Drop doctorspeak and get real with patients

Drop doctorspeak and get real with patients

If you’re a doctor, I bet you speak doctorly. You act doctorly. And dress doctorly. And spend your days in clinic with other doctorly doctors.

But life is what happens while you’re busy staring at computerized flow sheets, algorithms, and billing codes.

Real life happens outside of man-made medical institutions. Patients live in the real world. And I always wanted be a real doctor — a doctor who specializes in being real with real people meeting them where they really live and work and play.

So last week, I left my office to treat people on the streets. Over 6,000 patients. For free.

Beside a row of port-o-potties, I volunteered my services to those in need. Some required medical care. Others just psychological support. All received a smile. Many left laughing.

I live in Eugene, Oregon: the birthplace of running. TrackTown USA. America’s premier summer marathon runs right in front of my house.

Unfortunately being too healthy can be hazardous to your health. There are medical ailments unique to long-distance runners. Chiefly: chafing. Thighs, armpits, and yes, nipples. After miles of shirt friction, even the toughest nipples get torn up. Bras protect women. But look at these bloody nipples on men.

The proper medical term: marathoners thelorrhagia. But medical jargon often creates fear and confusion, so I use normal words anyone can understand. Plus I made a sign:

Drop doctorspeak and get real with patients

How should guys protect their nips?  Some use duct tape or bandaids. Others go topless. A few wear sports bras. Here’s another solution:

Drop doctorspeak and get real with patients

I got out on the streets at 5:00 am.  Even brought my boyfriend’s daughter — an avid athletic supporter:

Drop doctorspeak and get real with patients

And recruited a man on the sidelines to cheer with me:

Drop doctorspeak and get real with patients

I know what you’re thinking: “Did anyone really take her up on this?”

Drop doctorspeak and get real with patients

Well, one guy yelled, “Too early. It’s only mile 3.”

“I got Band-Aids,” another dude announced as he pounded his chest.

A husband said, “No thanks,” until his wife interjected, “Yes, we’ll take some!” I squirted a glop on her palm; she applied the goo to his nips as he ran away from me.

When I posted these pics on Facebook, a friend replied, “You’ve out-weirded me, Pamela.”

“Hey, I didn’t make this nipple thing up just to be rubbing runners’ nipples.”

Doctor means teacher. The best teachers make learning fun. Mission accomplished.

Watch how one doctor can prevent 12,000 bloody nipples from 17 countries in one hour:

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Pet Goats and Pap Smears. Watch her TEDx talk, How to Get Naked with Your Doctor

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  • querywoman

    Though it was not Dr. Pam’s intent here, she is on one of the threads as I am here. She says bras help protect the nips of women runners.
    For reasons related to my skin disease, I cover my hair with hats, wigs, and scarves. I see literature about patients covering themselves in my skin doc’s case. I told him a scarf kept me from scratching my head. He already knew that.
    Scarves are very comforting. In the summer, they make a cooling cover and help protect me from the Texas sun. In the winter, even a thin one helps me stay warm.
    I can use a scarf as visor to block the sun and look at something.
    In Texas, people run around half-naked in the heat and sun. It’s better to do as the Arab men do, wear long, white, flowing clothes. Why do so many of the Arabs stick their women in black robes?
    Covering yourself with more clothing is better than sunscreen.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Totally agree (as a super white pale person who has NEVER Had a tan in my life – I ONLY burn): Sunblock with light white fabric much better than dark fabric or sunscreen with all it’s hard-to-pronounce ingredients that may have their own health hazards.

      • querywoman

        Yep, you are a redhead and I am on blonder. You posted something once about a black man whose BP went up at the sight of a copy.
        You don’t look like you are very likely to have trouble with the cops, and neither am I, unless we should have a used, druggie hard look.
        I have a small tan now. You can see my bra lines. Several of my docs are darker. I have 2 Asians or Asian mix. I’m wonder if they could see my tan. Since you are pale, I bet you could see it.
        It’s kind of hard to see, but it’s there.
        My derm tells me to get some sun. One of the residents wanted me to get office light treatment, but the senior guy didn’t agree.
        He’s told me several times to get sun, natural light therapy. No, I don’t spend 5 hours in it. It feels good, maybe 30 to 60 mins on Xposed body.
        I don’t think sun is evil.
        A hat or sunbonnet, for women, is traditional.

