What Your Doctor Is Saying

A Day in the Life

By Robert H. Shmerling, M.D.
Beth Israel Deaconess Medical Center

Doctors frequently use medical terminology even when they don't need to. Maybe it's just habit or the need to make the medical record seem more, well, medical. Habits are hard to break, and doctors are no exception. And that's why your doctor may ask you about common activities but use uncommon words to record your answers. Just try reading your medical record — you may be surprised at the amount of "translation" required even when the topic is not particularly medical.

Here's how a typical day might sound if narrated by your physician.

Morning

You awaken and ambulate to the bathroom; although you are awake, it feels like somnambulism. Your gait is antalgic but it's just post-static dyskinesia. Xerostomia improves after gargling. The dentinal sensitivity is tolerable as long as you can clear both supragingival and subgingival plaque; after all, if you have enough caries, implants may be required. After expectoration, you shower, noticing more than usual amount of follicles in the drain — could you be developing the dread alopecia? You walk into the dining room with a festinating gait; after mastication and deglutition, you finish your high-lactose, high-fiber meal, drink fluids high in ascorbic acid and drive to work. On the way, you rely heavily on proprioception and visuomotor integration. The new refraction sure makes it easier to forget you're myopic; fortunately, presbycusis isn't a problem — at least not yet.

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Afternoon

Sitting at the computer, your efficient saccades make quick work of the document. Fortunately, the ergonomic evaluation helped the cervical myalgia that had been so bothersome for weeks. The staff meeting goes well, thanks to your high neurocognitive function, although there was that moment when anomia stopped you in your tracks and your assistant had to come to your rescue. As embarrassing as that was, your boss's constructive apraxia was even worse, or maybe he wasn't really trying.

The day wears on, and soon borborygmi and epigastric pain reminds you it is time to eat. After lunch, your thoughts turn to the cold, damp and short days of the season and your reflux returns — seasonal affective disorder? Dysphoric mood with somatization? These are possibilities, you think, but anaerobic, aerobic, isotonic and isometric exertion might just do the trick. At the gym, you know you're working hard — after all, the diaphoresis, tachypnea and vasodilation are obvious; but the monitors tell you that your tachycardic response is at the target range for cardiovascular fitness given your chronological state.

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Evening

Finally, you leave work and stop by the local diner where your workmates meet you for regular doses of ethanol. You wonder: Some ethanol is healthy, but am I ingesting too much? In fact, one of your friends tells you about a guy at work with hepatic dysfunction; he won't be joining you this evening — doctor's orders.

You're careful not to repeat the events of last night. Eating too fast, dysphagia, aspiration and eructation complicated your meal; so you order something bland. After dinner, you realize that somnolence will soon give way to lethargy and obtundation; just standing, you feel presyncopal. It's all you can do to get home, get supine, and begin your unconscious routine of bruxism and physiologic hypnic myoclonus. The rhonchi are audible throughout the apartment; even the neighbors have complained and the cat won't sleep in your room anymore because you sound like you have stridor. Maybe you should have your pharynx evaluated — sleep apnea can be a dangerous thing. Soon, you're drifting off to sleep. All is still, except, of course, for your fluttering uvula.

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A Basic Failure To Communicate

Your doctor may use terms that are unfamiliar to you even without realizing it. As strange is it may seem, medical terms that are foreign to you may be so routine for your doctor that he or she forgets what is "normal" and what is technical. And though they may not like to admit it, it is not rare for two doctors to have problems communicating with each other, especially if they practice in different areas of medicine. The solutions to this important problem: Doctors must use language that their patients understand, and patients should speak up when they don't understand what their doctor is saying.

While it's true that sometimes meaning can be "lost in translation" there is almost always a way to relay the information from doctor to patient using plain language. A well-chosen metaphor or analogy can also go a long way. For example, when describing congestive heart failure, doctors may liken the heart to a balloon that has been filled with water and stretched out and unable to go back to its original, smaller shape. When I talk with arthritis patients about the cartilage that lines their joints, I often mention fried chicken: that shiny white material at the end of a chicken leg is cartilage and is an easier, more familiar way to talk about joints than trying to provide a technical description.

