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This blog summarises a conversation hosted on Twitter by Cochrane UK, inviting views on the use and misuse of language when talking about long-term conditions. 

Following on from Anne Cooper and Bob Swindell’s blog The impact of language on people living with long-term conditions: having the rug pulled out from underneath you Cochrane UK hosted a tweetchat to discuss the language used to talk about long-term conditions, its impact, and alternatives to language that people find problematic. There are so many different aspects to this that we couldn’t hope to do more than scrape the surface of a few of them, but here are some of the points that were raised. Do feel free to add your own via the comments facility below the blog. 

Plain language is important 

Using plain language is an important part of ensuring that information is communicated in ways that are easy to understand. The use of terminology can be confusing, especially when it is used differently by different people. Be prepared, if you’re a health professional, to speak plainly, even if that is to deliver bad news, but also mirror the language people use if possible. 

Respect and reflect people’s choice of language about themselves  

Someone described how health professionals sometimes reject the language she uses to talk about her mental health problems, often attempting to make it sound less serious. She said this makes her feel disbelieved, and that this behaviour, a refusal to use certain names and words, contributes to mental health stigma. 

When a health professional (or anyone else) uses the language a person uses themselves about their health, this shows that they have listened, and it shows respect. Pertinent to this is the What Matters To You? initiative. 

Avoid judgmental language 

 ‘Non-compliant’ or ‘non-adherent’ were mentioned as judgemental and as revealing a perspective that is all about the practitioner rather than the patient. ‘Sufferer’ and ‘survivor’ were others. It would be interesting to hear more views on these last two, as I have also seen them used by people about themselves, but sense that the shift away from their use may be gathering momentum. 

Language can apportion blame, such as asking someone with Diabetes “How well controlled are you?” or “have you been eating correctly?” @emmajdoble notes “I much prefer ‘how are you coping’ or ‘managing’. Or ‘that I am finding my diabetes challenging or difficult’. I feel this puts the blame on diabetes rather than me!” For Olivia @just_TUX, “I often get ‘what did you do to set off an asthma attack?’ but would prefer ‘do you know what triggered your asthma?’” 

Some alternatives for language used in the context of personality disorder were suggested recently and what a different feel the alternatives have! ‘Survival strategies’ instead of ‘acting out’ and ‘attention needing’ rather than ‘attention seeking’, among others. 

This reframing is important and it’s one of the key principles of the @NHSEngland ‘Language Matters’ guide: “Avoid language which attributes responsibility (or blame) to a person for the development of their diabetes or its consequences”. This could easily be adapted for other conditions, of course. 

@Anniecoops noted that “When we developed #LanguageMatters we discovered the importance of neutral and factual labelling, choice, and positive motivating language. but for me always #PersonFirst too.” 

It’s not just about alternative terms. “Specific language alternatives don’t interest me. A reduction in direct or inferred blame, telling off patients and scare tactics are important to me.” @DiabeticDadUK 

Use sensitive language 

This was mentioned in the context of talking about suicide and is so very important. The Samaritans have this guidance on how to talk about suicide safely online. 

Words can traumatise… 

This is also about sensitivity and thinking about the possible impact of your words. @Claire_F1att shared this: “I actually had a nurse ring me when I was diagnosed and she left a voicemail message saying she was a palliative care nurse… I wasn’t palliative and found the use of that word traumatising. I didn’t seek support from her… as a nurse & as a rational person I am/was aware palliative doesn’t mean dying but as a patient I found the word quite distressing.” 

The language of war 

Dislike of the language of war and battles was raised here and this aspect of language use on its own could fill a tweetchat and much more. Indeed, a great deal has been said elsewhere about these military metaphors that have been used for centuries and that we still see so often, especially in relation to cancer (‘beating cancer’, ‘lost their brave fight against cancer’ etc), with all that implies about efforts by the person with the illness to ‘win the battle’ – or not… 

“I’m not fighting cancer and I’m not a “warrior” either, I’m just “dealing with cancer” each day at a time. I’m not at war with my own body. Yes, a few bits don’t work as they should but it’s still pretty amazing so I’ll work with it, not against it.” @FionaMartin123 

“I know I haven’t ‘beaten’ cancer, I haven’t ‘fought’ it either. But I have lived as effectively, thoroughly and wholly, as I can.” @therapy2optimum 

“There is a lot of war language used with chronic illness, which isn’t always helpful- brave, fighting, beating illness- and then losing the fight… it can add to a sense of blame- didn’t fight hard enough etc.” @sarah16107480 

The blog Battling, brave or victim: why the language of cancer matters reminds us that people’s preferences vary, a recurring theme in this chat. 