        • SteveCaley

          Perhaps some day I’ll tell the story of the Black Man who kept Getting Sunburnt…It’s a good story.

          • querywoman

            Blacks have shown me where they get darker in summer.
            I wonder if the mysterious Dr. Caley could see my tan lines, the gorgeous healthy tan against the straplines for my bra???
            It depends on the light!

      • Patient Kit

        As someone who spends a lot of time at the beach and in the ocean in a bathing suit, please, let’s not discourage the use of sunscreen because it might have ingredients with their own health hazards. I do have a light tan, but I never ever burn. I always use sunscreen.

        • http://www.idealmedicalcare.org PamelaWibleMD

          Sunscreen better than skin cancer. Sunblock better than sunscreen.

          • querywoman

            All things are about balance.
            All life on this earth comes from the sun.
            Dr. Pam, you do do look very pale in the photos. Next time, how about a hat? They need a chin strap to stay on!
            If you could see me, you’d probably be wondering how I get a mini-tan and you don’t!

          • http://www.idealmedicalcare.org PamelaWibleMD

            It was 5:30 am and I was only out for an hour, I took the risk of getting some UVs.

          • querywoman

            Hope it wasn’t too early for your Vitamin D manufacturing process.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Yes. Another local problem for Oregonians: Hypovitaminosis D

          • ninguem

            Not to mention hypercannabinoidemia.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Hey, no jokes about my cardboard signs?

            ninguem you usually take a jab at me about now.

          • ninguem

            Well, now that you mention it.

            About those sore nips.

            Do you treat them or cause them?

            Here’s your next patient.

            http://fourfivetwodotcom.files.wordpress.com/2012/01/52011.jpg

          • querywoman

            Dr. Ninguem, do you wear a trenchcoat when you go to the public library?
            Once I Xplained to a Nigerian male nurse what Americans mean about a guy in a trenchcoat at a public library!

          • SteveCaley

            Surprisingly, in New Mexico, too. What’s up with that?

          • querywoman

            Dr. Steve, has anyone studied the long-term effects of North European folk migrating to hotter, sunnier areas of the world? Or that of the darker peoples migrating to less sunny areas?
            Supposedly, home sapiens originated in Africa and migrated after they mastered fire.
            That’s not surprising; they wanted to get cooler!

          • http://www.idealmedicalcare.org PamelaWibleMD

            Weird!

        • querywoman

          Patient Kit, everything on the earth is really natural. Titanium and zinc oxides are effective sunscreens. I’m not sure how much processing it takes to make them into usable skin creams, but titanium and zinc mineral deposits occur.
          When not at the beach, it’s better for you to cover more of your body with light colored clothes than any cream. You can apply that stuff lightly to the exposed parts of your body, if you wish.
          That’s what Dr. Pam and I were discussing.
          The Arabs need to cover their body for another reason. The sand scrapes their skin. I only fault them for sticking their women in the hot sun in black robes
          I use a lot of olive oil on myself, and I think that has some positive effects on skin in the sun, though it’s not a blocking product.

          • Patient Kit

            I’m a very light natural blonde and I never burn, so the sunscreen I use seems to be working well. We (voluntarily, not forced by our husbands or culture) wear a lot of black lightweight fabric in the summer here in NYC, not so much white or light-colored clothing. It’s been like that here for as long as I can remember in the summers. Maybe because we’re always sitting on mass transit and in public spaces. White clothing gets dirty fast in NYC.

          • querywoman

            Wearing black is custom, based on adaptation to your environment. I don’t see that much lightweight black fabric in Texas in summer.
            I think I have a lovely healthy tan that I can see in my bathroom mirror. However, outside in the sun, if I pull my sleeveless top shoulder down, I can’t see the tan marks.
            I spose you have a similar tan.
            I do have a guy friend, a natural blond, who really does get a tan.

