ozarque: Linguistics; medical language; conscious awareness

ozarque (

ozarque) wrote,
@ 2006-03-27 15:09:00

Linguistics; medical language; conscious awareness
In the context of our recent discussion about why the language of linguists is so often almost impossible to understand, I said "Have you ever watched a tv spot where a reporter pleads with an MD to 'explain that to our viewers in ordinary English' and the doctor tries version after version without ever managing to do that? The same thing happens with linguists." And

lyonesse commented:

"just to ask, how do you think the english speaker with the md is supposed to be able to know what english is "ordinary" and what is "extraordinary"? do you think markers for this feature exist in every speaker's language, and if so, what causes a word or phrase to be marked thusly? and if marked, do you think this linguistic feature is consciously accessible to the speaker when they're speaking spontaneously? heaven knows that other, far-better-documented features (syntactic class, noun case, verb tense) are often quite opaque to their producers."

The manner of speaking that I've been calling "MDeitySpeak" is called a "register" -- meaning a manner of speaking that is tightly linked to a particular role in an individual's life, and that is typically used by everyone who fills that role. If I am understanding her correctly,

lyonesse is asking at least four questions; I'll do my best to answer them below without lapsing into the linguistics register.

1. Do I believe that native speakers of MDeitySpeak are consciously aware of its grammar?

Only in the limited sense that native speakers of English (or any other language/dialect/register acquired natively) are consciously aware of its grammar. They are aware of things they've been taught, the way native speakers of English are aware of things about English they've learned in "language arts" classes. If a medschool prof tells a medical student specifically that "Doctors never say 'I don't know' -- remember that!", the chances are good that the student will retain conscious access to that chunk of information.

2. Do I believe that native speakers of MDeitySpeak can access that grammar deliberately and systematically?

Yes, I do -- although, because they have little conscious awareness of the grammar, they're unlikely to be able to explain how they do that, or to be able to recite or write down the rules they're following. Native speakers of English who are asked to recite or write the rule for constructing an English question that can be answered with "yes" or "no" are ordinarily unable to do that -- but they are able to demonstrate their ability to access that rule deliberately and systematically, because when you ask them to give you an example of such a question they can do it immediately and without hesitation. People learn various registers of their language as they learn various roles in life. The little boy who says "Goodby, Dr. Anderson" to the pediatrician, "Bye, Mom!" to his mother, and "Later, dude!" to a friend is demonstrating the ability to shift deliberately and systematically among three different registers. Adult physicians are capable of the same feat, although there are individual medpros who -- for a variety of reasons -- are unwilling in public to give up the armor that MDeitySpeak provides.

3. Do I believe that the mechanism of access -- that is, the index that the native speaker uses to retrieve information about MDeitySpeak from memory -- is something like a feature [+MDeitySpeak] on items of the register?

I don't believe that it's literally the case; we have no idea, in physiological terms, how to describe the "physical appearance" of items of language in the human mind. But metaphorically, that's a perfectly appropriate way of describing the situation. You could just say that a word like "nephrolithiasis" or a gesture like hand-steepling is marked in the mental grammar with the feature [+MDeitySpeak] so that the speaker can retrieve it efficiently.

4. If the answer to #3 is yes, what do I believe causes that feature to become attached to the items?

The individual is told specifically, during the course of medical training, that a particular item is characteristic of "the way doctors talk" and makes a note of that. The individual notices a particular item of speech or of body language that other doctors use consistently, and learns that item independently. The individual reads an article in a medical journal on "How to Talk to Your Difficult Patient" and learns one or more items that way. The individual greatly admires some other doctor and tries hard to model his or her language behavior on that doctor's language behavior -- perhaps even going so far as to take notes and make lists and memorize their contents. Each time something like this happens, the doctor [metaphorically] identifies the item of MDeitySpeak, attaches the feature [+MDeitySpeak] to the item, and stores it in her or his longterm memory.

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	jphekman 2006-03-27 04:40 pm UTC (link)
	I'm pre-vet, and taking the same classes that pre-med students take. My biology professor informed my class at one point, "and that term that I just taught you actually means X, but you have to learn these words that doctors use in order to be considered a part of the community. It's like a secret handshake." The rest of the class laughed, but I thought of you :) (Reply to this)

technomom
2006-03-27 04:53 pm UTC (link)

This is why we technical writers exist, y'know ;-) We actually spend time figuring out how to translate MDeitySpeak - or LSpeak (from linguists), or PSpeak (from programmers) or ESpeak (from engineers) or whatever is called for into Common, or even into $Speak at times.

I can't imagine why linguists, any more than any other specialist, should be expected to do that for themselves.

(Reply to this)

Hmm.

resolute
2006-03-27 05:05 pm UTC (link)

My field, Air Traffic Control, has what I believe might be two registers. There's the highly structured and formally taught vocabulary and syntax used to communicate with aircraft and with other controllers regarding ATC matters. An approach clearance would be an example of this.

"November one two three four, one two miles southeast outer marker, turn right heading two eight five, maintain three thousand eight hundred until established on a published portion of the approach, cleared I L S three one approach Pierre airport, change to advisory frequency approved, cancellation this frequency."

And then there's the informal folk-term-laden vocabulary of the work culture, with no special grammar.

"Flow said send him direct, but sixteen's packed, so you gotta get forties between him, him, and him over Gopher."

