(Updated with additional quotes and links to articles about doctors abusing language.)
Steven Pinker, the Harvard psychologist and best-selling author, has a wonderful essay in the Wall Street Journal about why smart people are so often bad writers. Although the essay doesn't touch on the subject of doctor-patient communication, every single word applies to doctors and the way they communicate (or fail to communicate) with their patients.
Here's the core of Pinker's argument. Read the rest of it. And if you're a doctor and you don't see how this is relevant to how you communicate with your patients then you need to think again.
Why is so much writing so bad? Why is it so hard to understand a government form, or an academic article or the instructions for setting up a wireless home network?
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In explaining any human shortcoming, the first tool I reach for is Hanlon's Razor: Never attribute to malice that which is adequately explained by stupidity. The kind of stupidity I have in mind has nothing to do with ignorance or low IQ; in fact, it's often the brightest and best informed who suffer the most from it.
I once attended a lecture on biology addressed to a large general audience at a conference on technology, entertainment and design. The lecture was also being filmed for distribution over the Internet to millions of other laypeople. The speaker was an eminent biologist who had been invited to explain his recent breakthrough in the structure of DNA. He launched into a jargon-packed technical presentation that was geared to his fellow molecular biologists, and it was immediately apparent to everyone in the room that none of them understood a word and he was wasting their time. Apparent to everyone, that is, except the eminent biologist. When the host interrupted and asked him to explain the work more clearly, he seemed genuinely surprised and not a little annoyed. This is the kind of stupidity I am talking about.
Call it the Curse of Knowledge: a difficulty in imagining what it is like for someone else not to know something that you know.
Update:
From the archives of the New England Journal of Medicine, here's two more worthwhile perspectives about doctors abusing language:
In 1975 Michael Crichton, the best-selling novelist and MD, neatly dissected the various forms of language abuse he found in, of all places, NEJM itself:
An eminent surgeon strides purposefully into the operating room each day — but to read his papers, you wonder how he finds the courage to get out of bed in the morning. His writing indicates he is unsure of everything, and has no particular convictions on any subject at all.
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...it now appears that obligatory obfuscation is a firm tradition within the medical profession. Since everyone employs the same technics, surely no one is fooled by these linguistic maneuvers. With time, they have simply become the accepted mode of expression. Medical obscurity may now serve an intra-group recognition function, rather like a secret fraternal handshake. In any event it is a game, and everybody plays it. Indeed, I suspect one refuses to play at one's professional peril. This may explain why only the most eminent physicians, the Cushings and Osiers, feel free to express themselves lucidly. They are above attack.
In 1979 Nicholas Christy wrote about Medspeak:
Medspeak is an Orwellian invention of interns and residents, a lingua franca: "a spoken language used for communication among speakers of different and mutually unintelligible languages...used solely for limited purposes."
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The consequences of Medspeak — that is, the consequences of pedantry, cryptic brevity and the use of verbal smoke screens — are funny, so long as communication is not the purpose of spoken medical language. We see that the purposes of Medspeak are not communicative but manipulative, like Mediaspeak, and perhaps derived from Mediaspeak. Those purposes are to look smart, to get on with the job, to control the attending physicians and to avoid making a definite commitment to a diagnosis or a course of action.
Hat tip: Theodore Kurtz, UCSF
