'Don't tell me that words don't matter. ‘I have a dream’ — just words? ‘We hold these truths to be self-evident, that all men are created equal’ — just words?‘We have nothing to fear but fear itself’ — just words?” — Barack Obama, 2008
True story: A paramedic and his shift supervisor are kneeling next to a collapsed, unconscious child on a soccer field. One paramedic is evaluating the airway, which would be a difficult intubation because the child is overweight and vaguely gagging. “Oh, it sucks,” the supervisor says, looking down the throat and deciding he definitely does not want to RSI this child. Thirty seconds later, the paramedic brightly chirps, “Succ is in!”
We work in a field where words matter. Our success or failure is often determined by our ability to communicate. We go through four years of medical school and multiple years of residency only to learn that the medical skills we have assembled are merely the underpinning of our practice. The actual delivery of medical care is one part knowledge but also one part theater (that all-important “bedside manner”), one part writing (as charting develops more and more prominence in our work), one part rhetoric (convincing the cranky hospitalist to admit the same diabetic yet again who has, yet again, stopped taking his medications), and one part team sport (you are truly lost when you have lost the support of your partners or, God forbid, your nurses). Words are a key factor — or maybe the key factor — and common denominator in every one of those elements.
But we spend less time talking about our words than almost any other part of our medical practice. We should think as critically about the narratives we choose and the words we choose to fill them as we do about our choice of antibiotics. Our journals and trade publications are filled with coverage of the truly esoteric tools and debates of our profession while for the most part ignoring our most frequent tool: our words.
I am genetically forced into thinking a lot about words. My parents are humanities professors, and my sister has a doctorate in comparative literature. Like a stem cell that somehow missed the DNA memo, I am genetically purposed to be an English professor but somehow wandered instead into medicine. Like a surgeon reaching for a scalpel or a radiologist wanting a visual picture, I just can't help myself. One of my favorite activities in medical school was founding IRIS: The UNC School of Medicine Art and Literary Journal with my good friend and fellow humanities renegade Joe Scattoloni, MD. We pushed the envelope on linking words, pictures, and medical care (and today's editors still do the same; see FastLinks).
But even if you don't have the same genetic handicaps and quirky predispositions that I do, words are still an intrinsic part of your work. I challenge you to think of a single therapeutic agent you use on every single patient as often as you do your words. Not only that, but this is your primary tool in every turf war, administrative issue, research publication, and interprofessional dialogue. Like the most potent medications, words are extraordinarily powerful and extraordinarily dangerous. The way we use, misuse, or confuse words is one of the most critical priorities for those working on safety improvements and the reduction of medical error.
I get twitchy every time I hear a physician say, “It's just semantics,” “This is just wordsmithing,” or some other dismissive reference toward a thoughtful analysis of the words we use and how we use them.
In fact, words are the most ubiquitous feature of emergency medicine — bar none — and one of the most critical tools to use correctly.
With that in mind, I will be writing this column in Emergency Medicine News quarterly, and we will examine words, including the rich fields of literary criticism, linguistics, grammar, and communication psychology, and how they affect our practice of emergency medicine. Just as specialty discussions of airway management go far beyond your first-year anatomy class in medical school, I hope these discussions go far beyond your elementary school grammar class. I hope each installment will intrigue you as we examine why we use words the way we do, inspire you as we explore ways to use our words to greater advantage, and irritate you as we reveal that myths are just as prevalent in our emergency medicine verbiage as they are in our medical practice.
And we will do all that without any of the high technology trappings of modern medical practice: no ultrasound, no needleless syringes, no stethoscopes, no fiberoptics. Just a single time-honored medical tool that deserves some dusting off: words.© 2013 by Lippincott Williams & Wilkins