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Should we always get the words right?
DISSECTING ROOM
LIFELINE Alison Holmes Alison Holmes trained in medicine, infectious diseases, and tropical medicine in London and Oxford, in the UK. In Boston, USA, she completed a fellowship in infectious diseases, pursued research in molecular epidemiology and bacterial genetics, gained an MPH at Harvard, and became codirector of the Boston City Refugee and International Health Centre. She is now senior lecturer in hospital epidemiology and infection control at Imperial College, London, an honorary infectious diseases consultant, codirector of the International Health Unit, and the medical adviser to the Overseas Training Programme of VSO. Who was your most influential teacher, and why? Harold Lambert. He convinced me that infectious disease was the most fascinating and challenging of all specialties. What would be your advice to a newly qualified doctor? Be kind to your patients and to their families. What is the best piece of advice you have received, and from whom? “Life’s too short to drink cheap beer”, G Lang of New York City. How do you relax? Feet up, glass of wine, TV. What is your greatest regret? Not having more children. Do you believe there is an afterlife? No, but I’m hoping. What are you currently reading? Margaret Atwood’s The Blind Assassin. What books are you not reading? I just could not finish Salman Rushdie’s The Ground Beneath Her Feet. What is your favourite country? May I choose a continent? Africa— I was born in Nigeria, had a wonderful childhood in Tanzania, a home, then work in Swaziland, incredible trips to Zimbabwe, fell in love in Botswana, and was taught to fly in the Eastern Cape. What part of your work gives you the most pleasure? Getting the right diagnosis, identifying the organism, starting the right treatment—and then seeing someone get better.
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Should we always get the words right? ince having to use a wheelchair as a result of spinal cord injury, many people have approached me with varying strategies. Comments have included “What are you doing in a wheelchair?”, “It must be really terrible being in your position at such a young age”, and “You’ve had a stroke”. But, if a stranger must say something, what would be a suitable thing for them to say? An initial “I hope that you don’t mind me asking” makes no judgment of the person’s situation other than to acknowledge the potential sensitivity of the question to follow. On the other hand, “I don’t mean to be rude, but . . .” is more confrontational and intrusive, and a harder remark to dismiss. People often find these sorts of situations rather awkward, but being able to admit our insecurity and fallibility can be a positive thing. Thus, a simple apology in advance for saying anything inappropriate can sometimes be revealing and strengthening in an exchange, whether doctor-patient, doctor-health professional, or any other. Somehow, it can ease tensions that might have otherwise distracted. Certainly, doctors should not be lazy with language and should try to be accurate in terminology when talking to patients. Even so, an overzealous medical explanation can lead to misunderstanding by the patient, and mean that other important aspects of the consultation process are overlooked. Communication is indeed a two-way process. One particular encounter as a medical student made this very apparent to me. In my wheelchair, I approached a gentleman on a medical ward who was recovering from a stroke. He had been attending physiotherapy twice daily, and he started to complain to me in a frustrated manner about its rigours and how I could not understand. After he had finished telling me his grievances, I pointed out my situation with a wry smile. The incident
S
was passed over with amusement rather than animosity, and the gentleman apologised—his comment had certainly been made without any malicious intent. It goes to show that even when impairments are not hidden, and the clues are as obvious as a wheelchair, they are sometimes missed. Assumptions in an exchange come from both sides. So how do we change things? We are rarely able to alter someone else’s prejudices. Nevertheless, we should certainly try to recognise our own, so that at least they are not so strong. Being a person with a longterm impairment does not necessarily make me a good communicator. It has simply made me consider other people’s perspectives, whether or not they have an impairment, more than I would otherwise have done. As a doctor, attempting to imagine yourself in the patient’s situation makes you consider that person more compassionately and individually, rather than as another patient in the conveyor-belt of cases. This ability can in itself affect how you relate to that person. What matters is communicating what we mean. Communication should not be overshadowed with the worry of getting every word right. It’s the sum of the words and sentiments with which they are said and received that really matter. Language constantly changes, often reflecting society’s attitudes. Long gone are the days that crippled and handicap were tolerable words—and disabled is even now becoming less acceptable. Although it is important to keep track of this change, the most valuable thing to do is constantly to examine one’s own ability to communicate. Although I would always want to acknowledge the difficulty and challenge of getting the words right, non-verbal communication should not be forgotten. Sometimes a friendly face and pleasant manner are more important than the words—but ideally both should be right. Tom Wells
THE LANCET • Vol 359 • February 23, 2002 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.
