Medicalese

By Dr. Jim Ferguson

I’m often asked to comment on or explain what another doctor told a friend or family member. However, I’m careful to comment, other than in general terms, because I have incomplete information. Doctors call superficial opinions “curbside consultations.” They do a disservice to patients and are medicolegally risky because the law stipulates such medical conversations are actual consultations.

It is true that the arcane language of medicine (medicalese), like the legalese of lawyers, can confuse laymen. And like many professionals, it’s hard to operate outside of who I am. I’m a doctor wherever I go. So, not infrequently, I’m asked to explain a diagnosis or a condition, and sometimes a confusing, noncommunicative medical term.

Though I’m fluent in medicalese, several years ago I’ve learned a new term called medical jousting. No, this is not a holdover from the games played by medieval knights. Medical “jousting” is the practice of casting disparaging remarks about other doctors or undercutting a colleague’s patient care. It can be as subtle as furrowing one’s eyebrows while listening to a story or more obviously uttering a disapproving harumph. Sowing the seeds of doubt in someone’s mind, especially with incomplete information, is inappropriate and leads to worry, illwill and lawsuits where no one wins.

The language of medicine is the language of science and derives from Latin and Greek. Alexander the Great conquered the known world in the 4th century BC, and disseminated Greek language, philosophy and culture throughout the world. This process became known as Hellenization, deriving from the Greek word Ellinismos, describing people of Greek lineage. Later, Rome controlled much of the known word around the time of Christ, and incorporated Greek culture into the Pax Romana of its Empire. For the next millennia and a half, the language of education and science was built upon these two ancient cultures.

Understanding some root words, a few prefixes and some suffixes may help you decipher some medicalese; you’re on your own with legalese. The word tumor means a swollen area. A boil is a tumor and so is a breast lump. The former is rarely malignant and most breast lumps are likewise benign or non malignant.

The prefix hyper- refers to an elevated state. Attaching hyper to thyroid refers to an excessive amount of thyroid hormone, the molecule that regulates the metabolic rate of the cells of your body. A deficiency of thyroid hormone is described by the word hypothyroid. Like the idle on your car, you want to be in balance. If set too high your engine races, and if too low your cellular engines chug along and may stall. I once had a patient who fired me because I would not prescribe excessive doses of thyroid replacement hormone for her. She told me she liked the way she felt when she was “hyper,” and it helped to control her weight problem. I explained the dangers of such inappropriate therapy, but she decided to find another doctor.

The suffix -oma means a swollen area or lump also called a tumor. An example is a carcinoma or a cancerous tumor. A meningioma is a non malignant tumor of the meninges or the brain’s covering/enclosing membrane. Meningiomas are the most common primary brain tumor. By primary I mean, a tumor originating in the brain rather than secondarily spreading to the brain. After the age of 40 more than half all brain tumors occur from cancers beginning elsewhere and spreading to the brain. Malignancies of the breast, lung and melanoma are especially prone to do so.

Glioblastoma is in the news again with Arizona senator John McCain’s diagnosis. When considering all cancers, this aggressive malignant brain tumor is not common, but is dramatic and carries a terrible prognosis. Joe Biden’s son died of Glioblastoma, as did Ted Kennedy. One of my favorite writers, a relative’s husband and two members of my wife’s dance class also died from this type of cancer. So, despite statistics this malignancy is on my radar.

The average human has approximately 100 billion brain cells or neurons. Integrative functioning of the neurons produces thoughtfulness. Glioblastoma is a malignancy of the brain’s neural tissue and often presents as confusion, seizures or neurological deficits. Because the brain resides in the protective helmet of the skull, there is little room for swelling, and as a result headaches and nausea are also common with brain tumors.

Additionally, there are about 100 billion other brain cells which support the function of the neurons. These are called glial cells, known as astrocytes, oligodendrocytes and ependymal cells. Not to get lost in the weeds, but these cells also can undergo malignant degeneration. An example is an astrocytoma.

Lately, I’ve been going to doctors with various family members. My wife, Becky has the wise observation that two sets of ears are better than one. And when you are sick or scared processing information is different than during a routine examination. Most of us know of the childhood game “telephone,” where a whispered message changes over repeated telling. And everyone hears things a bit differently. For this reason doctors often encourage a family spokesperson for hospital discussions with family. Even these written words are only an approximation of my thoughts and require processing by each of my readers.

The Psalmist said we “are fearfully and wonderfully made.” This 3000-year-old writing is marvelously demonstrated in the intricacies of the human body. And there is more. As I write, the 100 billion neural cells in my brain function to produce thoughtful words. And I find it majestic that the number of neurons in my brain is on the order of the number of stars in the Milky Way galaxy. And our galaxy is only one of 100 billion other known galaxies in the Creation.

The ancient Greek philosopher, Protagoras once said that “Man is the measure of all things.” Perhaps he did not recognize his statement as one of hubris, the greatest sin in ancient Greece. Unfortunately, hubris exists today in secular humanism, a perspective built on reason alone. Perhaps these modern day sages are unaware of the Proverbist who likewise observed, “Respect of the Lord is the beginning of wisdom.”

 

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