BY MIKKAEL A. SEKERES, MD, MS
As oncology doctors and nurses, we have entered a discipline within medicine that is almost beyond reproach. Every day, we face people who have been given the news they have dreaded their entire adult lives, that they have cancer, and we tie that word to them in a way that is all too personal, and real. Somehow, we have all learned to repress our natural urge to shrink away from these terrible diagnoses, from that word cancer, and we confront the challenges of treatment, and sometimes of treatment failure, alongside our patients.
But sometimes, our language betrays us.
I am no innocent bystander. I, too, have been guilty of backing into answering questions, of being corrupted into linguistic meekness at the hands of my own subconscious by that scourge on our collective diction: the double negative.
“So Doc, how often do patients actually get a neuropathy from vincristine?”
“Well, it’s not uncommon.”
Not uncommon? Does that mean it’s common? At what percentage does it go from being not uncommon to common? 20%? 40%? Is that a category on drug labels that I somehow missed? So, if a side effect is seen in 1-10% of patients, it is not uncommon. But if it is serious or seen in >10% of patients, it is common and garners a black box warning. Right?
How about this one: “Do you use iron chelation in your patients getting blood transfusions?”
“Rarely -- you know the practice is not without its detractors.”
Whoa -- I think I got chest pain from that one. So, iron chelation is not without people who say you should go without chelation, meaning you should leave iron within the body. Got that?
I think it is our natural tendency to be kind -- to minimize the impact of what we’re saying, be it a discussion of chemotherapy side effects, or an opinion about the value of a given treatment when we disagree with someone -- by easing into a response, even by lengthening our answer by adding additional words, to give our listener more time to absorb it. We also do this by being redundant.
“Do you want to give the patient another course of chemotherapy?”
“I think we’ll hold off on treatment at the present time.”
I love the phrase, “at the present time,” because it really kills two birds with one stone: it’s both redundant (that the decision is being made at this moment is implied in both the question and the answer), and it uses 4 words, 16 letters, to replace the word “now,” representing regional spread, if not an outright metastasis of verbiage.
How about this one: “So, you’re suggesting a 4-drug regimen?”
"It’s a very unique chemotherapy combination that was utilized by a group in France.”
Now I think the chest pain I had before is radiating down my arm. I better chew on an aspirin. To be fair, the first part of that response is an error endemic not only to oncologists, but also to local newscasters throughout the country, particularly on the FOX network.
The word “unique” means “one of a kind.” It is thus impossible to modify--you’re either one-of-a-kind, or not, but you can’t be very one-of-a-kind -- even if you’re Lady Gaga.
“Utilize,” on the other hand, is defined by Fowler’s Modern English Usage as being merely a pretentious form of the word “use.” I call it an intellectual muscle car. We deploy utilize when we want to sound even more erudite, and more confident, than we feel, never mind the extra time it takes to complete our statement--bonus! But it ends up sounding officious. Just don’t tell that to the utilization review people who follow me around on the oncology floor -- they have enough to worry about.
Finally, there’s the ubiquitous passive sentence construction, seen often enough in our daily conversations, but infecting medical journals like a plague. During my residency, I once commented to an advisor that I wanted to write a letter to the New England Journal of Medicine castigating them for allowing such banal language into such an esteemed publication. He gently counseled me that, rather than being a career-defining moment, it would more likely represent my career’s premature demise.
“Ten patients were enrolled on to this study” can be changed to, “We enrolled ten patients.”
“Bone marrow samples were collected over a 10-month period” can become, “We collected bone marrow samples over 10 months.”
And so on. Again, the intention is innocent--we avoid first-person construction so as not to seem too cocky, so we don’t take too much credit for study results, even when we are clearly responsible for them. But in so doing, we risk the consciousness of the reader or listener, if not --more importantly for our study’s solvency -- the reviewer of our submitted article.
Like my father the journalist once cautioned me, simple, direct statements, whether in spoken or written language, work best at communicating your thoughts. Our patients have enough to worry about with their medical conditions. They shouldn’t have to wrestle through complicated sentence structures as well.
Clear enough? Well, it’s not dissimilar to the very unique advice any grade school English teacher would ask us to utilize, at the present time.
Dr. Sekeres, OT Clinical Advisory Editor for Hematology/Oncology, is Director of the Leukemia Program at the Cleveland Clinic Taussig Cancer Institute and Chair of the Hematology/Oncology Pharmacy & Therapeutics Committee. He is a staff member in the Department of Hematologic Oncology and Blood Disorders and holds a joint appointment in the Departments of Translational Hematology and Oncology Research.