?”
I can say it much better in German than Spanish: “Ich bin krank. Kannst du mir helfen?” Whichever language is used, the sentiment expressed by the patient is what’s important. Clinicians—nurses, doctors, NPs, PAs, PTs, RTs, and etc.—have their lingo, and it’s extremely valuable for efficiency and precision in health care. But that verbiage is in service of the patient, or should be, and patients cannot be expected to learn the language of health care the way I’m learning Spanish.
Health care workers will only really understand what patients are saying using the lived language both know. The technical language of medicine exists because bodies and modern treatments are complicated, but it’s important to get the relationship between jargon and real language right. Patients already know the language of their illnesses and one job of clinicians is to translate the patient’s story into precise, useful jargon so that the clinical story of each patient will be intelligible, in medical shorthand, for other health care staff. The patient’s language will never be the same as the clinician’s, but using the latter as a transliteration of the former is what needs to happen to help patients heal.
I’m interested in your stories about jargon used and stories heard, or not, in health care. Leave a comment if you’re so inclined.
Thanksgiving is next Thursday! After a languid fall I find it is suddenly the middle of November. I wish everyone a lovely holiday. As always, six years out from cancer, I’m grateful to be well and cancer-free.
Hugs to all,
Theresa
Wow, this is fascinating! It sounds like medical abbreviations should be the next phase of standardization and simplification (along the lines of, say, making all the controls on all the anesthesia machines the same) to avoid errors. Incidentally, my BIL is a pediatric ER doc, and they have an abbreviation that cracks me up: FLK, for funny-looking kid. They use it for a kid who comes into the ER, and there is nothing obviously wrong, but the kid looks off somehow, and so the doctors assume something is wrong and they need to find out what it is.
Btw, if you are like me, before you know it, Spanish will be your default foreign language, and when you’re casting about for a German word, a Spanish one will pop up. Or at least that’s what happened to me with Czech and German!
Acronyms are really interesting and can mean different things in different industries. My husband, an airport engineer, often referred to PIDs, perimeter intrusion detection. To me, as a nurse who had worked in women's health, it meant pelvic inflammatory disease.