November 29, 2004

Terminology Sparks Healthy Debate; An Internal Medicine Physician Has a Lot of Explaining to Do

With apologies to linguists, I offer some thoughts about medical vocabulary and language.

Why do some medical specialties have great names while others have identity crises? In an effort to understand this vexing issue, I randomly ask people what family physicians do for a living? Almost everyone correctly answers this question. When I ask about internal medicine physicians, no one seems to know.

When Marcus Welby and his classmates graduated from medical school, they completed one year of graduate medical education (GME), qualified for a medical license and established a practice. Modern- day family physicians complete three years of education beyond medical school, working their way to the front lines of medicine as they care for unborn babies, elder adults and everyone in between.

The family practice specialty name is a stroke of marketing genius. It is easy to recognize and pronounce, accurately conveys a complex job description, and is pleasing to the ear.

Names don't get any better than that.

The first cousin of the family physician is the internal medicine physician. This name, I dare say, conveys less meaning.

Internal medicine refers to what is inside the body, in a nonsurgical context. Internal medicine physicians also complete three years (or more) of education after medical school, focusing all of their attention on adults.

One must be 18 or older to sit in these waiting rooms, and if pregnant, will probably be referred to an obstetrician.

When I mention the name of my specialty, a typical response is "You're an intern? Listen lady, I've watched ER enough times to know that I don't want any intern taking care of me! Go find a real doctor to come in here."

Interns are doctors who have earned their medical degrees and are in their first year of graduate medical education.

In the beginning, "resident physicians" literally took up residence within the walls of their training institutions. They have completed their internship, but have not yet finished their GME. To this day, many "on call" remain in the hospital overnight.

Whenever my sister "the nurse" has a frustrating experience with the world of health care (which is just about every time she, her husband or kids go to the doctor), she phones to tell me, step-by- step, what "we" did wrong.

"I called the doctor's office to ask the nurse if she would please send a copy of the pathology report to my 'family doctor' (meaning me)," she might say.

Whoa! Stop the conversation! My sister, who should know better, has just committed a personal foul in the game of medicine: Fifteen- yard penalty for roughing the doctor.

I am an internal medicine doctor, not a family doctor.

There are plenty of health-care professionals around who can't explain the difference between an internal medicine and family physician. Beyond fussing about our name, shouldn't we internal medicine physicians come up with a better one -- one that eliminates the constant need for explanation?

And more to the point, what does all of this mean to patients? Surely, they are more concerned about their health than the name of our specialty.

Name confusion extends to treatments, too.

If one's tonsils are taken out, one has a tonsillectomy, and if part of one's colon is removed, it's a partial colectomy. A pattern emerges. Why then, is the removal of a uterus called a hysterectomy?

Hysterectomy evolved from the Greek word hysterikos. Considered a uniquely feminine trait, hysteria or hysterical behavior was attributed to disturbances of the uterus, leading to the conclusion that removing a woman's uterus would eliminate her hysterical core and calm her demeanor.

The archaic concept behind this name belongs in the compost pile, right along with the banana peels and coffee grounds. Let's recycle those letters into a less troublesome combination.

From this moment on, when referring to the removal of a uterus, think uterectomy. If we can (almost) rid the world of smallpox, we can eliminate the word hysterectomy from our vocabulary.

Finally, a few words about mumps. This viral infection causes "chipmunk cheeks" by attacking the parotid glands. It can also invade the male genital tract, causing orchitis, which is medical speak for testicular inflammation, and is similar to the word orchid. What do exotic tropical plants have in common with the mumps?

The flowering plants are called orchids because their roots resemble miniature testicles. The name stuck. If you are recuperating from a uterectomy, and a gentleman decides to brighten your day with a bouquet of flowers, gently remind him that it is not a good time for orchids!

Dr. Lynn McDonald is a physician specializing in internal medicine, hospice care and palliative medicine. She lives in Dayton.

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