Farmer Bob proved that medical jargon can scare patients (almost) to death

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We are all familiar with the power of words, whether it be those of kindness or anger, or those intended to harm or to heal.

This power is especially pertinent for us as doctors, as we are often given a window into the most private and vulnerable parts of people’s lives.

In my early years of medical school, I failed a mock OSCE station for using the word ‘hypertension’.

My perfectionist brain simply could not fathom how I could lose marks on something so trivial. I stared at my score sheet, the words “use of medical jargon” with two imposing underlines scrawled under the station number.

Years later as an intern, my world now a real-time OSCE, I realised for the first time the implications of medical jargon. Maybe my tutors were onto something after all.

I was treating a patient, ‘Bob’, a charming gentleman in his late 70s, the quintessential portrait of an Aussie farmer. I met him in the rehabilitation ward, after a gruesome incident of lawnmower versus leg.

Bob and his adventure-fuelled stories were always a highlight of my long and tiring six-hour-plus ward rounds.

After spending close to a month in a major metropolitan hospital, he was finally transferred to our regional hospital, which was several hours from his beloved farm. Inching closer and closer to his goal — to get back on that same lawnmower — his spirits were high, and he remained full of optimism and hope.

Staffing circumstances required me to round alone and report to my consultants after. Fresh out of medical school, I felt grossly unprepared for this undertaking.

One day on a routine round, I found Bob crying hysterically, mumbling some sort of prayer, wooden cross in hand.

I was shocked to say the least. I had walked past his room not long before, where I saw him completely at ease, reading a book as usual.

“Bob, what’s wrong?”

“This is it,” he choked, clutching the cross to his chest. “This is it…”

“What is it?”

“I’m going to die. I’m … it’s sepsis.”

I stood there dumbfounded.

 “Bob,” I said calmly, “you’re not going to die. What’s brought this on?”

It took some time to piece together the events that had transpired over the past hour.

It turned out the visiting specialist who operated on Bob’s knee had stopped by.

Among the many complications poor Bob suffered during his hospital stay was an infection in the joint.

The surgeon had casually referenced the “septic joint”, for which Bob was on the tail end of a long course of antibiotics.

Bob did know he was on antibiotics and was aware of the infected joint complication; however, for him, sepsis was not synonymous with joint infection.

The surgeon left as quickly as he came, leaving Bob distraught, trying to process his grief.

For Bob, like many others, the word ‘sepsis’ carries with it the connotation of suffering, pain and death.

The moment that word left the surgeon’s lips, the damage had been done, despite the fact that Bob’s knee was completely fine.

Blood pressure soaring, I had been left to pick up the pieces of the panicked farmer.

I remember Bob saying something along the lines of: “If I gave you some tools, materials and told you to build a shed, would you know what to do next?”

Humbling, indeed.

I sat down with Bob and went through his entire medication chart at his request, explaining everything, jargon free. He was eternally grateful. 

Months later, after being discharged back to his farm, I was called rather dramatically over the hospital speakerphone to present to reception.

I was terrified, but much to my surprise it was farmer Bob, driven by his wife with the most beautiful bouquet of flowers, chocolates and a card — signed with his bed number.

I still have the card to this day. I was pleased to hear he was back on the lawnmower.

Taking it to heart

Bob’s experience reminded me of a story from the late Dr Bernard Lown, cardiologist and author of The Lost Art of Healing — a must read for all medical professionals.

In his chapter ‘Words that Maim’, Dr Lown recounts an experience from his training days, where his consultant diagnosed a patient with “a case of TS” (tricuspid stenosis) before whizzing away to the next patient.

The lady had instantly taken this abbreviation to mean ‘terminal situation’.

Once the supervisor left, every attempt was made to placate the patient — with no success.

It did not take long for her breathing to become more laboured, vitals raging, and although just examined not long before with a clear chest, she now had severely fluid-congested lungs, not responsive to the usual methods of management.

She died later that night.

I can think of many other (less dramatic) examples of an intense emotional reaction to poorly chosen or medically loaded words.

One time, I was pleased to inform a patient of their “benign” condition — but as I scanned their face for that smile of relief, I noticed they were just as stressed as when they arrived.

It turns out the patient did not know that ‘benign’ meant ‘no cancer’.

Another more amusing incident involved a patient asking me rather anxiously about their diagnosis of ‘rhinorrhoea’ — a word not used by me, but by one of the other doctors.

The thought that someone would use this term beggars belief, as it truly does sound like a rare diarrhoea contracted from a rhinoceros. 

Back to Dr Lown’s book, he recalls reviewing another patient recovering well following a heart attack.

The patient appeared in the lowest of spirits and unusually tachycardic. Upon enquiring what was wrong, the patient replied: “The intern tells me I had a heart attack; the junior assistant resident speaks of an acute myocardial infarction; the senior resident calls it a coronary thrombosis; while the attending physician indicated I had suffered an acute ischaemic episode. How in God’s name can anyone survive when there is so much wrong with his heart?”

So, this is a gentle reminder to choose your words carefully — their potential for injury is great, but we know they are even greater for healing and recovery.

To quote Dr Lown: “I know of few remedies more powerful than a carefully chosen word. Patients crave caring, which is largely dispensed with words. Talk, which is therapeutic, is one of the underrated tools in a physician’s armamentarium.”