Reality outside language, anyone?

A few days ago, I entered into yet another discussion about ‘language of medicine’, brought about by a tweet about ‘language shaping culture’, and in particular about the word ‘provider’ which is used to describe doctors. The thread contained a reference to another article which had taken up exactly the same issue. The authors don’t like the word ‘provider’ and say that the new language of medicine must be changed. I think they have it upside down.

A few weeks ago, I wrote a post encouraging medics to stop talking about language.  Obviously, I didn’t think that I would be successful and the discussions on the language of medicine continue. Now, it’s ‘provider’ which somehow offends physicians. The argument is that the word is too generic, hides more than it reveals, particularly with regard to the role and the level expertise.  Hartzband and Groopman add:

“Provider” also signals that care is fundamentally a prepackaged commodity on a shelf that is “provided” to the “consumer,” rather than something personalized and dynamic, crafted by skilled professionals and tailored to the individual patient.

Does the point make sense? Yes. So, the issue is linguistic, we must change the ‘new language of medicine’. No. The issue is not linguistic at all, and changing language will not achieve much (A little digression here. The changes in how medicine works are also discursive (not linguistic, there is a difference), and I do wish that healthcare professionals listened to that.)

As I am trying and trying to find new arguments to get clinicians off language, let me try something like this. Imagine how the word ‘provider’ came to be used (it is unlikely that it happened just like that, but bear with me). As medicine has been becoming more and more commodified, and we pay more and more to get the services we need (and in the USA it happens much more than here in Europe), the relationship between medical organisations and me started changing. Moreover, as money gets scarcer, doctors are fewer and further apart, nurses’ jobs get escalated up (some now carry a stethoscope and are dressed differently) and we must employ more (and more) medically unqualified people to do the jobs that used to be done by more qualified people. So, we’ve just created an unqualified job for someone who will be taking my ECG and we must call it something. The conversation could therefore be something like that:

  • What do we call those medically unqualified people?
  • Let’s call them assistants.
  • That’s a great idea, how about clinical assistants?
  • Brilliant.
  • We still are short of doctors.
  • Are nurses not enough?
  • No, people want doctors.
  • Well, there ain’t any. So, let’s call them all providers.
  • Ah, so now our customers will be seen by a healthcare provider?
  • Yes. All highly qualified.

Possible? Eminently. Is the issue linguistic? Not for a second. Yes, language helps to pull it off, but the problem is not linguistic. We can stop calling doctors providers, but there will still be too few of them. Patients might (although I’d like to see evidence for this) see through the financial cuts more readily, but changing language will not make doctors and nurses materialise.

And this is precisely why I despair when the discussion about patient safety, patient care and more generally, about healthcare provision is reduced to whether we should use one word or another. No one sits down in a hospital board with the goal of shifting some words around. No, they meet to discuss money, but, yes, the consequences of such discussions are sometimes also linguistic. But those linguistic strategies are secondary (possibly – tertiary) to what happens outside language.

One of my first posts on this blog was about a discussion about living organ donation. I attended an organ transplantation congress and there was a discussion about whether to allow poor people to sell their organs (I’m sorry, whether to incentivise people to donate). And the discussion partly about what living donation for money should be called. Ironically, as the only linguist at the conference, I pleaded with them to stop talking about language and focus also what happens outside.

You know, for pity’s sake, someone will go blind when they ‘donate’ their cornea. That’s right, when you haven’t got enough money to feed your kids, you will sell your cornea and go blind. Label this, doctor!

It’s really not about language, is it? The really funny thing is that they ignored me completely, happily defining phrases, labels, concepts. You know, medicine really does know about language! After all, language matters and medicine is (really) part of linguistics, as surgeons will no longer cut patients open but only ‘construct them linguistically’. But as the omniscient doctor tells me, a humble linguist, about the real workings of language, I just want to scream.

So, finally, perhaps I’ll start a new discussion. For I really do wish doctors stopped calling themselves doctors. As the authors of the article rightly point out, the word ‘doctor’ comes from Latin for teaching and only those with a doctorate used to be called that (here is a brief account). GPs and other physicians should not be called doctors, and, really, you as a profession usurped this title.  And yet, somehow, I don’t get discussions on the language of medicine which attributed a doctorate to physicians in a much cavalier way.

I do hope that medics will start debating it for three reasons. First, I hope that their linguistic omniscience will be fed and kept satisfied, second, because the discussion is so insignificant that it will not harm anyone, third, it will get them off discussing important issues in terms of language.

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