Home' Trinidad and Tobago Guardian : January 5th 2016 Contents A15
Tuesday, January 5, 2016 www.guardian.co.tt Guardian
Words elicit different emo-
tions and mean different
things to different peo-
ple depending on one s experi-
ences, upbringing and genes.
When you say the word "Carni-
val" to me, I think, "Steelband,"
"Calypso" and "J Ouvert." Anoth-
er would say, "Soca," "bottoms"
and "feathers." Yet a third thinks
"short pants," "freeness" and
It s the same in medicine. The
problem may lie in a patient s
inability to tell the truth or a
doctor s inability to communicate
"Is there any illness that runs
in the family?" is an apparently
innocent enough question that
can paralyse parents with fear
and raise the possibility of heated
exchanges over the desk.
"Not on my side!" "Mine nei-
ther!" That could mean there is
an aunt somewhere with sickle
cell disease or someone spending
time in St Ann s.
There always is something,
somewhere. The honest answer
might be, "I not sure, nuh? I
think meh aunt may have sickle,"
or "yuh cousin still taking that
medicine for the depression?" Or
"we might have a little allergy
somewhere, Jenny skin doh swell
up from time to time?"
Another one is "no problems at
birth whatever" only to find out
six months later, when the child
is not rolling over and has no
head control, that the baby was
born "flat" (not breathing, limp,
unresponsive) and required resus-
citation for ten minutes before
spontaneous breathing was estab-
Even at normal births there is
always a bit of tension until the
baby takes a breath or seems a
bit mucusy or a trifle bluish for a
minute or so.
These innocent sounding
phrases send up my heart rate
more than a stuttered answer
where I can see that the parents
are really trying to answer hon-
estly and face up to possible
problems. In the short term,
denial answers like these seem to
calm parents. Whether they help
in the long term is another mat-
ter. It s up to the attending pae-
diatrician to help sort things out.
On the side of the doctor, per-
haps the most difficult thing is to
communicate the diagnosis prop-
erly, that is, without scaring the
parents but without understating
It s amazingly difficult and
after more than 40 years in the
business I am still not sure I can
do it well. Beware the doctor
who thinks he is doing a good
job at communicating a diagnosis
and a prognosis. There is no area
between doctor and patient more
fraught with difficulty.
Even the phrase "doctor and
patient" may cause a problem.
Some people do not want to go
to a doctor, they want a service
provider. Some people do not
want to be called a patient, no,
they are clients or partners. Some
docs become indignant, "I am
the doctor!" A few welcome the
partnership. The doctor is a god
is not the right model. Neither is
the patient is a doctor.
Words mean different things to
Take "Gastro." For me gastro
simply means "diarrhoea and
vomiting with perhaps a little
fever and abdominal cramps,"
easily treated with fluids and
diet, over in three to five days.
Most parents would blanche,
shudder and take deep breaths
when I used to say "Gastro." I
stopped when I realised the emo-
tion I was eliciting. To many it
seemed I was almost announcing
a death sentence. To them "Gas-
tro" meant a moribund, dehy-
drated child who needed to go to
Now I say "stomach flu." That
is acceptable. It s the same dis-
ease with the same treatment
and same prognosis. Problem is
some parents take the diagnosis
light and may not take the
appropriate measures to ensure
their child recovers. That s
another problem of communica-
Another common one is "asth-
ma." That word still scares a lot
of people. An article published in
the British Medical Journal in the
mid 50s recommended that the
word asthma should never be
used. At that time "asthma"
meant serious illness because of
the fear and confusion historically
surrounding the illness. The
death rate from asthma was quite
A breathing difficulty probably
caused by various diseases but
resembling asthma, had been
described by Hippocrates, about
2,500 years ago. It was not until
the start of the 20th century that
the differentiation among these
various medical entities which
cause difficulty breathing, among
which were, "cardiac asthma,"
"tuberculosis," "hysterical asth-
ma," "chronic bronchitis,"
"emphysema" and true asthma,
was made. In the 50s people
were still confused and afraid of
"asthma." So the name was
changed to "wheezy bronchitis."
Somehow the word "bronchitis"
was more acceptable.
Effective treatment for asthma
appeared in the late 60s and
there should be less fear now but
it usually takes several genera-
tions for the wrong notions
about a particular disease to go
We have an equally wonderfully
confusing situation right now in
the country with the "flu" and
the "swine flu" and the "flu vac-
cine" and the "swine flu vaccine"
and the "H1N1 flu" and the
"H1N1 vaccine," because of the
politics being played by the for-
mer Minister of Health with the
disease and the difficulty that the
Ministry of Health has in com-
municating with the public.
It s all basically the same. Flu
is flu. Some strains are a bit
worse than others. Swine flu is a
different strain of flu, not espe-
cially bad. Another name for
swine flu is H1N1 flu. There is no
separate swine flu or H1N1 vac-
cine, it is included in the general
flu vaccine and has been so for
several years. Communicating is
DAVID E BRATT, MD
MEDICAL COMMUNICATION Beware the doctor who
thinks he is doing a good
job at communicating a
diagnosis and a prognosis.
There is no area between
doctor and patient more
fraught with difficulty.
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