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The Bottom Line

While it may seem unnecessary for health care professionals to use medical terms when a "regular" term will do, there are reasons they use technical jargon. More precise terms, fewer words, and a common language with other medical providers make that the best way for doctors to communicate with each other and record information in your medical record. Still, it's usually true that technical language is not better language for talking with nonmedical people. After all, the point of language is to communicate, and if the terms are obscure and the audience includes nonmedical people — as is increasingly the case as more and more people ask to read their medical records — communication will fail. If you don't understand what your doctor is saying (or writing), ask for a translation and keep asking until it is clear.

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Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

Glossary

ambulate — walk
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somnambulism — sleep walking
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antalgic — painful
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post-static dyskinesia — difficulty or stiffness moving after being sedentary
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xerostomia — dry mouth
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dentinal sensitivity — sensitive teeth due to thinning of the protective covering of the middle layer (or dentin) of the tooth
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supragingival and subgingival plaque — a gel-like material containing bacteria, viruses and other organisms that sticks to teeth; when present for a prolonged period of time, it may promote tooth decay
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caries — cavities
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implants — dental devices surgically inserted into the bone of the jaw to anchor a crown or a denture
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expectoration — the act of coughing something up, such as phlegm or mucus
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follicles — hairs
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festinating — shuffling, stuttering
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alopecia — hair loss
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mastication — chewing
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deglutition — the act of swallowing
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high-lactose, high-fiber meal — such as cereal and milk
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ascorbic acid — vitamin C, as in orange juice
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proprioception — sensation of position
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visuomotor integration — taking in visual information and moving the body in response
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refraction — using a lens to bring objects into focus; used to determine the "prescription" for glasses
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myopic — nearsighted
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presbycusis — impaired hearing
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saccades — the normal jerky eye movements used when scanning a page
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ergonomic evaluation — assessment of one's environment, such as where one works, to maximize comfort during use; for example, adjusting the chair, keyboard and computer monitor to avoid wrist, elbow or neck strain
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neurocognitive function — how well your brain processes information
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cervical myalgia — muscle pain in the neck region
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anomia — difficulty thinking of an object's name
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constructive apraxia — difficulty drawing a figure
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borborygmi — rumbling noises from within the intestinal tract
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epigastric — the area just above the stomach, in the middle upper abdomen
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reflux — when a substance washes back outside its normal area, as with stomach acid "refluxing" into the esophagus causing heartburn
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seasonal affective disorder — depression or feeling sad during certain seasons (especially winter)
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dysphoric mood — depression or depressed mood, sadness
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somatization — physical distress that is psychological or stress-related; for example, a tension headache that reliably follows emotional stress may be a form of somatization
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anaerobic — without oxygen; for example, exercising muscles that are working so hard (as during a sprint) that they must use available energy without the immediate use of chemical reactions that require oxygen
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aerobic — with oxygen; for example, exercising muscles that are working steadily and rely on increased oxygen availability; jogging or biking at a steady but demanding pace that increases the heart rate is aerobic exercise
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isotonic — describes an exercise in which muscle tone does not change, as in stretching
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isometric — describes an exercise in which muscle length does not change, as in holding a heavy weight still over one's head
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diaphoresis — perspiring, sweating, feeling flushed or hot
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tachypnea — breathing rapidly
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vasodilation — dilation of vessels, as when arteries or veins open up during exercise
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tachycardic — describing a fast heart rate or pulse
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chronological state — one's age
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ethanol — the form of alcohol in alcoholic beverages
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hepatic dysfunction — abnormal liver function
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dysphagia — difficulty swallowing
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aspiration — inhaling something into the lungs or airways
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eructation — burping or belching
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somnolence — sleepiness, decreased level of consciousness
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lethargy — slowness to respond
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obtundation — severely decreased level of consciousness
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presyncopal — the feeling you may lose consciousness
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supine — lying flat on the abdomen
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bruxism — grinding teeth
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physiologic hypnic myoclonus — harmless twitching movements that occur as one falls asleep
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rhonchi — noisy breathing from turbulence in the airways
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stridor — a harsh, vibrating noise coming from the airways in the neck
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pharynx — throat
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sleep apnea — interruptions in breathing during sleep
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fluttering uvula — the uvula is the tissue that dangles from the back of the throat and causes gagging if touched; it moves rapidly, or flutters, when people snore
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