The naming of health conditions – time for a rethink? 

 It’s time to rephrase Heart Failure, suggested one person, when this a normal process as we age, unless brought on prematurely. They also told us about a call to rethink how doctors talk to some people with reduced kidney health, replacing the term ‘Chronic Kidney Disease’ with different bands of kidney age. 

I am aware that the territory of language around deafness (Deaf, deaf, hard of hearing, hearing loss, and more) can be difficult to navigate. People have different preferences – and often strong feelings about it. 

Labelling and lumping together 

Being labelled by a health condition can be unwelcome. @Anniecoops says she hated being called a Diabetic (or one of ‘The Diabetics in the waiting area’) and prefers ‘Anne who has Diabetes’. A label might mean that they look at the diagnosis before the person. But it should be driven by choice. As the Language Matters: Language and Diabetes document says: “it is up to the person concerned as to how they would like to be addressed, supported and understood but as healthcare professionals, we need to be aware of the need to give them that choice, not make it for them.” 

The language (and images) used by the media 

Influencing the media in how they portray and speak about people with Diabetes was one of the aims of the Language Matters publication. Of course, public perceptions, attitudes and language are influenced by the language used by the media, and the images used too. Poor choices of words and images can give a negative impression of a health condition and the people who have it and contribute to stigma and stereotyping. 

Advice and guidance 

There is much that is common to the use of language across different health conditions, but some helpful condition-specific resources were mentioned during the conversation. Also, speaking to patients about how they think of their condition, what words they use, can be really helpful. 

References (pdf) 

Read the rest of the blogs in our ‘Living with Long-Term Conditions’ series. 

Join in the conversation on Twitter with @CochraneUK or leave a comment on the blog. 

Please note, we cannot give medical advice and do not publish comments that link to individual pages requesting donations or to commercial sites, or appear to endorse commercial products. We welcome diverse views and encourage discussion but we ask that comments are respectful and reserve the right to not publish any we consider offensive. Cochrane UK does not fact check – or endorse – readers’ comments, including any treatments mentioned.

Sarah Chapman has nothing to disclose. 

 

Professor John Skelton’s keynote at the Languages in Medical Education online conference at Voronezh N.N. Burdenko State Medical University, December 2020.

Watch more presentations from the conference here

Virginia Allum, EALTHY’s clinical nursing advisor and Head of Medical English for Specialist Language Courses, is a busy woman. As well as writing courses, training teachers and providing expertise and support for EALTHY and SLC, she is an item writer for the Occupational English test (OET). Remarkably, she also works part time as a Registered Nurse, bringing her unique blend of experience, humour, and knowledge to patients across the Western Isles off the coast of Scotland. Yesterday she received the first dose of the Pfizer vaccine. This is her story. 

I feel very privileged to have received a Covid-19 vaccination today at NHS Western Isles where I work. The procedure had all the hallmarks of a pandemic response. We arrived with our masks on, sat in chairs spaced the correct distance apart and received information about the vaccine (the Covid-19 mRNA Vaccine BNT162b2 or ‘Pfizer’ vaccine). Important questions were asked to ensure all precautions were taken and then it was on to the ‘vaccination room’. Consent given, I had my injection, or ‘jag’, as it is known here on the Isle of Lewis (I haven’t been able to find out why it isn’t ‘jab’…in any case, I was used to the term ‘shot’ in Australia).

I returned to my chair in the waiting room where I was observed for 10 minutes and then sent home to rest. I hope to receive the second dose in 12 weeks.

It started me thinking about all the vaccinations I have received in the past, vaccinations which protected me from some very nasty diseases. Some of you will know that I was born in Australia and so started my vaccination history there.

Triple Antigen and Polio

In 1953, the Diphtheria-tetanus-whole-cell pertussis vaccine (DTPw) was introduced. This was a 3-dose infant-based schedule which I was to receive 5 years later. In Australia, mass production of the inactivated polio vaccine began in July, 1956, two years before my birth, so I was amongst the early youngsters vaccinated against poliomyelitis. The oral Sabin vaccine (live attenuated oral polio vaccine) was not registered until 1964 after trials in Tasmania. Australia and the Western Pacific Region was to be declared polio-free in 2000.