LIFELINE Alison Holmes Alison Holmes trained in medicine, infectious diseases, and tropical medicine in London and Oxford, in the UK. In Boston, USA, she completed a fellowship in infectious diseases, pursued research in molecular epidemiology and bacterial genetics, gained an MPH at Harvard, and became codirector of the Boston City Refugee and International Health Centre. She is now senior lecturer in hospital epidemiology and infection control at Imperial College, London, an honorary infectious diseases consultant, codirector of the International Health Unit, and the medical adviser to the Overseas Training Programme of VSO. Who was your most influential teacher, and why? Harold Lambert. He convinced me that infectious disease was the most fascinating and challenging of all specialties. What would be your advice to a newly qualified doctor? Be kind to your patients and to their families. What is the best piece of advice you have received, and from whom? “Life’s too short to drink cheap beer”, G Lang of New York City. How do you relax? Feet up, glass of wine, TV. What is your greatest regret? Not having more children. Do you believe there is an afterlife? No, but I’m hoping. What are you currently reading? Margaret Atwood’s The Blind Assassin. What books are you not reading? I just could not finish Salman Rushdie’s The Ground Beneath Her Feet. What is your favourite country? May I choose a continent? Africa— I was born in Nigeria, had a wonderful childhood in Tanzania, a home, then work in Swaziland, incredible trips to Zimbabwe, fell in love in Botswana, and was taught to fly in the Eastern Cape. What part of your work gives you the most pleasure? Getting the right diagnosis, identifying the organism, starting the right treatment—and then seeing someone get better.
720
Should we always get the words right? ince having to use a wheelchair as a result of spinal cord injury, many people have approached me with varying strategies. Comments have included “What are you doing in a wheelchair?”, “It must be really terrible being in your position at such a young age”, and “You’ve had a stroke”. But, if a stranger must say something, what would be a suitable thing for them to say? An initial “I hope that you don’t mind me asking” makes no judgment of the person’s situation other than to acknowledge the potential sensitivity of the question to follow. On the other hand, “I don’t mean to be rude, but . . .” is more confrontational and intrusive, and a harder remark to dismiss. People often find these sorts of situations rather awkward, but being able to admit our insecurity and fallibility can be a positive thing. Thus, a simple apology in advance for saying anything inappropriate can sometimes be revealing and strengthening in an exchange, whether doctor-patient, doctor-health professional, or any other. Somehow, it can ease tensions that might have otherwise distracted. Certainly, doctors should not be lazy with language and should try to be accurate in terminology when talking to patients. Even so, an overzealous medical explanation can lead to misunderstanding by the patient, and mean that other important aspects of the consultation process are overlooked. Communication is indeed a two-way process. One particular encounter as a medical student made this very apparent to me. In my wheelchair, I approached a gentleman on a medical ward who was recovering from a stroke. He had been attending physiotherapy twice daily, and he started to complain to me in a frustrated manner about its rigours and how I could not understand. After he had finished telling me his grievances, I pointed out my situation with a wry smile. The incident
S
was passed over with amusement rather than animosity, and the gentleman apologised—his comment had certainly been made without any malicious intent. It goes to show that even when impairments are not hidden, and the clues are as obvious as a wheelchair, they are sometimes missed. Assumptions in an exchange come from both sides. So how do we change things? We are rarely able to alter someone else’s prejudices. Nevertheless, we should certainly try to recognise our own, so that at least they are not so strong. Being a person with a longterm impairment does not necessarily make me a good communicator. It has simply made me consider other people’s perspectives, whether or not they have an impairment, more than I would otherwise have done. As a doctor, attempting to imagine yourself in the patient’s situation makes you consider that person more compassionately and individually, rather than as another patient in the conveyor-belt of cases. This ability can in itself affect how you relate to that person. What matters is communicating what we mean. Communication should not be overshadowed with the worry of getting every word right. It’s the sum of the words and sentiments with which they are said and received that really matter. Language constantly changes, often reflecting society’s attitudes. Long gone are the days that crippled and handicap were tolerable words—and disabled is even now becoming less acceptable. Although it is important to keep track of this change, the most valuable thing to do is constantly to examine one’s own ability to communicate. Although I would always want to acknowledge the difficulty and challenge of getting the words right, non-verbal communication should not be forgotten. Sometimes a friendly face and pleasant manner are more important than the words—but ideally both should be right. Tom Wells
THE LANCET • Vol 359 • February 23, 2002 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.