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Physicians' 'Small Vocabulary' Leaves Room for Learning


A small vocabulary in the context of the miracle of the human organism is a tragedy.

We allopaths don’t appreciate empty slogans; rather, we embrace essential facts - essential physical and mechanical truths, and we attempt to convey them with as much brevity and precision as possible. Fanciful descriptions and paradigmatic statements are most often than not clinically useless, and therefore we have no use for them. We can perhaps lay blame on the linguistic and syntactical excesses used by those who espouse alternative medicine for the lack of mainstream appreciation for its fundamental tenets. 

For example, linguistic lovelies such as "holistic," "consciousness," "energy fields," and "psychic body," "intrinsic nature," "pain body," and "conditioned self" are not typically used in standard charting, and are rarely used in academic and community hospitals and medical centers. Of course one often hears the phrase "that patient has psych issues" to refer to that nebulous region of the mind/emotions that plays a regular and daily role in clinical medicine, to which any emergency room or internal medicine physician can attest.

It is important never to forget that language creates the context for all things in human society, including clinical medicine. Unfortunately as English-speaking Americans, we do not as yet have the language to address the human being in its entirety. We have great precise words for specific parts of the body, but without a proper vernacular to address the whole person, we can never really see the big picture. The lack of official scientific language for the complex inner workings of human subjectivity and experience, and the historical disappointment with religious/cultural/artistic descriptions has left the modern physician with a very small vocabulary. A small vocabulary in the context of the miracle of the human organism is a tragedy.

Furthermore the vocabulary we use is wholly antiquated. It is Newtonian in its inherent structure. Because clinical language is Newtonian / Cartesian, it is excellent for application in clinical problems which are mechanistic. This is why we allopaths are so good at fixing acute medical and surgical problems. These problems are mostly mechanical. Clogged arteries, ureters, biliary trees, glomeruli, veins, these aren’t much different than any clogged plumbing or pipes. We commonly use the analogy of clogged pipes and plumbing to explain illness to patients in the hospital. We have excellent vernacular for that. Our Cartesian-based language is perfect for that.

Chronic disease doesn’t work as purely mechanistically as acute disease does. Chronic disease is a dizzying amalgamation of intersecting and interdependent hormonal, intracellular, epigenetic, neuroimmunologic, electrical, and chemical activities. Every day new endogenous peptides and bioactive agents are discovered that are connected to basic physiologic and pathophysiologic events. And it is all extraordinarily complex. The recent debate about salt intake and excretion in the pathophysiology of hypertension is a perfect example- the human organism is extraordinarily complex, and Starling's forces are just the beginning- not the end.

Acute illness can be reasonably understood in the framework of Cartesian language. Chronic illness must be understood in the framework of a more modern, up-to-date vernacular; a vernacular which takes into account our new physics. Einstein, Bohr, and Bohm left the mechanics of the Middle Ages behind. Why can’t we do the same?
Anyone who scoffs at my preoccupation with language doesn’t understand that without the words for something, there is no understanding of it. I never learned in medical school what the technical term was for the interlacing and interwoven neuroendocrine systems. Hypothalamic-pituitary-opiate axis? Axis? Is that the best it gets? Axis isn’t even a term that connotes anything biological.

So while I rely on what I’ve been taught in training and by my teachers to fix sick humans in the hospital, in the community clinic and in homes of patients I visit for house calls, I rely on what I’ve been taught by my life about the human condition. I pay attention to what my gut tells me, to patient body language, to masked emotional pain, to the role of memory and interpretation of memories, to what I know about the inevitability of decay and the essential importance of dignity and what can be loosely described as peace of mind.

I don’t need fancy language to describe and understand the human soul. I can perceive it with my brain and my heart, my thoughts and feelings, which coalesce and reinforce each other. I can look into a patient as they tell me about why painful memories of their past trigger their angina symptoms, and I can feel it, and my therapeutic plan of action focuses on how to deal with such pain. Yes I give the meds too, but I listen to what is really happening. This is what I consider the beginning of holistic medicine - looking at the whole human organism. Maybe there will be a less cheesy and more scientific word for the medical science which addresses the whole human being, but we’ll have to wait for our society to finally catch up with the worldview already discovered by physicists one hundred years ago. When our society does this, our medical methodologies for chronic illness will be quantum.

For more information on Dushyant Viswanathan and our other Practice Notes bloggers, click here.

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