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USE OF FEW ENGLISH WORDS VERY USEFUL TO A GP IN MAKING A DIAGNOSIS
OP Kapoor
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
I was educated in Punjab, now in Pakistan where English was taught to us in the final two years of Secondary School Education. In my experience, most of the general practitioners, like me, are weak in English language.
During last many years, I have realised that some good English words have been linked with a medical word to impress. The following are a few examples:
1.‘Unstable’ angina is a very good example to indicate that this angina can kill.
2.‘Accelerated’ hypertension can always explain sudden rise of blood pressure in patients, who are otherwise well controlled on drugs. Even ‘accelerated angina’ (anginal attacks occurring more than three times a day) is a dangerous angina.
3.‘Mismatched’ ventilation perfusion lung scan is diagnostic of an important condition i.e. pulmonary embolism. Similarly, mismatched perfusion and metabolic myocardial perfusion scan is diagnostic of hybernating myocardium which really calls for coronary bypass surgery.
4.‘Lone’ atrial fibrillation can occur in any middle aged, non-alcoholic patient with no other risk factors and is not dangerous to life and can be controlled easily with drugs.
5.‘Pooled’ blood samples are necessary (at least three) to get an accurate reading of serum testosterone whenever it is reported low in an apparently normal person.
6.‘Demand’, ‘Supply’ and ‘Work load’ are three important adjectives to judge the prognosis of angina. "Angina at low workload" and "supply led angina" are dangerous.
7.‘Tempo’ is very important in diagnosis of an acute ‘thundering headache’ which always indicates a vascular accident in the brain or in the skull (Sagittal sinuses or in the blood vessels of the neck like dissection). While a migraine patient can complain of "thundering headache", the history elicited will show that a migraine headache always ‘builds up’ gradually in intensity. Similarly, the tempo of acute onset of high fever and tempo of sudden development of jaundice is seen in Weil’s disease.
8.‘Intensified’, ‘dedicated’ ICU are very good adjectives used to identify a good ICU.
9.‘Motivation’ and ‘Compliance’ of a patient in private practice, determine the results of your treatment especially in a condition like obesity.
10.‘Defaulter’ especially in a disease like TB will call for extra, prolonged treatment with anti-tuberculous drugs.
11.‘Window period’ is a dangerous period in the history of AIDS where the "sero-conversion" may not produce a positive HIV Test.
12.‘Auto regulation’ mechanism like a thermostat (air-conditioner) will make you hold on your drugs to lower the high blood pressure in a patient having a high blood pressure, after getting a stroke.
13.‘Urge’ incontinence is often seen in patients having an enlarged prostate. A patient will pass a few drops of urine only if he decides to pass urine on a full bladder and the latrine is not instantly available.
14.‘Stress’ incontinence occurs in 10% female population, when during a severe bout of cough, a few drops of urine are passed because of weak perineal muscles.
15.A ‘dark’ coloured urine is not the same as ‘black’ coloured urine. The adjective of ‘dark’ coloured urine is used for the urine of a jaundice patient, while ‘black’ (Coca-Cola) coloured urine is used for a patient of haemoglobinuria.
16.‘Rescue’ courses of steroids given to asthmatic patients who are on steroid inhalers, can save hospitalisation and even deaths which can occur after exacerbations, following a viral infection.
17. In a patient having arrhythmia ‘Ablation’ can be done in the conducting system of the heart with radio frequency. Similarly ‘endometrial ablation’ is the latest interventional surgical treatment for patients having severe menorrhagia, rather than removal of the uterus.
18.‘Cosmetic’ angioplasty is a beautiful terminology used by people who are doing malpractice and doing surgical interventions in patients where these procedures are not called for.
19.‘Timing’ of a procedure like angiography is important to identify a GI bleed. A wrong timing leads to mistakes in the diagnosis.
20.‘Promiscuous’ sex, ‘Causal’ sex, ‘Anal’ sex, ‘Vaginal’ sex, ‘Oral’ sex are the terminologies which are useful during history taking.
21.‘Provocation’-provoking a bronchial asthma in making a diagnosis is often practised in the laboratories. This is done by doing various histamine tests. Exercise induced asthma is also diagnosed by ‘provoking’ it on a treadmill, where the ‘fall’ of FEV or SPO2 by 10% is diagnostic. The treadmill exercise test or pharmacological stress test or nuclear stress test (myocardial perfusion) are examples of ‘provocation’ to make a diagnosis, in a patient of ischaemic heart disease. Acid perfusion test to diagnose oesophageal spasm is also an example of ‘provocation’.
22.Finally, many doctors use words like ‘frustration’, humiliation’, ‘wishful thinking’, ‘fringe benefits’, ‘provocation’, ‘materialistic life’, ‘setback’, ‘goodwill’, blessings’, ‘knee-jerk reaction’, ‘turbulence’, ‘aging gracefully’, ‘low profile’, ‘bonafides’, ‘breakthrough’ etc. during their day to day social conversations.
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