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with Rod Moser, PA, PhD

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Monday, January 14, 2013

Speaking Medicalese

By Rod Moser, PA, PhD

doctor

Medicine has always had a semi-secret language of its own. At one time, the language was Latin, just like the Catholic Church. To this day, we still use Latin abbreviations on prescriptions and notes. For instance, when clinicans prescribe a medication four times per day, we use the abbreviation “q.i.d”, which is Latin for quater in die.  Other example would be p.r.n.; Latin for pro re nata, which means as needed. This is not to be confused with p.r. which means per rectum!

Two generations ago, nearly all prescriptions were written in Latin; mostly used as a secret language so the patient was not aware of what they are taking. Since patients could not read what was written by the doctor, they just assumed it was because of poor handwriting. Pharmacists were given concocting recipes, instead of names of pills. It was the responsibility of the pharmacist to decode the Latin prescription names, determine the proper amounts, and then compound a medication that was appropriate for the patient. Most prescriptions were then mixed with alcohol to hold it in proper suspension. A lot of booze was prescribed disguised as tonics or elixirs, and pharmacists were truly chemists and not just pill-counters or bottle-labelers.

Most diseases have Latin or Greek routes in their name. What we call chicken pox is really varicella, not to be confused with variola (small pox).  The Latin term guttae (gtt), means drops, as in giving 3 ggts every four hours. This can be written as 3 ggt Q4h on a prescription pad or in your medical chart.  There is even a type of psoriasis called guttate psoriasis where the skin lesions look like little droplets.

My nephew is working on his doctoral thesis for his Doctor of Divinity. He teaches both Latin and Greek. I suspect he would have absolutely no problems reading a medical prescription. In the future, I would like to go to Italy, so I am hoping my Latin experience in medicine will help me decode some of the Latin phrases on some of the Roman ruins.

Even when medical providers are not confusing patients by using Latin abbreviations on their medical records or prescription, they tend to talk Medicalese. Many will just rattle off some obscure medical term to a patient and just assume that they will understand it. Once during rounds in the hospital, the attending physician pointed out some abdominal “edema” on a child. Later on, when I returned the child’s room, I found her crying.

“I don’t want a demon in my tummy!”

Probably the funniest misinterpretation of a medical term came from an older patient of mine who claimed that her sister had a condition called “Screaming Mighty Jesus” when she was a child. It took a bit of research and time to figure out that she misinterpreted the medical term of “spinal meningitis”.

We often gather a cadre of medical providers in a room to look at the same patient with a puzzling rash. Openly, in front to the patient, they may hear such scary terms as pityriasis rosea, atopic dermatitis, or a viral exanthema. It is up to the last medical provider in the room to interpret the consensus and explain the diagnosis.

Some medical diagnoses just have ominous-sounding names. If I have a family that is overly-sensitive to these things, I may just tell them that their child has a “chest cold”. This is much more palatable than the word pneumonia. A parent is okay when a child is diagnosed with “pink eyes”, but tends to get concerned when you tell them they have viral conjunctivitis. It is so much nicer to inform a parent that the lesions on the lips are just a cold sore, rather than blurting out that their child has herpes labialis, and just leave the room.

The ultimate scary word is cancer. If an adult patient asks me to comment on a skin lesion, I try to avoid saying that it may be skin cancer, at least until I get the biopsy back. I do make it a point by purposely saying “you do not have cancer” if I feel the patient has an underlying fear that their symptoms are cancerous, and it has been proven by examination that this is not the case.

Medical providers should avoid speaking Medicalese without a thorough explanation of what those words actually mean. Latin is fine for abbreviations, but when it comes to patients understanding and participating in their care, this should always be clarified.

Sticks and stone do break bones, and (medical) words can definitely cause harm.

Photo: iStockphoto

Posted by: Rod Moser, PA, PhD at 9:00 am

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