Are these both examples of registers, or would the latter merely be an example of a slang vocabulary molded onto "everyday" English?

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	Re: Hmm. Response to resolute.... ozarque 2006-03-27 05:16 pm UTC (link)
	They're definitely registers -- probably best described as a single register with a formal/technical level and an informal level. And I assure you that a linguist would see plenty of "special grammar" in your second example. Thanks for your comment. (Reply to this)(Parent)

meowse
2006-03-27 06:23 pm UTC (link)

I'm a software professional, with a large vocabulary ("algorithm", "iterate", "pointer", etc.) of domain-specific terms of art. I am also, periodically, called upon (1) to document my own or someone else's work, (2) to help a non-technical friend with a technical problem, and (3) to write a sales proposal for a primarily non-technical audience.

I find that the translation process is radically different in each case.

In case (1), the main difference between how I think of the topic under discussion, and how I write documentation, is the degree to which I explain the details of the current project. There is, I believe, no "linguistic" transformation taking place: rather, the challenge is one of semantic mapping (probably, itself, a geek-flagged term), where I attempt to make sure that my reader has the necessary project-specific background knowledge at each point in the documentation. But I use standard geek terminology in writing the documentation, assuming that my audience is fellow geeks.

In case (2), the primary challenge is linguistic, and largely seems to involve replacing single-word terms of art ("bus", "bandwidth", "Cat-5 Ethernet cable", "toggle") with descriptions ("the wires inside the computer that let the different parts of it talk to each other", "how much information can be carried across that type of wire", "that blue cable with a thingie that looks like a phone jack on the end, that runs from your computer to the box that the cable plugs into", "right-click on the connection and click 'disable', then right-click on it again and click 'enable'"). In this case, there's no attempt to establish status or a sense of mystique with "geek-speak"--it's simple communications efficiency that has led us geeks to evolve terms of art like "power-cycle", "flush", and "CPU". But it also means that the task of putting things in "plain English" is very simple, and involves a largely context-insensitive dictionary lookup and transformation.

In case (3), the challenge is simultaneously linguistic and conceptual. I'm responsible not only for translating geek-speak terms of art into "layman's terms", but also for taking on the intended audience's perspective and focusing on their goals. A businessman honestly doesn't care whether "the selected architecture is linearly scaleable with respect to incoming data load"--he cares that "performance problems can be easily addressed with the purchase of more servers". So when writing a sales proposal, I'm attempting to cross two communications barriers at the same time--one linguistic, consisting of variant vocabularies, and one semantic, consisting of different purposes, goals, and measures of utility.

I think there may be utility in breaking down the "doctor-translation problem" along similar lines. When a doctor is talking to a patient, is the challenge of "putting it in layman's terms" primarily linguistic, or primarily conceptual? Is it more a matter of saying "bleeding beneath the skull that's putting pressure on your brain" instead of "sub-dural hematoma", or is it more a matter of saying "I'm afraid that your husband's head injury has caused swelling that is putting pressure on his brain, which we are now treating by basically 'keeping him asleep' for a few days while we wait for the swelling to go down" instead of "We've artificially induced a coma to reduce tissue necrosis subsequent to a sub-dural hematoma."?

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kelsied
2006-03-27 07:24 pm UTC (link)

Well... sometimes it's just "how doctors talk" but it seems to me that the major problem is back to navigating that tech/non-tech interface. As a specialist, it's very uncomfortable to use non-technical language. You lose nuances that are important, and it can feel like you're oversimplifying to the point of misleading people or lying.

It's something I struggle with daily. To be frank, I haven't found a satisfactory solution. I can write fluent oversimplification, and fluent technical detail, but hitting the mid-range (for an audience that is somewhat familiar with what I'm doing, not technically oriented, but that needs to develop a high level of familiarity with certain relevant technical details)... I mean, it just baffles me.

It's hard to find a way to communicate difficult information in a way that isn't patronizing, but that also includes all the important details in a way your audience can understand, without offending people or making them frightened or wasting their time or losing their interest.

I run into that problem in health benefits; my husband runs into it with computers; my mother runs into it as a retirement specialist... it's not just doctors who aren't sure quite how to bridge that gap.

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metalfatigue0
2006-03-28 12:02 am UTC (link)

It's hard to find a way to communicate difficult information in a way that isn't patronizing, but that also includes all the important details in a way your audience can understand, without offending people or making them frightened or wasting their time or losing their interest.

Amen!

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lyonesse
2006-03-27 07:57 pm UTC (link)

these are interesting contentions. i have to ask, though, did you get these ideas from talking to "MDeities"? (& what do they think of that term?) or if not, then how?

i don't have an md, but i do have an advanced degree and a bunch of experience in discourse communities with varying sets of more-or-less local usages. personally, i find i have a fairly hard time remembering when i'm supposed to say "gaba-a agonists" (the term that springs first to my mind, which i guess is from some grad course in neurochemistry), when i'm supposed to say "benzos" (which is the term i think md's tend to use), when "alprazolam" and "diazepam" (which is what it says on the bottles you get from the drugstore, when "valium" and "xanax" (which is what relatively wealthy white americans to whom the stuff is advertised seem to call it), when "minor tranquilizers" (the term i think they use in undergrad-type psych classes), and when "that stuff the bush daughters keep getting in trouble for taking" (familiar to people who watch television). some of this may be insensitivity to register on my part -- i know all these terms *exist*, but i don't always know when i should use which, and i'm perfectly certain there are more terms i just don't know (say, what you'd ask for on a street corner in a not-so-pleasant part of town). in my head, i always come up with "gaba-a agonists" first. i suspect under pressure, such as in a teevee interview, i'd come up with "gaba-a agonists" and want to stick with it, since it makes the clearest and best sense to me myself, and i have no idea how i'm supposed to talk to teevee interviewers, really. (referencing the bush twins would be tempting, but i suspect it would also be rude.)

