Words

It is the nature of neurology to see things that are difficult to diagnose. We commonly see people who seem to have problems that no one can explain. One of my colleagues said to me that if he didn't know what was going on, then it was Neurology. I had a GI doctor consult me for evaluation of a patient who had stomach pain. He couldn't explain why there was stomach pain, so he called me. (I think it was what we call "stress".) Sometimes I diagnose the problem but I've become very comfortable not knowing what's wrong with patients. I've decided that even when I think I know what's going on, I should wonder if I really know. One of the most common mistakes that physicians make is having the wrong diagnosis but failing to question the first diagnosis and come up with a new one. The diagnoses that I make which others (sometimes many others) have not seen are almost all due to language. We don't get a good history. Actually, it isn't really that the doctors fail to get a good history. It's different. It's that doctors fail to properly translate. The patients speak English (for the most part). The physicians think in Medicine. Many times, the languages just don't translate well. For example, there is "weakness". When people say "weakness" it means nothing at all. That particular word means "ZXCDL". What is that? That's nothing. They may as well not have said anything at all. It's the same thing with the words "dizziness" and "numbness". These are common words. You would think that common words like these have a meaning that we all understand. I don't understand these words at all. Neither, I think, do most doctors. Some of them think that they know what these words mean. I see them get wrong diagnoses because they think that they understand these words but they don't. Most physicians think that "weakness" implies loss of muscular power, which would be indicated by the maximum amount of force that a muscle or group of muscles or all muscles can exert against resistance. Patients often think weakness means lack of ability to do what they were previously able to do. This may be due to what we call "exercise intolerance" or easy fatiguablitiy. It is sometimes due to lack of coordination, inability to walk, generalized lack of initiative, or shortness of breath. It may be due to many other things as well. I have twice now fixed "weakness" by treating the sleep apnea that hadn't been diagnosed. So in my mind it meant "sleepiness". In the patient's mind it meant "weakness". It's a communication problem.
Even when we listen to each other very carefully, we don't hear what we say to each other properly. We don't understand each other. We think that we know what we've said, but what the other person hears isn't what we intended them to hear. We live in different worlds with different languages. Every person walks around with their own language. This makes life challenging. This creates conflicts between people. It creates great difficulty with others. When we don't understand someone, we should realize that we don't understand them. This way, we can still have compassion for them. When we don't understand our patients too many of us think that their problems aren't real. We think that they're making it up too much. I very rarely think that patients have psychogenic illness. In fact, I think I'm very bad with that diagnosis. I don't think that many people come to doctors because they enjoy it as entertainment. I think they've found something wrong in their body. We just don't understand them. It seems to me most of us don't even understand our own husbands, wives, children, siblings and parents. We don't understand our friends and co-workers. The "closeness" we feel with some of the people some of the time is directly related to our ability to "connect" which comes from the ability to communicate, to understand each other. When simple words like "weakness" are so hard to understand it's no wonder that we find it hard to get along.