Travel overseas: The International Certificate of Vaccination (the ‘Yellow Card’)

This record was developed by the WHO and one which my parents had to have completed before we travelled from Australia to the UK (by boat, via South Africa) so my father could work there. I was vaccinated against smallpox (and still have the scar on my upper arm), cholera and yellow fever. My first vaccinations were given to me by my grandfather (a GP) who refused to give me the boosters as he didn’t want to be remembered as ‘Grandpa who gives needles’. A different GP was sought for the boosters!

Hepatitis B

Liver with Hepatitis B infection highlighted inside human body and close-up view of Hepatitis B Viruses, medical concept, 3D illustration

In 1982, a serum derived hepatitis B vaccine was registered for use in adults and in 1985, for neonates. In 1986, vaccination using 3 doses was recommended for at-risk adults, e.g. Aboriginal and Torres Strait Islanders, immigrants and refugees from high risk countries, healthcare workers, IV drug users, recipients of factor VIII or IX blood products and household and sexual contacts of hepatitis B carriers. Between 1987 and 1988 two recombinant hepatitis B vaccines were registered in place of the serum derived vaccine. I was given the 2-dose vaccination against Hepatitis B in 1987.

HPV

In June, 2006 a 4-valent human papillomavirus vaccine was registered for use in females aged 9–26 years as a 3-dose schedule. I was not in the age group to receive this vaccine, but my daughter was proud to receive the vaccine which had been developed by the University of Queensland in Australia by Professors Ian Frazer and Jian Zhou.

Covid-19

And now, today I have received a new type of vaccination.

‘Pfizer is collaborating with German biotech company BioNTech to focus on a technology called an mRNA vaccine. Unlike conventional vaccines, which are produced using weakened forms of the virus, RNA vaccines can be constructed quickly using only the pathogen’s genetic code. Many standard vaccines work by injecting a dead or weakened form of the pathogen into the body in preparations that are designed not to make you sick but rather to build immunity. The key to building this immunity is that the portion of the pathogen called the antigen trains the immune system to recognise and respond to the infectious agent.5 RNA vaccines work by introducing into the body a messenger RNA (mRNA) sequence that contains the genetic instructions for the vaccinated person’s own cells to produce the vaccine antigens and generate an immune response.’

(https://www.pfizer.co.uk/behind-science-what-mrna-vaccine)

How far have we come from the 18th century when Edward Jenner inoculated a 13 year-old-boy in 1796 with cowpox to demonstrate immunity to smallpox. Two years later the first smallpox vaccine was developed.

The virus that the Covid-19 vaccine is fighting is tiny; the coronavirus is 0.1- 0.5 nanometres. (a red blood cell is 7-8 nanometres). To my mind, this makes the development of a vaccine against such a tiny ‘monster’ a miracle!

 

Thank you to Specialist Language Courses for permission to republish.

Spoonerisms or malapropisms, commonly referred to as slips of the tongue, are a perfectly natural aspect of communication. They’re also the source of much amusement. Who doesn’t enjoy hearing lexically confused celebrities – Justin Bieber once claimed he was ‘detrimental to his own career’ – though I reserve most of my delight for the communicative cockups of politicians. Trump and Bush Jnr are well known for their weird wordery, but here’s a goody from Tony Abbott, former PM of Australia: ‘No one, however smart, however well-educated, however experienced … is the suppository of all wisdom.’ I feel a joke forming – no. Can’t. Too rude. 

Remember former US Vice-President Dan Quale? He famously came out with ’I stand by all the misstatements that I’ve made’ while Richard J Daley, former mayor of Chicago, uttered some gems during his term in office, once calling a tandem bicycle a ‘tantrum bicycle’ and referring to Alcoholics Anonymous as ‘Alcoholics Unanimous’. 

These days, we’re certainly more aware of slip-ups, errors and abuses because so much is being written, not only in emails but on social media, in forums, blogs and newspaper comments sections. We also seem far more tolerant of spelling mistakes and grammar oddities (assuming we’ve spotted them in the first place). If you doubt this, correct someone in the Comments section of a newspaper and see what happens. The so-called grammar police – who really seem more concerned with punctuation and spelling than structure and form – get short shrift when they pop up to correct a misplaced apostrophe.  