which of the above terms would you mark as "MDeitySpeak"? "benzos"? the slightly more formal but i think more rarely uttered "benzodiazepines"? which term would you like a person on television to use as "plain", and why?

for the record, i was never told during my education that "gaba-a agonists" was "the way neuroscientists talk". i don't think i was *ever* told that about anything, as far as i can remember. (although i still say "neuron" and "axon" with a long "o" at the end, since my neuroanatomy 101 class was taught by a gentleman from south america -- but that's a quirk. i realize it's wrong for the discourse community i mostly belong to, but it still coms out of my mouth that way.) but, umm, we talked about gaba, and gaba receptor subtypes, and what chemicals that weren't gaba did what to that system, and "gaba-a agonists" is what ended up topmost in my lexicon.

i guess i would find it less surprising to imagine a similar thing happening in medical school than imagining students being given lists of "how doctors talk" terms to memorize and replacing their previous lexicons with them. i don't think i had too much lexical information about gaba-a agonists prior to my grad-school experience, and most of the terms i can come up with for synonyms came later. (i may have had "valium", but i'm not clear that i knew what it meant, and the bush twins hadn't yet begun their lawbreaking careers.)

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victoriacatlady
2006-03-28 12:51 pm UTC (link)

I suspect you gravitate to "gaba-a agonists" because it's a term that actually explains something to those people who, like you, understand something of the chemistry of the nervous system. Most of the other variations are just relatively meaningless labels.

As for which terms would be useful as non-MDeitySpeak, I would suggest "minor tranquilizers" as the primary one with "Valium and Xanax" as second in line. "Minor tranquilizers" covers an entire class of drugs, whereas Valium and Xanax are just examples; however, they are familiar examples, especially Valium. That familiarity makes them more accessible to non-MDieties.

In fact, I would say the most plain-speak term would be simply "tranquilizers." If you add the word "minor," you then get into the question of which tranquilizers are minor and which are major and why, and that's a question that should probably be avoided unless it's actually relevant.

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lyonesse
2006-03-28 04:59 pm UTC (link)

i am assuming, for the sake of making the problem more interesting, that a high level of specificity is called for (at least from the speaker's perspective). when i say "tranquilizers" it brings to mind not only the gaba-a agonists (for which i have a tender regard) but also say ketamine (which i regard mainly as a scary drug of abuse). i couldn't reasonably substitute those terms in my idiolect, even if the nominal meaning of "to tranquilize" were the important thing, since although ketamine is a "tranquilizer" (mostly used in veterinary medicine) it does not typically make a human being anything like "tranquil". (come to think of it that may be why "tranquilizers" is extant but deprecated as a term in my personal lexicon in general -- i don't care for "narcotics" for a similar reason, in that the legal and scientific usages of the term are both familiar to me but quite contradictory, and i can't feel like it's a word i can use at all sensibly with anybody outside a strictly-among-neurochemists community.)

another point i'd like to linger on is the contention that md's (i must say i find the term "mdeity" quite snide, and i don't think it's polite) are taught "you talk this way because you are an md" in a formal way, encoded in event memory. i don't remember being told to use "gaba-a agonist", ever. i do remember -- not in the sense of event memory, which i *don't* have for this, but in the general sense of "it must have been then" when i found out what it meant, and adding it to my lexicon in the same ordinary way i learned "t" for the local transit system and "frappe" for an ice-cream beverage when i moved to my current geographical region. if there's a different process going on in medical school than there is in grad school for neuroscientists, i have not heard of it from any medical-school graduates i know, and i would like to know how

ozarque got the data upon which she based her claim about their language acquisition process.

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Response to lyonesse...

ozarque
2006-03-28 05:26 pm UTC (link)

" i would like to know how ozarque got the data upon which she based her claim about their language acquisition process."

Happy to oblige.

My data is based upon twenty-five years of teaching seminars and workshops at medical schools, medical conferences, medical clinics, and large hospitals -- every single presentation accepted for Continuing Medical Education credit -- plus twenty-five years in private practice as a consultant to medical professionals -- plus twenty years as a troubleshooter to medical institutions and organizations that were suffering negative effects caused by problems of communication.

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	Re: Response to lyonesse... lyonesse 2006-03-28 05:29 pm UTC (link)
	i'm sorry, but that is a general answer to a specific question. did you ask them, "where did you learn to say [hepatotoxin, benzo, other-example-of-md-speak]?" if so, what did they say? or did you do some other kind of investigation specific to this issue? or is this just a general impression from your long and broad exposure? (Reply to this)(Parent)

redbird
2006-03-27 09:14 pm UTC (link)

Another relevant question, I think, is which register--or registers--is being asked for when someone asks a doctor to put something into "ordinary English." There's what I might call "father knows best," in which the doctor uses--or tries to--ordinary vocabulary, but of the form "take this pill and you'll feel better" rather than "penicillin will probably cure your infection."

