Communication is at the heart of the medical enterprise. We doctors share our research and our interpretations of that research in words. We use words to learn about the concerns of our patients and record our impressions, our findings, and our plans; words to share with patients and families what we have discovered, how we interpret those discoveries, what we believe to be the best approaches to optimize outcomes based on the best medical information currently available, and we use words as therapy.
We have also become increasingly aware that how we say what we say matters it matters to whether and how we are understood and to what impact our words have. Some of our word choice is, of course, idiosyncratic, but some is more a matter of convention. It has long seemed to me that the conventions governing our communication about medical concerns, both within and outside of the medical community, afford likely matter for refinement. For I have been troubled by some of the words and phrases that have been introduced, ostensibly to help us to say what we want to say.
One common expression, the one that has galvanized me into print, maintains that a patient is given or receives a diagnosis—as in, “At the age of 35, Mr. X was given a diagnosis of leukemia.” The first thing that comes to my mind when I read this is “But it didn’t suit him so he returned it.” In other words, I suppose, a response to the fact that a diagnosis is not a vase of flowers or a new shirt, to be picked or sewn or bought at a store and given as the usual gift is. Who would give such a gift? We would, of course, doctors, the folks who have diagnoses in stock, who to some extent actually invented and promote, and, in many cases, profit by them. Taking that into account, perhaps then the appropriate phrase would be, “At the age of 35, Mr. X paid for a diagnosis of leukemia.”
Of course, although most of us have substantial facility with them, we doctors do not actually own or control diagnoses. Each valid diagnosis simply identifies a condition, a disease that already exists that afflicts one or more individuals, and our job is to try to unmask the conditions by naming them; we identify them to a variable degree of certainty. That is our Sherlock Holmes side—we are detectives. We seek, approach, reach, find, even make diagnoses. However, if we are wise, although we may share what we believe we have identified, we should never “give” it to anyone. Making a gift of a diagnosis would put us in an awkward moral position. That’s because the giving of gifts usually has a purpose. And although we would certainly argue that any such gift is entirely altruistic, others might attribute to it less noble intentions. Gifts are often intended to influence their recipient, to express affection, or to get something in return; they can create gratitude, guilt, indebtedness, or resentment in the recipient; they can suggest that the giver is superior to or richer than the receiver.
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-Alan Jay Cohen, MD
This article originally appeared in the April 2019 issue of The American Journal of Medicine.