          • Patient Kit

            Actually, it sounds like I might be guilty of having a darker tan than you. I definitely have tan lines that show where my bathing suit was. But I’m on the beach all day on weekends, often until sundown, and in the water a lot. I do re-apply after a swim. Maybe my tan is more medium than light. I love the ocean and love being outdoors and I take both skin cancer and aging seriously. I thought that because I use enough sunscreen that I never burn, that I am ok. I guess I might be better off staying out of the sun. But then I would miss one of the things I love most in life — swimming in the ocean. Risk/benefit.

          • querywoman

            Yep. You got it. My tan is almost imperceptible. I think it’s gorgeous in my bathroom mirror.

            You are doing what you want in life. If you live longer than your pale ancestors, your chance of getting skin cancer goes, and it may or may not be wise to use the modern sunscreens.
            I read it an art mag about a sculptor who used lead to make sculpture. Lead is wonderful malleable and makes great sculpture. He hammered it, bent it, and did all kinds of stuff.
            He died of lung cancer, attributed to working with lead. Of course, we really don’t know if was related to his heavy use of lead. We strongly suspect it was.
            He did what he wanted to in life.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Patient Kit & querywoman ~ just curious your take on doctorspeak and having docs out of the office and in the streets. Ya like the idea?

          • querywoman

            Doctorspeak is, “medical airs.” I taught second grade Sunday School with a doc who had trouble dropping his airs.
            When he first came in, the children would ask him, “Will you press on my stomach.”
            I’d say, “No, he’s not at work.”
            I have seen that doctor serve the homeless plates of food at church services to the homeless.
            So I answered you in a roundabout way,.
            You got out on the street and showed yourself as an ordinary person. What was in your mystery nonprescrip nipple cream? What you don’t know is how many non-runners with infected nipples who read about what you did. This has to be a common, embarrasing problem.

          • http://www.idealmedicalcare.org PamelaWibleMD

            special secret recipe. :)

          • querywoman

            I could design you a, “Dr. Pam’s Snake Oil,” label. You are following a fine medical tradition, hucking patent meds!

          • SteveCaley

            The skin tans to the degree it wishes. The problem is when people who don’t tan well try to tan.
            BTW: Pallor is a sign of high rank in Japan. They used to ULTRA – avoid the sun (especially women) so they’d look whiter. Go figure.

          • querywoman

            I am pale, pale, pale, but raised in a time where suntans are desired. Some men have dug my lily white skin.
            During my brief marriage, when I was much younger and dumber, my then husband didn’t care for my blonde hair and pale skin. He wanted me to get a tan!
            Often among the American Negro, lighter skin has high status: “high yellow.” A Nigerian immigrant told me that’s only an American thing. He said his lovely daughter is very dark.
            Make peace with what you are, everyone!

        • querywoman

          Modern skin cancer is probably also associated with longevity. It’s probably something our ancestors did not live long enough to get.

          • querywoman

            Snowflake the albino gorilla lived most of his life in a Barcelona zoo. He got skin cancer, was on human meds: antidepressants, antibiotics and anti-tumor drugs.
            He was 38 to 40 at his passing (I think he finally got a lethal needle), whereas a gorilla in the wild usually only makes it to about 25.

      • SteveCaley

        Fitzgerald I, then? You are one of my people! I come from the Eternally Fluorescent Irish. My mom got a bad facial sunburn under a hat from the reflections off the Atlantic during a little harbor cruise.

        • querywoman

          Ha! Ha!
          Dr. Pam looks like she has milky white, translucent redhead skin.

          • querywoman

            Pamela, as we know, there is no such thing as a white person or a black person. I’m a very pale beige.
            You look milky white in the pix, but you are clearly much darker than that white coat.
            Do you think you are a pale pink-tinged beige?
            I bragged about my tan to my blond doctor today, and he did see it.
            It will be a few months before I see the two light brown Asian doctors. I hope I will still be tanned by then.
            My back and arms freckle, but never my face! Do you freckle?

