Idioms and axioms provide a glimpse into medical culture


Idioms are expressions everyone understands as something other than what the literal words say.  For example, when I talk about “putting all of my eggs in one basket,” everyone knows I’m not really talking about eggs.

We say things like:

It’s raining cats and dogs.

It was a piece of cake!

I heard it straight from the horse’s mouth.

We have a few idioms in medicine, too.  If I talk about “hanging crepe” in a patient’s room, I’m not talking about putting up streamers.  In the hospital, we use this expression to say a patient probably isn’t going to make it, and their loved ones need to be gently warned.

Axioms are widely accepted truths, and you’ll hear them often in medical settings.  I can’t tell you how many times I’ve had colleagues tell me, “The longer you stay, the longer you stay.”  This statement is literally true — longer is longer — but it means more than that.  It means that “just one more thing” always leads to “just one more thing.”

What follows are examples of idioms and axioms that offer a glimpse into medical culture.

The enemy of good is better. My husband taught me this one.  Surgeons say it all the time.  When you try to re-do something and make it “better” you always run the risk of making it worse.  If this happens, you are left castigating yourself, “Why didn’t I just leave it alone?”

I think this same adage is true in Vegas.  Keep playing for more and you will lose.  Stop at good and you just might walk away a winner.

Whenever I’m cooking or painting or doing just about anything, this saying reminds me to hands up, and step away.  Good is good.

There are only two reasons not to do a rectal exam:  no rectum or no finger. I have ten fingers, so I really don’t have an excuse unless a patient doesn’t have an anus.  I do more rectal exams in a month than I can count on my ten fingers.  You get over it.  Sort of.

A rectal exam is a standard part of the “secondary survey” in trauma patients.  The place where I did my residency was a well-oiled machine — a level 1 trauma center of the highest caliber.  Patients would roll in, get all their clothes cut off, and things would proceed the same way every time.

It was the second-year resident’s job to examine the patient from the neck down and call out findings, including “Good tone!” and “No blood!” after the rectal exam.  I was the lucky one calling out my exam to a room full of people when I literally couldn’t find an anus.  I got nervous.  Honestly how stupid was this going to sound?  I said, “Uh, he’s got … he’s got …  He doesn’t have an anus!”  He had truly had it removed/sewn closed (due to some sort of pathology).  There are, in fact, some patients who can’t get a rectal exam.

The number of complaints is inversely related to the severity of the illness. Said another way:  The more things a patient complains about, the less likely it is that there is something bad wrong with them.

Imagine walking into a room with two patients on two stretchers.  Who do you go to first?

Patient on stretcher #1:  “My leg!  My leg!”

Patient on stretcher #2:  “My back hurts, and I’m nauseated and dizzy and my hands are tingling.”

Patient on stretcher #1!  Would be the nearly unanimous answer from my colleagues.

A fellow physician would sometimes ask the people with long lists of complaints if their teeth itch — and by golly — some of them would say they did!

Every woman is pregnant until proven otherwise. This sounds funny to just about anyone except the physicians who have seen “immaculate conception.”  There are women who present to the emergency department with abdominal pain who deny ever having had intercourse and then — surprise!  They are magically pregnant!

Just recently, I asked a patient if she could be pregnant.  She responded, “Nope.  I’m a lesbian.”  Her pregnancy test?  Positive.  She later confessed she had a lot of explaining to do to her girlfriend.

Pretty much if you have a uterus and you’re between the ages of 11 and 45, you’re getting a pregnancy test in the emergency department.

The solution to pollution is dilution. This is another one I learned from my husband.  I tell this to patients while I squirt large volumes of fluid into their open wounds.

Never, ever say the “Q” word. The medical community is surprisingly a superstitious bunch (the kind of people who really believe saying, “It’s quiet,” jinxes it and automatically elicits heaps of craziness).  I got berated a time or two for saying, “Wow, it’s really quiet!” before I gave it up.  It’s not worth getting blamed for the inevitable fall-out because regardless what you say, it never stays quiet for long.

Eat when you can, sleep when you can, pee when you can.  When you have a spare minute, eat (even if you’re not hungry).  Sleep at the desk if you have to.  Empty your bladder when you can (even if you don’t have to go).  You learn to follow this advice by not following it and ending up stuck for hours hungry, tired and having to hold it.

If you hear the sound of hooves, don’t look for zebras. Health care providers talk about zebras all the time — the cases we’ve seen once and may never see again.  These are the stories that intrigue us, but “zebras” are rare.  Said another way, “An uncommon presentation of a common problem is more common than a common presentation of an uncommon problem.”

So I’m not sure if this post hits it out of the park, but in terms of axioms and idioms that offer insight into medical culture, I’d say these hit the nail on the head.

Kristin Prentiss Ott is an emergency physician who blogs at her self-titled site, Kristin Prentiss Ott.


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