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The Multilingual Physician

April 12, 2019

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Becoming a physician requires learning an entire new language.

Some estimate the number of vocabulary words of the student will double over four years of medical school. Comprised of Greek and Latin roots, medical language is estimated to amount to 15,000 words. Therefore, the student will learn about ten new words per day on average. These terms allow doctors to communicate with each other in specific ways about various disease processes and treatments. Then, the ideas are translated back to lay language through our daily work, and custom tailored to the particular patient or family at hand. This is just the first step in becoming a multilingual physician.  

Interventional radiology has a verbiage all its own. A relative of that used by biomedical engineers, it deals with physical properties of the equipment we use to navigate through the body. Examples include words like hydrophilic (water-loving), tapered, or angled. The beautiful tapers and angles allow us to drive through bile ducts or the kidney’s collecting system to relieve a blockage, providing relief through a conduit measuring a couple millimeters in diameter.

Interventional radiologists employ words normally used in construction,

like “drill,” “cross,” and “plug,” for actions performed in the body. These words lend themselves to the physical, tactile nature of the work, which can treat without cutting or ligating. Likewise, these kinds of words convey the “feel” inherent to an interventionalist’s experience, like when we “pop” into an anatomic compartment to remove infected fluid, or to “dig,” through a chronically occluded artery to restore blood flow.

We use onomatopoeia: words that sound like what they mean: take “slurry,” for example. Gelfoam and contrast slurp back and forth as they are suspended between two syringes, preparing to stop arterial bleeding in a pelvic crush injury.

The language of interventional radiologists embraces neologisms.

Making up words is one of the diagnostic criteria for schizophrenia. Like “Crazy Charlie,” Charles Dotter, the father of IR, maybe you have to be a little nutty to do IR. Terms are made up because procedural techniques are always evolving. So we “Dotter a lesion,” or “embo,” or “recan.” In the land of minimally invasive procedures, the creativity to invent new procedures and new terminology is highly valued.

Sometimes, simplistic terms are given to elegant solutions. A neuro-IR faculty at Brown used the term “thingie” to refer to a homemade cheater, made from a hand-cut sheath introducer. This wasn’t due to a temporary loss for words; this was a term he used for years. The “thingie” was a free tool, that was always available to ease a wire back through a hemostatic sheath valve or catheter hub. Saving us time and kinked wires, maybe the “thingie” deserved a better name. But I like to think it was used purposefully, as a term of endearment. 

Speaking of “cheater,”

let’s not forget about the embarrassing terms we call out in the IR suite. There are phrases that would illicit giggles, were they heard by a random passerby. “Let’s hookup!” is short for “Shall we connect to the power injector?” We often ask for a “three-way,” but what we want is a small acrylic connector called a three-way stopcock. Using common slang is almost another language in the armamentarium of a multilingual physician. 

Leaders in IR sometimes employ technical concepts to describe strategies to shape the future of our specialty. Triangulate, for example, is a mathematical term many use to describe the process they use to target a structure in the body under image guidance. Dr. Laura Findeiss, President of the Society of Interventional Radiology (SIR), used the concept to discuss how we can tackle political and policy challenges at our annual meeting. We can look at variables, like how we think another society may act with respect to certification for stroke thrombectomy, for example. Knowing these variables, we can draw a strategic plan from the imagined line between what we know and what we don’t. We can guesstimate where variables converge, and act accordingly, with the goal, in this case, of improving patient access to this critical procedure. In her discussion, the deftness of her language was key in reaching the multilingual physicians making up her audience. 

We learn a different language as physician leaders.

During a plenary session at the SIR meeting last month, we got to hear Clay Johnston, M.D., PhD, the inaugural dean of Dell Medical School in Austin, describe the process of building a new kind of curriculum. His team had the opportunity to tackle the current problems in medicine from the ground up: through medical education. Their vision is to help change medicine as we know it.

Some of the language Dr. Johnston employed used to sound like gobbledygook to me. Before I became a leader myself, many of these terms sounded like buzzwords thrown around by business people and administrators. More recently, they have started to seem like important concepts, not accessible with our everyday language. So I am trying to learn more, as I walk the leadership pathway, and begin to think about bigger challenges. A steady stream of audiobooks and podcasts populate the backdrop of my day. Through them, I absorb more of this new language. 

As leaders, we learn to speak different languages; we become multilingual in a way. As they switch between these languages throughout the workday, I wonder how many docs even realize they are doing it.

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