  • querywoman

    Throwing aside our conversation here about sunscreen, etc., all she did that day was promote common sense! We need more doctors doing that.

    I’m not athletic. I did not know about nipples bleeding in marathons. It makes sense, as nipples stick out and rub against clothes.
    Supposedly, the ancient Greeks competed nude in the Olympics!

    • http://www.idealmedicalcare.org PamelaWibleMD

      We need to take health care to the people not herd everyone into our “patient-centered medical homes.”

      • querywoman

        Absolutely! You showed yourself as a real person. Those rubbed raw nipples probably last forever. All of us who intact nipples get nipple erections, not just Simon Cowell.

      • SteveCaley

        Healthcare is an organic and indivisible extension of society and culture. It cannot be removed from the societal physiology and put in a “home.”

  • http://www.idealmedicalcare.org PamelaWibleMD

    So is everyone on board with dropping doctorspeak?

    • JR DNR

      I think it’s pretty funny when doctors here use technical language in the comments when replying to patients. It makes me think they don’t realize their words are technical! (As I do a google search to interpret what they are saying…)

      • http://www.idealmedicalcare.org PamelaWibleMD

        Aha! A critical (and often unrecognized) skill needed to develop a therapeutic relationship is to speak the same language.

        Unless your patient is also a physician, please, please, please drop doctorspeak. Anyone disagree?

        I wonder how many medical errors and bad outcomes are result of uncontrolled medical jargon. Thoughts?

        Anyone else concerned about this?

        • SteveCaley

          Often, I have found, MY jargon was a phenomenon of shyness and inexperience. I use as my interview model sometimes “Randy” from “My Name is Earl,” the somewhat dim brother who wasn’t great at social convention, but a great question-asker.
          “Where’s your leg?” “Is that a store-bought eye or your real one?” “You only have one breast. What’s up with that?” Those are impossibly hard questions. I used to stammer about and bother the patient terribly before I learned how to be real.

          • querywoman

            I like the way Indian (as in Hindustan docs), address patients, as, “Sir,” or, “Madam.” Even one of my mama’s 2nd generation Indian docs. He looked like an Asian Indian doc as he applied his light brown hands to the pulses on Mama’s fat body.
            Gentle, full of Asian wisdom, in spite of being born in the US of A.
            When she first went to him, had a Chinese or other Asian rezzident tagging along with him
            She said, “The two of them wouldn’t make one of me.”
            She adored them both, and so did I.

        • SteveCaley

          In retrospect – (see below) Some of my diagnostic shyness may have come from when I was three years old, and on the subway. I noticed with a particular start that a fellow passenger was Black. I did not know of racial terms or propriety, and only pointed out the observation – “HEY! Momma! THAT man is BLACK!” which he was, not brown or such. He was not blue or orange; but I had not seen a man who was BLACK before, and asked my mother for her expertise, which she withheld, inexplicably, shushingly. Perhaps it was a perceptive failure. “Look, he’s BLACK!” He smiled – he must have been, in fact, aware that he was BLACK.
          Upon corroboration of the observation, I went on to the diagnosis – “Momma, WHY is he BLACK?” We really went nowhere with the rest of the discussion. I did learn that one ought not to ask; it took me another thirty years to re-learn it.

          • querywoman

            And now you realize he was deep brown.
            I have striking cold pure white eczema lesions woven into my pale beige arms.
            I am no more white than the classic dark African is black.

        • querywoman

          Lawyers should also drop lawyerspeak. Lawyers were once paid by the written word.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Yes. I think their 15-page contracts could be chopped down to one paragraph.

          • Patient Kit

            Lawyers are paid to intentionally confuse people with their language. Doctors, on the other hand, are not intentionally trying to confuse patients. Docs are actually trying to communicate.

          • querywoman

            Not really. Modern lawyers would love to use simpler words but then they have to stick in all those dependent clauses.
            I knew a lawyer who once worked for a company that was in some kind of toy business. He was in a real estate leasing division. He said the contracts were so complex that it took a lawyer to read them.

    • ninguem

      …….mailing Dr. Wible a corncob pipe……..