Meaning is an altogether more slippery beast

But meaning is an altogether more slippery beast. When communication takes place, and language competency is not called into question – that is to say, both participants are judged to be proficient in whatever language they’re using – each participant assumes that lexical choices are deliberate and appropriate. You rarely see vocabulary being corrected. If you tell me you’ve eaten four doughnuts, I’m not going to be too impressed, but I’ll believe you. I may well seek confirmation – four? FOUR? – but I won’t wonder if you really meant one or that you intended to say sandwich. If you tell me you’re a plumber, I won’t wonder if you meant fitness instructor. It gets trickier, though, when faced with less concrete, stodgy facts. ‘How are you feeling today’ or ‘Does this make me look fat?’ doesn’t always lead to an unequivocal response. I’m likely still confident that you’ve chosen the word you wanted, but I may not always be sure of the accuracy of the message or its veracity. Aside from bare faced lies, there are white lies, half-truths, evasive responses and vaguery. You could write a book on these aspects of communication – plenty of people have. I’ll talk a bit about it in my next blog post. 

But what happens when a mother tongue is not shared, or language competency is not evenly matched? With their multicultural populations, this is a typical scenario in many urban medical encounters in countries like the UK, the US Canada and Australia. Even without the challenges of accent and pronunciation, grammar issues and health literacy issues, miscommunication because of vocabulary is a common source of frustration, confusion and, sometimes, medical error.  Unlike the rarefied atmosphere of the classroom, where students are safe to make mistakes, and where there’s time to investigate the collocations, connotation, range of meaning, register and appropriacy of a single word, a real-time medical interaction permits no such analysis.  

Meaning in medical encounters

When we speak about communication issues in medical encounters, we’re often referring to those interactions where the patient doesn’t understand or fully understand what their doctor is saying. Over the last decade or so, many papers have investigated just how little medical terminology patients understand, and the impact of not understanding on the patient’s health and well-being. (See for example Chapman, K., Abraham, C., Jenkins, V., & Fallowfield, L. (2003)). Studies like these continue to appear in disciplines other than applied linguistics and for a variety of languages and areas of medicine. 

Some linguists and healthcare communication researchers have shifted their focus away from what patients don’t understand and on to what they do understand and how they use the medical terms that they know. (Fage-Butler & Jensen (2016) and Koch-Weser, de Jong & Rudd, (2009; 2010) are well worth reading.) These studies reveal a considerably more complex picture than the standard understand/do not understand dichotomy. The so-called ‘expert patient’ – often a patient living with a chronic condition – has been described as having a kind of ‘vertical knowledge’ which suggests that they can use ( a lot of complex) medical terminology relevant to their condition. In light of these findings, assessing what the patient understands or doesn’t understand should be an essential part of the consultation. As Fage Butler and Jensen (ibid) write:  

Appropriate pitching of terms can avoid the potentially damaging effects of poor communication brought  about by inappropriate (too complex or too simple) use of terms. This is not an easy task. It takes time for  a health-care professional to establish what terminological level is appropriate, which can be problematic  in an already time-pressed consultation. 

The authors also make clear that we need to be cautious in assuming that patients and medical professionals are using medical terminology in the same way. This is a hugely important point. Meaning divergence, as this is called, can often pass unnoticed with both participants assuming a common, shared meaning where in fact none exists. For example, in oncology, talk of disease progression may pass without comment, but the patient may not have understood that this is not something to be pleased about.  Another example of this – and it’s one I like to trot out because it a great example – is the term ‘chronic’. How many international health professionals know that it can be used in certain varieties of English to mean ‘bad’?  If I tell my doctor my pain is chronic because it’s intense, the doctor is likely to understand that I’ve had it for some time and the remark may pass without comment. Dahm (2012) found that people (and that includes medical professionals) are more aware of meaning divergence when they’ve had personal experience of it. She also found that the very concept of meaning divergence can be difficult to grasp for some people. For some, it can mean that the severity of my condition, the intensity of my pain or the impact on my life is not being fully understood or appreciated by you. 

The role of experience in how we understand words

Experience also plays a role in how we all use and understand words. Patients may use terms differently to medical professionals because as patients we emphasise the experience of the condition or symptom, and, just as personal experience of a condition varies from one person to another, so do the meanings attached to the words we use. In the same way, medical professionals will understand different aspects of the same word depending on their experience and area of expertise.  A psychiatrist will have quite a different understanding of the term ‘schizophrenia’ than a GP. The patient with schizophrenia, in turn, possesses a different understanding to both psychiatrist and GP. This is a fascinating area. (Professor John Skelton, EALTHY President, alerted me to this a few years ago, though he expressed it far more elegantly than I have just done.) 