There's a register that I can usually get doctors into by using a little bit of biology or medical vocabulary, the "educated layperson" register. That's one where they accept that I have some understanding of mathematics, and won't take an antibiotic for a viral infection.

There's a "simple metaphorical" register, the one my GP tried to use when I had plantar fascitis--she was drawing analogies to a cut-up chicken at the supermarket, and I only got the name of the diagnosis by asking her, explicitly, what it was called so I could look up more information later if I needed to. That's not the register I wanted at that moment, but she uses it because many of her patients do find it helpful. It has two advantages, I would guess: one is that people can visualize the problem, and the other is that it establishes a connection, which is useful when you're giving a patient low-tech treatment like "no high heels, and don't go barefoot" rather than medication or surgery.

There are probably several others--but I suspect part of the problem is that the doctor isn't sure whether to be aiming for educated layperson or simple metaphorical. Part of that problem may be in the nature of broadcast journalism--the affect and known background of the journalist asking the question may call for a different register than would be most appropriate for the audience.

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beckyzoole
2006-03-27 09:48 pm UTC (link)

I've found that MDs generally over-simplify. The older ones have become cynical from dealing for years with an under-educated and under-informed public. The younger ones are fresh from med school courses on bedside manner and clear communication. Either way, they use too much "ordinary English" and not enough precise medical terms.

My fiance

bbwoof just spent 9 days in the hospital, and is now home recovering from abdominal surgery. Our emergency room experience was made even worse by the way medical personnel spoke to us in "simplified English", as if his illness had made him a child or an idiot. Neither one of us is a medical professional, but we're both intelligent adults!

As a computer geek, I know what

meowse meant by saying that "there's no attempt to establish status or a sense of mystique with "geek-speak"--it's simple communications efficiency that has led us geeks to evolve terms of art". It's the same with any technical field, including medicine.

I would so much rather have a doctor respect my capabilities by using the correct term for something ("MDeitySpeak"), than insult me by talking down to me, using baby-talk and over-simplified explanations!

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naohai
2006-03-27 10:47 pm UTC (link)

I would so much rather have a doctor respect my capabilities by using the correct term for something ("MDeitySpeak"), than insult me by
talking down to me, using baby-talk and over-simplified explanations!

I agree with this as well. If I don't know what a term means, I'll ask, or else provide sufficient feedback that the speaker understands how conversant I am with the topic.
I don't find technical jargon intimidating, perhaps because I'm in a field that uses a lot of technical vocabulary myself (software engineering).
I'm often called to translate technical concepts for a lay audience. However, simply knowing that someone is a layman doesn't give me enough information to figure out what translation set I should use for them. I need to know what is interesting to them (and not), how comfortable they are with new vocabulary, what explanatory metaphors will make sense to them, etc etc.

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MDs

zianuray
2006-03-28 06:16 am UTC (link)

In my first interview with any doctor, I hand them a written list of my requests (actually requirements, but they take "requests" better).

One of these is "Do not talk down to me. Use the language you would normally use. If I need a definition, I will ask."

If they have trouble with this idea, or with any of my requirements, I find someone else. There's LOTS of docs in this area.

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starcat_jewel
2006-03-27 10:51 pm UTC (link)

Point one, I tend to agree with

beckyzoole -- there are indeed some doctors who are incapable of recognizing when they are dealing with a patient who can understand some MDeityspeak. This is often exacerbated when the doctor is male and the patient female, and can be a symptom of cultural sexism as much as anything else.

Second, in your initial example, I've also noticed that what the reporter seems to mean by "ordinary English" is "in third-grade vocabulary or less", because no matter what the doctor says, or how simply and clearly it's expressed, it's still never good enough. Is it really asking too much of the average reader/viewer to expect a junior-high-school vocabulary and comprehension level? Because if it is, then I'm afraid it's much too late to fix anything about our social problems at all.

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meowse
2006-03-27 11:34 pm UTC (link)

Third-grade, no.

Middle-school? Unfortunately, yes.

As per this link:

Research tells us that to communicate effectively with a general audience in the U.S., we need to write at a 6th-8th grade reading level.

Another interesting statistic from that page, with particular relevance to MDeitySpeak:

The average reading level of American parents of young children is 7th or 8th grade, but 80% of pediatric materials for parents are written at the 10th grade level or above.

Consider with me, for a moment, how one would phrase those quotes to be understood by a general audience:

"Most people don't read very well. People understand simple sentences. Write simple sentences. Write them for 6th-graders. Keep the sentences simple. Then most people will understand them."

"Lots of us have young kids. We take our kids to doctors. Doctors give us hand-outs. The handouts are confusing. Doctors should write simpler handouts. 4 out of 5 hand-outs are too confusing."

Especially for a television audience, yes, pretend you're talking to your eight-year-old. If your eight-year-old can understand it, then the average adult can, too.

And, yes, I'm making certain assumptions about

ozarque's readership. I don't think they're unfounded.

