See more of our coverage on the effects of the misleading Center for Medical Progress videos here.
Unsurprisingly, there is a shock value to the anti-Planned Parenthood videos that were recently released by the anti-choice group Center for Medical Progress. Some viewers called the language used by the professionals in the video “cold and calculated.” But as a physician who provides abortion care, I did not perceive anything shocking. I attribute this to the context of the conversation: business among colleagues, or at least those pretending to be. Had the people who were unknowingly filmed been speaking to a patient during a health-care consultation in Planned Parenthood, I can see how their words or tone might be perceived as unsettling at the least. This, however, was not the case. In the given background, the language that was used is comparable to the language that is used amongst other medical professionals.
In medical school, we are told that we will learn a new language. And indeed, we do. Learning how to communicate is just one aspect of the art of medicine that I have been fine-tuning these seven years I’ve been in practice as an OB-GYN. Depending on whether I am speaking to a colleague or one of my patients, I will alter the words I use to ensure I will be understood by my audience. Not only must I choose the correct language, but I also have to use the correct and appropriate tone in order to communicate compassion to my patient or expertise to my co-worker.
Communicating effectively is a skill that may or may not be developed over time, as I am sure many physicians and patients can attest to. Physicians feel collegial trust in fellow doctors who are able to communicate clearly with the goal of ensuring appropriate patient care. Patients take comfort when they are able to understand the guidance of their physician. They are also more likely to trust a doctor who is relatable and compassionate, something that can only be perceived through effective communication.
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For example, if someone is having a miscarriage and experiencing the loss of a desired pregnancy, it would be inappropriate for me to say to them: “You’re medically and clinically stable and have had a complete spontaneous abortion.” That is what I might say to a colleague, but to the patient I would say, “I am so sorry you are experiencing this loss. You are safe and though this will be a difficult time for you and your family, you will be well and able to try again in the future if and when you are ready.” Neither of these statements is more or less genuine than the other; they are just different ways of conveying the same facts in the best way for different situations.
When discussing surgical procedures, the same principles apply. I will discuss the basics of a cesarean section to my patient as well as the risks and potential complications, but I will not describe the minutiae of the procedure. I do not say, “First I use the scalpel to make a Pfannensteil incision in the skin which I take down through the subcutaneous fat to the fascia.” When teaching a medical student or a resident physician, I would be more anatomical and straightforward in this way to ensure clear and concise instructions, and in order to teach high-quality medical care. If my patient were to hear me speak this way, though, she would most likely be horrified at how cold and unfeeling I might seem when describing the process of delivering a baby. At the least, she would likely be confused or offended at the “grossness” of my terminology. But therein lies the difference in language when speaking to professional colleagues versus the general, non-medical audience.
When these two “languages” overlap, possible conflict and confusion can ensue. For example, a c-section is done while the patient is awake and alert; few, if any, other major surgeries are performed under these conditions. As a surgeon who performs this procedure on an awake patient who can hear me talking, I am actively cognizant of the words that I speak while performing the procedure. When I ask the scrub nurse to hand me instruments I need, I can only call them by their proper names to ensure I am handed the correct instrument. Only recently did I learn that when I ask for a “bladder blade,” my patient may be thinking I am asking for a cutting instrument to use on her bladder! This is absolutely not the case; in fact, it is an instrument used to cover and protect the bladder from inadvertent injury. So while I use medical terms that are unambiguous by necessity to someone working with me in the field, there may be a significant misinterpretation by someone else who is not medically trained or who does not have the same knowledge.
Such is the case with the Planned Parenthood attack videos, which show medical professionals in situations with supposed colleagues: ones that do not call for “sugar-coating” procedural aspects but instead require candid, straightforward explanations of the processes involved. Of course, to someone who is not a medical professional, this may be so alarming or unfamiliar as to cause queasiness and a visceral reaction of anger.
Additionally, those working in high-stress professions will often use dark humor in order to cope with the emotionally draining aspects of their jobs. Firefighters, emergency medical technicians, psychiatrists, trauma surgeons, fighter jet pilots, and others may make off-color jokes to colleagues in order to procure an emotional release of how horrible experiences in the real world can be. The stresses involved in being a physician are not easily explained to nor easily understood by non-physicians, and I imagine the same can be said for attorneys and non-attorneys. Especially in obstetrics and gynecology, we see the worst of the worst outcomes, as well as the best of the best. We may say things to each other that might appear insensitive to a non-OB-GYN, but there are many instances of needing to depend on each other for support that only another OB-GYN can give and understand. However, this does not mean that this dark humor is a precise example of how the person feels and thinks about everything and everyone on a daily basis. That would be like saying anyone using sarcasm means they are an inherently mean person, period. Of course, this is not the case.
In general, context plays an important role in the way we communicate, not only with our own colleagues and friends but also with the media or, as in the case of physicians, with our patients. I’d have a failed practice if I didn’t treat each of my patients as individuals with different life stories, who needed and deserved to have communication that was appropriate and individualized. Writing a prescription for a medicine that someone cannot afford, for example, has done absolutely nothing for them and I have failed them as their health-care provider. Someone having a miscarriage who had desired an abortion is very different from someone having a miscarriage who had desired to parent, even though they are both “having a miscarriage.” My genuine sympathies and compassion will be conveyed to both, but I may use different language for each depending on the individual I am treating.
The art of medicine not only includes knowing and understanding the human body, but also the human spirit and human experiences. We can communicate the same information to a variety of audiences but we may use different language to do so. Effectively communicating with colleagues is one aspect of medicine, while effectively communicating with patients is another. It is critical for my patients’ well-being that I do not speak to them as if they were a colleague, but rather as an individual with individual experiences and background, so that I can provide the best health care I can.
Not knowing this and not executing these distinct forms of communication in health care is detrimental to real people with real lives.