I remember reading a letter written by a hospital doctor to a patient’s GP, copying-in the patient. The individual had been experiencing problems with balance and the specialist had arranged an MRI scan – which is able to look in great detail at those parts of the brain controlling balance, movement, orientation, etc.
What struck me, in that letter, which, in keeping with current good practice was copied to the patient, was the wording, the terminology used to describe the scan report.
The patient’s cerebellum, that part of the brain which controls balance and coordination, was described by the doctor, as having a ‘moth-eaten appearance’
My next blog is about moth-eating and perception, but in relation to this report, I was struck by this strange confluence of good and bad practice, person-centred and medicalised care.
I imagined the patient, or perhaps his wife, son or daughter reading the letter and absorbing the ‘moth-eaten’ description.
What would I do if a part of my brain were moth-eaten? How would this make me feel? Would the very fact that the moth-eating has taken place have potentially numbed me to this revelation, or would the wording have provided succor, to explain why I had been falling.
Our brains – the most sophisticated systems in the universe are a miracle of complexity and simplicity. We know so much about how the neurones communicate between one another, we know which part of the brain controls which aspect of experience or behaviour, yet, how it all fits together, the gestalt of consciousness, of being, takes us to Cohen and Stuart’s revelation that if the brain were easier to understand, we would not be intelligent enough to understand it. (as quoted by Jostein Gaarder is Sophie’s World)
Moth-eaten takes me to the core, or the historical essence of medicine, when mustachioed Victorians in morning-suits, stood over cadavers describing pepper-pot skulls, cobble-stoned colons, raccoon eyes, honeycomb lungs and caput medusa veins, in a time when doctors were doctors, patients were patients and we all knew our place.
In essence, where I am heading with this, is, that although we have a great historical heritage within medicine and modern medicine is heading into areas previously never imagined – genomics, translational medicine, psycho-neuro-immunology, we need to keep returning to principles about why we are and what we are doing and who we are doing this to.
So, perhaps moth-eaten might be less eloquently described using other words that convey the same clinical meaning, yet provide a more sensitive translation.
How we use language, how we communicate between one another and with patients, carers and relatives can make the difference between caring and compassion and hurt and fear. Let us choose our words with precision and sensitivity.
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