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	beckyzoole 2006-03-27 11:47 pm UTC (link)
	Most people in this country are high school graduates. Apparently, a high school graduate can be expected to read at only a 6th grade level. The educational system has failed these people! We ought to be attempting to increase the reading, writing, speaking and reasoning abilities of the general public. (Reply to this)(Parent)(Thread)

	metalfatigue0 2006-03-28 12:05 am UTC (link)
	Well, ozarque seems to feel the solution to that starts with proper nutrition, and I can't say she's wrong. (Reply to this)(Parent)

kelsied
2006-03-28 09:22 pm UTC (link)

It depends on whether you want to reach "everyone" (and if so, you should write at a sixth grade level), or "most people" (in which case, you can write at a 12th grade level).

But when writing for a "general" US audience, one is usually communicating important information, like "here is how you get your drugs under the new Medicare prescription drug program." You're trying to reach as many people as possible. And at that point, absolutely, you use the lowest common denominator. Because the people who are most vulnerable are going to be the ones who don't read well, who have english as a second language, or limited education... the people, in short, who don't understand how to navigate the system, or how to do the research they would need to do to learn how to navigate it.

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beckyzoole
2006-03-28 12:22 am UTC (link)

This is often exacerbated when the doctor is male and the patient female, and can be a symptom of cultural sexism as much as anything else.

We came upon more of it, though, with the largely female nursing staff. The doctors, both male and female, tended to shift back into "educated register" more quickly once they heard us using that form of speech.

With nurses, we'd get a lot of "I'm going to give you a shot in the belly now" -- at which point I'd ask "What are you giving him? Why are you giving him heparin? Yes, but why is he considered to be at risk for clotting? Can you tell me how frequently he is to be given this injection? Which doctor ordered it? What is the dose? Does it have to be abdominal -- his abdominal wall is very tender." We'd get minimal answers, if any at all.... and a few hours later, the same nurse would return with "Time for your belly shot" again, and "Can you go potty?".

In my dialogue, and in

bbwoof's, nobody over the age of five says "belly" or "potty" to anyone else over the age of five! Illness and the hospitalization process is inherently depowering, and infantilizing the patient just makes it worse.

What I would have much preferred would have been an approach that would have empowered and educated the less-educated patient, and respected other patients. It would be easy to put it in simple language, and wouldn't take more than a minute or two longer than a quick "here's your belly shot!" and a jab. Something like:

"Dr. Guerra has ordered an xx ml dose of heparin for you. You'll need to get this every xx hours while you're on bedrest. This is standard hospital procedure for almost all patients on bedrest. Are you familiar with heparin? Yes, it reduces the ability of the blood to clot. One of the dangers of bedrest is that blood doesn't circulate well in your legs if you don't use them. So there's a danger of blood clots forming in the legs, and traveling to your lungs or heart or brain -- right, that could be dangerous. If you'd like, I can bring you a pamphlet on blood clots, and one on the risks and benefits of heparin. You'll see that the side-effects of heparin are minimal. Yes, I know that your abdominal wall is tender, but we've found that this is the best injection site to ensure that the heparin gets evenly distributed in both legs. Is it better a little higher up, here?" etc.

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metalfatigue0
2006-03-28 02:43 am UTC (link)

"A minute or two longer" × 30 patients = not realistic.

and a few hours later, the same nurse would return with "Time for your belly shot" again, and "Can you go potty?"

That, on the other hand, is inexcusable.

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	junior-high-school vocabulary zianuray 2006-03-28 06:19 am UTC (link)
	When I was a mechanic in the Army, our tech manuals were written to a FIFTH-grade comprehension level. Keep in mind that at that time, a new inductee was required to have a High-School Diploma or a GED. Still, many of the mechs couldn't "get it." (Reply to this)(Parent)

metalfatigue0
2006-03-27 11:58 pm UTC (link)

Well, three out of four is good. (I would say that your item #3 is definitely not "ordinary English.")

Perhaps some of the difficulty faced by the "medpro" (medpros unbellyfeel Ingspeak?) stems from the desire not to oversimplify, either to avoid being perceived as condescending or to avoid losing information that the speaker considers important, even if the listener might not see it as important.

I think meowse overstates the difference between tech-support communication and marketing communication; in both cases, the listener has a model of the discourse domain that omits many nuances and collapses many entity distinctions that exist in the speaker's model (while perhaps including nuances and distinctions that are invisible to the speaker). To communicate effectively, certain information must be preserved, and certain information must be discarded; an error in either direction is potentially catastrophic.

Personally, I always err on the side of conserving information, because (like beckyzoole) I am hypersensitive to the perceived implication that I might be unable to assimilate some complexity. When someone says they don't understand what I'm saying, my response is often to explain some part of my model of the discourse domain, so that they will be able to understand what I said; after all, that's what I'd want them to do if our roles were reversed.

Unfortunately, my experience has been that the vast majority of people don't really want to augment their understanding of the discourse domain when they're in a crisis. Furthermore, some people are hypersensitive at all times to the perceived implication that their domain model lacks an important piece.

So: some people perceive the use of any term outside their ordinary speech register as an assertion of superior status, while others perceive the use of a register less specialized than the speaker would use with a fellow professional as an assertion of superior status. Poor medpro! You just can't win!

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beckyzoole
2006-03-28 12:39 am UTC (link)

I wouldn't say that I'm hypersensitive to the perceived implication that I am unable to understand; at least, not under normal conditions.

