How to become a good doctor

It’s been a busy month, and I have a backlog of books to post about. I’ll start with the first of a couple of non-fiction titles from recent reading: one about the process of becoming a doctor, the other about failing to protect the British people during the pandemic.

 Sophie Harrison, The Cure for Good Intentions: A doctor’s story, Fleet hardback, 2021. 248 pp.

Sophie Harrison, The Cure for Good Intentions front coverThe author graduated in 1995 with a degree in English, then, after a few jobs, became an editor at Grantamagazine. On an exotic beach she had an epiphany and decided at the age of 28 to become a doctor. A junior doctor she met gave her a tip for her medical school interview: when asked why she wanted to become a doctor, not to say ‘Because I want to help people’ – everyone says that. But that was the answer she gave.

Her training began in 2003. This book is her entertaining and illuminating account of that process, from F1 through to qualification, rotating through different specialties. When she decided to become a GP, her colleagues were incredulous: that was for those not good enough to become specialist surgeons or whatever.

I was alerted to this book by hearing Harrison interviewed on the BBC Radio 4 language programme ‘Word of Mouth’, in which she told Michael Rosen about those sections of the book dealing with the language used by clinicians. These were the most interesting parts of the book for me – though there are many fascinating sections about her other experiences.

Medical students were advised to talk to patients

in what we believed to be everyday speech, although it was in fact another language again: infantile, nursery-inflected. We called abdomens ‘tummies’ and warned ‘this might feel a little chilly’. We used soothing, neutered verbs. I learnt to ask patients to ‘pop’ off their clothes before ‘hopping’ up onto the bed, where I would just ‘slip’ this nameless thing I was holding up their noses or down their throats or up their ‘tail end’.

There was also the slangy practitioners’ jargon that often veered into dark humour (a kind of coping mechanism). And the specialised, obscure technical language of medical science, as Harrison shows from her anatomy classes:

 Once I had known that the thigh bone connected to the hip bone. Now I discovered that the iliofemoral ligament arises from the anterior inferior iliac spine and then bifurcates before inserting into the intertrochanteric line of the femur.

 Other chapters deal with Harrison’s learning about our bodies’ internal organs, end of life, observations, the heart, surgery and medicines (especially opiate addiction), women and babies (and her own experience of an emergency caesarean), and pain and how to describe and assess it meaningfully (you can’t).

The final chapter deals briefly with the Covid pandemic. Doctors, like the rest of us, had to learn quickly a whole new way of speaking and acting, with attendant acronyms: PPE, WFH. When a new consignment of boxes of protective aprons arrived at her GP surgery, a nurse exclaimed: ‘These are bin liners!’ Another practice had scrubs donated by patients, who had sewn together old sheets and duvet covers. In my next post I’ll discuss a highly critical account of the British government’s hopelessly inept response to this crisis, and its continuous stream of boastful misinformation about the horrific reality on what they liked to call ‘the front line’.

Ultimately in The Cure for Good Intentions it’s the author’s stories about people and the ailing, imperfect bodies we’re all born with that provide the energy and hope in this engaging account. We’re all going to get sick and decline at some stage – as we all know only too well during this pandemic – and we all fear this inevitable process. Thank goodness we have caring, humane doctors like Sophie Harrison to look after us when we do.

The final paragraph sums up what she learnt going through medical training and acquiring the new idiolects of the doctor’s world:

I had learnt, at least, that medicine was not about finding new ways to express yourself, or how nicely you could put together a sentence. It was about trying to understand what others meant, not just the words they said.

 

 

Words, words, words

Few authors cited in the Oxford English Dictionary are responsible for as many arcane and obscure words as the polymath, Sir Thomas Browne (1605-1682). OED states he’s responsible for 4156 quotations illustrating definitions, 767 of which provided evidence of first usage of the word cited. 1575 of the quotations gave first evidence of a particular meaning. He appears at No. 73 in the OED’s current list of top cited sources, above Shelley, George Eliot, and Ruskin. [Note the use of the Oxford comma; this is about the OED, after all.]

After graduating from Oxford he studied medicine in Europe. He practised as a physician in Norwich from 1637 until his death. His writings – and his language – were deeply influenced by his scientific, theological and philosophical interests.

His erudite enquiries into science and religion are notable for their wit, their fascination with the natural world, and their attraction to the esoteric, and all of these characteristics are evident in his vocabulary. Like lithomancy: divination by signs derived from stones (not sure how that would work in practice – what kinds of stones – or signs? Some of our current political leaders appear to use this, or something like it, as a means of determining policy.)

Appropriately for the person who first talked of classical Latin, Browne’s neologisms are mostly scholarly derivations from Latin. They are often minutely, scientifically precise, but have a quality of baroque humour and curiosity which prevents them being merely pedantic ink-horn terms. Many originate through his efforts as, in one of his own terms, a zodiographer: a person who writes about or describes animals.

In Pseudodoxia Epidemica – an encyclopaedic exploration of received wisdom which refutes such vulgar errors as the belief that elephants don’t have any joints, or that children, without instruction, would grow up naturally speaking Hebrew – Browne describes a snail not as a boneless creature, but an exosseous one.

He writes not of the flight of birds, but their acts of volitation. Not the twittering of cicadas, but their fritiniency; not the booming call of the bittern, but its ‘mugient noyse’. Nightingales aren’t melodious, but canorous; earwigs aren’t wingless, but impennous. He invents peculiarly specific adjectives such as tauricornous (‘having horns like those of a bull’). Hedgehogs aren’t simply spiny or prickly, they’re aculeous.

Some while ago I posted on his use of latitant, ‘hidden, latent’, his example referring to the practice of diverse lizards, snails, etc., of hiding away for periods of time. I came across the term ‘latebricole’, living hidden in a hole, like certain types of predatory animals, especially spiders.

Many of Browne’s coinages are more generally useful than this, and some have proved enduring, most famously electricity, and medical, but also indigenous, ferocious, migrant, coma, therapeutic, anomalous, prairie, ascetic, carnivorous, selection and ambidextrous, among others.

Next time you’re engaged in pistillation (pounding with a pestle) in the kitchen – perhaps while preparing something cenatory (relating or pertaining to dinner or supper), prior to some accumbing (reclining at table, like a Roman dignitary) – or in balneation (bathing) in the bathroom, or in everyday moration (a delay, a tarrying), you can thank Sir Thomas Browne that you have the exact word you need – the mot juste, as Flaubert might put it…

I posted some time back on Browne’s Religio Medici and Urne-Buriall. He also popped up in one of my earliest posts on etymology (something I’ve neglected since) for his coinage of ‘sarcophagy’ (eating flesh).

I recall noting (but not posting) on ‘retromingent’ animals – those that urinate backwards, like cats (it’s used in medieval bestiaries, indirectly).

Note: this post is freely adapted and augmented from an article at the OED, downloaded and saved by me seven years ago, and now apparently not live on their site; I trust it’s not infringing copyright.