Words elicit different emotions and mean different things to different people depending on one's experiences, upbringing and genes. When you say the word "Carnival" to me, I think, "Steelband," "Calypso" and "J'Ouvert." Another would say, "Soca," "bottoms" and "feathers." Yet a third thinks "short pants," "freeness" and "rum."
It's the same in medicine. The problem may lie in a patient's inability to tell the truth or a doctor's inability to communicate the truth.
"Is there any illness that runs in the family?" is an apparently innocent enough question that can paralyse parents with fear and raise the possibility of heated exchanges over the desk.
"Not on my side!" "Mine neither!" That could mean there is an aunt somewhere with sickle cell disease or someone spending time in St Ann's.
There always is something, somewhere. The honest answer might be, "I not sure, nuh? I think meh aunt may have sickle," or "yuh cousin still taking that medicine for the depression?" Or "we might have a little allergy somewhere, Jenny skin doh swell up from time to time?"
Another one is "no problems at birth whatever" only to find out six months later, when the child is not rolling over and has no head control, that the baby was born "flat" (not breathing, limp, unresponsive) and required resuscitation for ten minutes before spontaneous breathing was established.
Even at normal births there is always a bit of tension until the baby takes a breath or seems a bit mucusy or a trifle bluish for a minute or so.
These innocent sounding phrases send up my heart rate more than a stuttered answer where I can see that the parents are really trying to answer honestly and face up to possible problems. In the short term, denial answers like these seem to calm parents. Whether they help in the long term is another matter. It's up to the attending paediatrician to help sort things out.
On the side of the doctor, perhaps the most difficult thing is to communicate the diagnosis properly, that is, without scaring the parents but without understating the problem.
It's amazingly difficult and after more than 40 years in the business I am still not sure I can do it well. Beware the doctor who thinks he is doing a good job at communicating a diagnosis and a prognosis. There is no area between doctor and patient more fraught with difficulty.
Even the phrase "doctor and patient" may cause a problem. Some people do not want to go to a doctor, they want a service provider. Some people do not want to be called a patient, no, they are clients or partners. Some docs become indignant, "I am the doctor!" A few welcome the partnership. The doctor is a god is not the right model. Neither is the patient is a doctor.
Words mean different things to different people.
Take "Gastro." For me gastro simply means "diarrhoea and vomiting with perhaps a little fever and abdominal cramps," easily treated with fluids and diet, over in three to five days.
Most parents would blanche, shudder and take deep breaths when I used to say "Gastro." I stopped when I realised the emotion I was eliciting. To many it seemed I was almost announcing a death sentence. To them "Gastro" meant a moribund, dehydrated child who needed to go to hospital immediately.
Now I say "stomach flu." That is acceptable. It's the same disease with the same treatment and same prognosis. Problem is some parents take the diagnosis light and may not take the appropriate measures to ensure their child recovers. That's another problem of communication.
Another common one is "asthma." That word still scares a lot of people. An article published in the British Medical Journal in the mid '50s recommended that the word asthma should never be used. At that time "asthma" meant serious illness because of the fear and confusion historically surrounding the illness. The death rate from asthma was quite high.
A breathing difficulty probably caused by various diseases but resembling asthma, had been described by Hippocrates, about 2,500 years ago. It was not until the start of the 20th century that the differentiation among these various medical entities which cause difficulty breathing, among which were, "cardiac asthma," "tuberculosis," "hysterical asthma," "chronic bronchitis," "emphysema" and true asthma, was made. In the '50s people were still confused and afraid of "asthma." So the name was changed to "wheezy bronchitis." Somehow the word "bronchitis" was more acceptable.
Effective treatment for asthma appeared in the late '60s and there should be less fear now but it usually takes several generations for the wrong notions about a particular disease to go away.
We have an equally wonderfully confusing situation right now in the country with the "flu" and the "swine flu" and the "flu vaccine" and the "swine flu vaccine" and the "H1N1 flu" and the "H1N1 vaccine," because of the politics being played by the former Minister of Health with the disease and the difficulty that the Ministry of Health has in communicating with the public.
It's all basically the same. Flu is flu. Some strains are a bit worse than others. Swine flu is a different strain of flu, not especially bad. Another name for swine flu is H1N1 flu. There is no separate swine flu or H1N1 vaccine, it is included in the general flu vaccine and has been so for several years. Communicating is confusing, oui!