      Now, them poultices be laced with feathermoss and mustard root. Mind you drop water on ‘em occasional and keep ‘em damp.

      http://www.wearysloth.com/Gallery/ActorsT/60561.gif

      • querywoman

        Is this the real you, Ninguem? I thought you self-identified as Hispanic???

        • ninguem
          • querywoman

            Forgive me, I don’t keep up with this stuff. We have discussed evolution some on this thread. Some things like skin evolve; some don’t .
            You write like a doctor, plus you say you are a doctor. But you are still a junior high school boy with your humor.

          • ninguem
          • querywoman

            Just the kind of thing I suspect a boy like you would enjoy!

  • http://www.idealmedicalcare.org PamelaWibleMD

    Anyone against getting out in the streets as a doc? Love to hear from ya!

  • SteveCaley

    Yes! Language is at its best when it communicates most effectively. Jargon is that which is overly complex in form without conveying more precise meaning.

    I luv that Latin, I surely do. But we train to use clarity and precision of thought, combined with a wealth of experience and learning, to bring forth a more holistic understanding of the person as impacted by the illness. Jazzy words entertain us, and sometimes the patient; but we should use the language that conveys the idea with the greatest effect.

    “It’s f***ing nothing, that’s what it is,” has been my response when queried by SOME patients, for whom it’s appropriate. They asked me for a diagnostic interpretation which reached deeper than the particular phenomenon, and wanted to know the relative seriousness of the problem.

    “You wanna know what to call it? It’s called a prominent xiphoid process, tell your friends. If you want to know. If they care. Why are you worried about it?

    That’s when you hear about the girlfriend getting him to have it checked out, and no, it’s not related to erectile dysfunction on occasion; but alcohol consumption is – and the song rolls on, and you can actually do something.

    A diligent and studious expostulation on the triosseus sternum, with the manubrium and corpus sterni and their particular amphiarthrodial articulations – that’s relevant when one wishes to bore the patient and prove you know your stuff. There’s times when that’s what the patient wants a dull, academic presentation to make up one’s own mind that it’s nothing so big a deal.
    Speak in the language of the patient. I dealt with primary Spanish speaking patients, and significantly improved my medical Spanish; if someone should struggle with expressions and accuracy, it should be me; the patient’s description is vital; more important than their speaking my language.
    Effect clarity and brevity. Answer the questions asked.

  • querywoman

    Dr. Pam went out in the streets, like an average person, but she showed herself as a doctor with her white coat.
    She had fun.
    She also showed that doctors don’t need prescription medicines or surgery to treat. She showed that doctors can teach us without nagging us about diet and exercise, which rarely works anyone.
    Maybe she gave ‘em nip cream that was just petroleum jelly with food covering. Nevertheless, ointments work. They are traditional.
    I use prescription cortisteroids on me eczema. Now I am also using silver sulfadiazine, usually used for burns.
    But, I also use pure clean olive oil or other vegetable oil on my skin, with my derm’s blessing. I consider that my main medicine.
    I would rather smear pure lard all over my skin that a cosmetic or dermatological lotion with added ingredients.

    Pure fat or oil is safer to use on the whole body.

  • querywoman

    My research into this topic has taught me today that it is wrong to assume that many of our ancestors did not make into 80s.
    That, of course, excludes the ones who died younger of skin cancer or other more common causes.

  • querywoman

    In a few days, I will be seeing a blond, blue-eyed male doctor. I’ll try to remember to point out my lovely, barely perceptible suntan.
    Be a while before I get back to my two light brown Asian docs!

  • querywoman

    We also can reasonably guess that, when our supposed ancestors began to have less hair than other mammals, that they began to cover their slightly hairy skin.
    I assume that they first used the skin, with or without fur, of other mammals to protect themselves. Then they probably learned to spin thread and weave cloth. Knitting and crocheting surely came letter.
    Clothing is a traditional skin protection, which predates sunscreen.

  • querywoman

    On the surface, from what we know, darker skin does appear to be more protective. So maybe paler skin is an “oops.” but what do we really know?