When I'm stressed, I do become more sensitive I suppose. But more than that, I respond to stress by going into information-gathering mode. I want to know everything I possibly can about what is going on. When a med pro treating me or my loved one uses simplified "ordinary English", I know that the nuances and distinctions have been eliminated. I want to get all of them, though. If I don't understand something the med pro says, I want to write down the technical terms so I can look them up on the Internet.

Telling me "his gall-bladder is stuck to something else in his belly" doesn't help me as much as knowing that there are multiple adhesions to the omentum. (If I didn't already remember the omentum from high school biology class, I'd immediately ask what it was, and how to spell it.)

On the other hand, when someone is on pain and/or on heavy pain medication, their ability to follow complex sentences may be impaired. And I know that many people respond to stress by "shutting down" and becoming impatient with all but the simplest, most straight-forward terms.

So I can understand the tendency to over-simplify when speaking with a patient in crisis. You do have a good point there.

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	kaytecat 2006-03-30 11:01 pm UTC (link)
	"I can only handle Fire bad, tree pretty." --Buffy, after a really busy day. Sometimes, in times of extreme stress, the simpler register is useful. (Reply to this)(Parent)

Response to metalfatigue0....

ozarque
2006-03-28 01:41 pm UTC (link)

I am so glad you posted this comment, because it is a flawless example of the problem I'm trying (not very successfully, I'm afraid) to make clear. [I suspect that that may have been your intention; if so, well done.]

I don't know enough about you to identify the register you've used above, but I give you my word: a very large percentage of people in the U.S., although they're literate, would not be able to understand what you've written. As long as it's not urgent for you to get a particular message across to them, that's irrelevant, and your language style (spoken or written) is entirely a matter of your personal choice and preferences. When the communication of a message is urgent, however -- for example, in the instructions (spoken or written) doctors give to patients, the instructions judges give to juries and witnesses, the information contined in emergency messages for evacuating a subway car that's on fire, and so on -- it becomes critically important to use a register that can be understood by virtually everyone who hears or reads it.

This becomes a serious problem when those who are trying to communicate the urgent information (a) are unaware that their language is far over the heads of those who need it -- usually because they were born into a privileged class and have had no experience outside the privileged classes -- or (b) are unwilling to "stoop" to a less lofty register.

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Re: Response to metalfatigue0....

meowse
2006-03-28 03:07 pm UTC (link)

Ah.

metalfatigue0 is simply speaking Geek. It's characterized by a profusion of polysyllabic (yet not gratuitously obscure) verbiage, a clear attention to subtleties of connotation as well as denotation, an emphasis on analysis, and a solid grasp of fields as disparate as linguistics, semantics, computer science, and science fiction/fantasy trivia.

And yes, that paragraph is a blatant, not to say egregious, example of same; as, tragically, is this self-referential sentence.

Flags (signifiers) that allowed me to identify precisely the register in which he was speaking (from which he was speaking?):
1) "medpros unbellyfeel Ingspeak" -- clear SF literary reference
2) "stems from" -- narrows it down to "liberal arts professor" or "geek"
3) "overstates the difference" -- a refinement of "exaggerates", indicating a high value placed on precision of speech
4) "model" -- ah, I'm ammending my above definition of Geek to include "an emphasis on analysis"
5) "discourse domain" -- narrows it down to either "deconstructionist", "liberal political theorist", or "geek"; and "liberal political theorist" tends almost to be a subset of "geek" these days.
6) "vast majority", "augment", "perceived implication" -- traditional Geek terms
7) high incidence of qualifiers ("some", "often", "the vast majority")

As to "born into a privileged class"--when you consider that most geeks are the children of geeks, and were thus born into families with better-than-average knowledge of nutrition, incredibly high levels of verbal interaction and word-play, adequate money, and good genotypic intelligence--yes, I think you'd have to consider the Modern American Geek to have been born into a privileged class.

Not that I'm complaining, mind you.

In other news, I think there are multiple fascinating assumptions buried in the simple phrase "are unwilling to 'stoop' to a less lofty register" that deserve a post all their own. On which, more later.

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metalfatigue0
2006-03-28 04:24 pm UTC (link)

[E]ither "deconstructionist," "liberal political theorist," or "geek"….

Guilty on all counts, Your Honor.

For that matter, I would guess from your tendency to put commas and periods outside double quotes that you have a computer science background.

(Reply to this)(Parent)(Thread)

	meowse 2006-03-28 06:31 pm UTC (link)
	Oh, very well done. :-) I wonder what other signifiers differentiate "computer geek" from "geek"? On a somewhat tangential note, I find it incredibly relaxing and soothing to talk to people who use language precisely and think rigorously. It's somewhat odd to think that the "average American" finds this sort of conversation stressful and confusing. (Reply to this)(Parent)(Thread)

gramina
2006-03-30 11:36 pm UTC (link)

I don't know, but I wish more programmers understood that that's a programming rule, not an English rule!

It doesn't happen so much where I am, but for years, most places I've worked, I have had people re-err their corrected-by-me prose to put the periods outside the close quotation marks. I don't mind fixing it the first time -- I understand finger-muscle habits -- but don't undo my corrections! sigh It wasn't til I took a C class that I understood why all those programmers had been so insistent that punctuation go outside the quotation marks.

/rant.

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	Re: Response to metalfatigue0.... dteleki 2006-03-28 04:47 pm UTC (link)
	1) "medpros unbellyfeel Ingspeak" -- clear SF literary reference And best of all, it's wrong. But it's wrong not just any old way, but wrong in a way that is easy enough to recognize and repair on the fly -- if you're in on the joke to begin with. It should be "Newspeak". In Orwell's 1984, there was Oldspeak, and Newspeak, and Ingsoc -- but no "Ingspeak". (Reply to this)(Parent)(Thread)

Re: Response to metalfatigue0....

meowse
2006-03-28 06:40 pm UTC (link)

I don't believe I'd classify it as "wrong": it's a literary reference, not a quote. "Ingspeak" is a plausible neologism in that fictional context.

And, as such, "medpros unbellyfeel Ingspeak" strikes me as an excellent (and delightfully self-referential) capsule summary of this whole discussion.

In other news, I find it almost impossible to describe a concept as "self-referential" without using the adjective "delightfully". I wonder if this is because, as some have speculated, consciousness derives from the ability of the brain to model itself, and thus is itself fundamentally self-referential.

Someday, we'll meet an alien race, and we'll say to them, "This sentence is a lie", and when they grin and respond with "Ceci n'est pas une fnarg", we'll both know we're conscious beings.[*]

[*] as opposed to those alien races which reproduce by parthenogenesis, have evolved without epiphenomenal consciousness, and respond to our type of sentience as if we were mad, quarantining us and attempting to cure us of our delusions. But I haven't written that book yet, just some notes. :-)

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metalfatigue0
2006-03-28 04:12 pm UTC (link)

I give you my word: a very large percentage of people in the U.S., although they're literate, would not be able to understand what you've written.

I have no doubt. However, I'm writing for you and for the other readers of this blog, and I would be very surprised to hear that any of you found my writing to be a challenge.

And—to reiterate my earlier point—sometimes it's not a matter of "unwillingness to stoop" (what an accusation!) but difficulty estimating what will and will not be important to the listener.

(Reply to this)(Parent)(Thread)

	kelsied 2006-03-28 06:07 pm UTC (link)
	"sometimes it's not a matter of "unwillingness to stoop" (what an accusation!) but difficulty estimating what will and will not be important to the listener." My experience exactly! (Reply to this)(Parent)

	gramina 2006-03-30 11:39 pm UTC (link)
	FWIW -- I actually had to pay attention. Just so's you know :) (Reply to this)(Parent)

Addendum

metalfatigue0
2006-03-28 12:09 am UTC (link)

That's not to say that there aren't instances when the translation is trivially simple—I don't think anything of importance is lost by translating "nephrolithiasis" to "kidney stones," for instance—but I can see how a stressed-out medpro, especially a hospital resident, might not stop to consider the translation possibilities available for each utterance, but instead adopt a default strategy which is guaranteed to miss the target on one side or the other most of the time.

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Re: Addendum

meowse
2006-03-28 03:14 pm UTC (link)

Rather than a simple vocabulary translation, I think it might be useful for doctors and nurses to change from a "what it is" focus to a "what it does" focus.

In other words, I think the important dimension is not "anticoagulant" vs. "blood-thinner" vs. "belly shot", but any of the three vs. "shot to help prevent blood clots while you're lying here".

"We need to make your kidney stones small enough that you can pee them out without pain. This machine uses sound to break up your kidney stones without needing surgery."

Hmmm. Now I'm imagining an experiment where "patients" are given a diagnosis and treatment plan by a doctor, and it is explained to them in MDeitySpeak, in layman's terms, and in functional terms. And then the "patient" is observed while they are asked to explain their diagnosis and treatment plan to a friend/peer, to see what register they use. Might be very useful for finding out how patients actually most want to receive this kind of information.

(Reply to this)(Parent)(Thread)

	metalfatigue0 2006-03-28 04:01 pm UTC (link)
	Oo! Good experiment! I want to read the pre-print. (Reply to this)(Parent)

Re: Addendum

kelsied
2006-03-28 06:10 pm UTC (link)

Yes, but I'll bet the results say that the answer is different for every patient.

Somehow, we have to train doctors (and other specialist-professionals who interact with non-specialists) to recognize different levels of patient competency, and speak to each patient at the level that is appropriate to them.

I'm pretty sure this is not a "one size fits all" kind of topic.

But if it is, I'd sure appreciate a copy of the cliff's notes... *grins*

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	Re: Addendum meowse 2006-03-28 06:45 pm UTC (link)
	Now I'm picturing a job, "Speaker-to-Patients", who stands there and translates between the patient's "Doctor, I've got a pain in my thingy" and the doctor's "Our radiological assay test has confirmed that you have splenomegaly." It might make a lovely piece of social satire. Then again, if educational standards keep dropping, it might make a good living someday. (Reply to this)(Parent)

Re: Addendum

gramina
2006-03-30 11:45 pm UTC (link)

I do think that part of my job as a patient is to clue the medical professional to what register I want.

wry grin I'm among the rare folks who get cytomegalovirus, typically referred to for obvious reasons as CMV, as an adult. My doctor, fairly new to me, gave me the diagnosis... and I looked at her with an apalled and amused expression and said "really big cell virus????" We did just fine after that :) (incidentally, it's a really big virus that lives in the cytoplasm, iirc.)

I've also been known to just tell doctors early on that I'm eight hours shy of a Bachelor's in chemistry and 12 of a Bachelor's in biology, and if I need to ask them to define something I will, but my main problem-solving mode is research, so...

It's a lot faster for me to give the doctor (or whatever professional expert I'm dealing with) a clear idea up front of the kind of register (?) I'm looking for, than to hope s/he will guess right. Now, one who ignores my perfectly civil request to be treated like I'm not an idiot.... they're fair game!

(Reply to this)(Parent)

kelsied
2006-03-28 08:08 pm UTC (link)

Well, it seems like everyone's pretty much agreed that it's important to be able to communicate at different levels of complexity, based on audience. But I still don't understand how.

And as I'm sitting here, trying to wrap my brain about it, in hopes of finding a place to even start thinking about how to identify audience competence levels and adjust my approach accordingly (because it is a skill I need to continue to develop)... I'm afraid it all starts to look very hazy and knack-like. "Well, you just listen, and based on how they respond to you, you just adjust how you're talking...

It may be easier to do face to face, when you can react to your audience in real-time. It's a lot harder (or even harder?) when you have to write something to send out to people and you won't be there to see how they react.

How do the rest of you approach this sort of problem?

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meowse
2006-03-28 11:02 pm UTC (link)

Usually, the way I've seen good doctors do it:
1) start at the lowest common denominator
2) watch with an eagle eye for any signs that the person you're talking to can handle more challenging communications
3) raise the challenge level until their questions start indicating that they're feeling lost
4) lower the challenge level a few notches so they're at a comfortable level rather than straining their comprehension abilities.

Another good approach, however, involves asking what I'd call "ranging questions". In my domain, that might be things like, "So...you know what an Ethernet cable looks like?" or "Have you ever worked in Java, C#, or some other object-oriented programming language?" By their answers to these questions, you can proactively tailor the level of challenge in your speech.

And, finally, there are some dynamic adjustment strategies that I find helpful:

1) watch for people finishing your sentences. You can generally up the challenge level a notch or two.

2) watch for people asking "go back"-type questions ("I'm sorry, I didn't quite get that--could you go over it again?"). Go-back questions tend to indicate more of a slippage of comprehension than clarification questions ("Now, the duodenum is part of the large intestine, not the small, right?").

3) although it sounds cliche'd, watch for glazed eyes (and for the verbal equivalents). When the listener is unresponsive, not "tracking" (reacting to) what you're saying, there's a decent chance that they're confused. Note that this does not apply if they have Asperger's Syndrome or related conditions--which is surprisingly common among computer science professionals. Such individuals will often display little or no feedback either while you are speaking or afterward.

4) watch for people deliberately (and correctly) using your terms of art. If they are, you can probably up the challenge level a fair bit. Referring to "NSAIDs" rather than "aspirin", or "abdomen" rather than "stomach" is actually a decent way to let a doctor know that you're not clueless.

5) watch for people deliberately (and incorrectly) using your terms of art. They're probably feeling inferior, scared, snow-balled, steam-rollered, unhappy, and insecure. They may even be imagining that you think you're better than they are. Back the challenge level *way* off, but avoid any hint of condescension. They're not children, they're just scared adults who are out of their depth.

There. That's my best practical advice on how to tailor your speech to an audience.

Oh, you also asked about writing things. How to do that? Write to a fifth-grade level, and offer lots of links to "more information" in Appendices and other documentation. Also, include a high-level "technical summary" with each section, but in a box off to the side instead of as a header. That way, savvy readers can just jump to that box, but readers with less experience in the domain won't be intimdated by it.

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	Response to meowse.... ozarque 2006-03-29 01:39 pm UTC (link)
	That's excellent and useful advice. Thanks for posting it. (Reply to this)(Parent)

	kelsied 2006-03-29 04:03 pm UTC (link)
	Thank you. That's very well-written and helpful. I appreciate your taking the time to write this down! (Reply to this)(Parent)

kaytecat
2006-03-30 11:36 pm UTC (link)

I am really enjoying this thread.

I work at a computer help desk, and I get calls from people at a range of different skill levels. Variants I have:

"I need to know how to do something"

"I need to know how to do something and I need it for a meeting that started 5 minutes ago."

"I am programming X and I need to fine tune this nuance"

"I can't get Excel to do X"

"I can't get this stupid program to do X"

"I lost my file and I need it NOW!"

...and so on.

I can often tell by the way someone phrases the question:

What their skill level is.

whether they want a targeted answer, hand-holding, or want me to do it for them.

What their stress level is.

Very high stress level means I go short, to the point, and gentle. They are in a hurry, and they don't have time for long explanations.

The need to preserve information, as someone mentioned above, can make it uncomfortable to simplify too much. Sometimes someone wants a short answer, but their question needs a longer answer. If someone calls a "column" a "row", or if they call a "table" a "database", I need to clarify so I can be sure we are both talking about the same thing.

I usually try to explain why a program is behaving a certain way, so they can avoid error in the future. I gauge how much information to provide by their language/skill level and their stress level.

But, quite frequently I use words I assume to be in common parlance, (and not just computer geek words) only to have people stare at me blankly and ask what it means. These are often words I started using in grade school. (But then, I read dictionaries as a kid). But Since these words come so easily to me, I often don't realize they are not in the common register until I get the blank look.

(NB: LiveJournal does not recognize the word "gauge". See? Even computers give me blank looks.)

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