So, as teachers of medical English what can we take from this? Well, the obvious thing is that Meaning is a Minefield (there’s a good summary of just how complex it is to talk about meaning here: https://plato.stanford.edu/entries/word-meaning/ ) and our students should be made aware that simple translations won’t necessarily cut it. Words have very intricate relationships with other words and with the context in which they’re used. Developing our students’ awareness of this seems crucial. And as human beings, our relationships with each other and how we communicate are equally as intricate.  We teachers can never hope to give our healthcare students all the knowledge they need to be competent communicators when they leave our classrooms, but we can help them acquire the skills they need to become effective communicators. These skills will develop as their professional skills and experience grow. Medical professionals using English in the workplace, more than anything else in my view, need the linguistic means to negotiate meaning with their patients and their colleagues, and to negotiate meaning with skill, with sensitivity and with the awareness that each and every interaction is unique. 

I’ll leave you with a few medical malaprops that had me in stitches. Literally. Not. (😉 ) 

  • She had postmortem (postpartum) depression 
  • Heart populations and high pretension (palpitations and hypertension) 
  • A case of headlights (head lice) 
  • Sick as hell anemia (sickle cell anemia) 
  • The blood vessels were ecstatic (ectatic) 
  • The patient was treated for Paris Fevers (paresthesias) 
  • It was a non-respectable (unresectable) tumor 
  • Nerve testing was done using a pink prick (pinprick) test 
  • I had smiling mighty Jesus (spinal meningitis) 

As we move further into the Coronavirus pandemic, I started wondering how the world’s populations felt at a similar stage of the 1918 Influenza pandemic. An article titled ‘”Destroyer and Teacher”: Managing the Masses During the 1918-1919 Influenza Pandemic’ (1) highlighted some interested social behaviours.  

I recommend reading the entire article especially the epilogue which may have you shaking your head sadly, especially George Soper’s comment in his 1919 article, The Lessons of the Pandemic (2)that : “.. . This may all seem very discouraging but it need not depress anybody. .. To rightly measure a difficulty is often the first step toward overcoming it.”  

In her article, Nancy Tomes gives a summary of the responses to the 1889-1890 Russian Influenza Pandemic and the 1918-19 Spanish Influenza Pandemic. As you read through the events of the timeline, you’ll no doubt have some ‘light bulb’ moments as you identify some examples of current behaviour patterns which are occurring. 

1889-1890 Russian Influenza 

  • flu thought to be caused by ‘microorganisms floating in the air’ 
  • contagiousness of influenza (the ‘grip’) not appreciated: Public Health (PH) authorities downplayed the importance of the virus coming to the US from Russia and left its treatment to private physicians 
  • medical advice generally to stay home and recover and keep infected people from others. No advice on how to avoid contagion 

1918-1919 

  • bacteria causing cholera, syphilis, typhoid and TB discovered; public health movement expands 
  • flu identified as a ‘germ disease’, named ‘x-germ’. 
  • flu described as a respiratory disease which could be transmitted through coughing, sneezing and spitting. 
  • advice for minimising spread: quarantine, isolation, disinfection, ventilation and personal hygiene 
  • other ideas still current – spread of flu on library books and postage stamps 
  • expanding mass media – newspaper reading at an all-time high 

By the 1918s, some of the issues facing current PH authorities and economists were starting to become evident: 

  • flu was seen as a ‘crowd disease’. More people packed into crowded cities.  
  • increase in mass gatherings, e.g. troop ships and theatres. During the 1918 pandemic, a ban on mass gatherings for people of all ages was instituted.  
  • By 1918, it was noted that the US relied on large cities for their expanding economy. Businessmen resisted quarantine measures like the shutting of factories. So, the question is raised about contagion control versus a stable economy (Familiar?) 
  • Comments suggesting people were affected more by fear than influenza started to appear in newspapers. Words such as  ‘fear’ and ‘panic’ were found in newspaper articles (Familiar?) 
  • the public appeared confused by the PH message: unsure about terms such as ‘essential versus non-essential services’ 
  • The pandemic revealed how economically important public amusements had become to local economies.”: in addition, it was clear that city dwellers relied on theatre, cinema and concerts for their social life.  

There were so many parallels in the article with our current situation that I was keen to read the author’s conclusion and/or forecast about any future pandemics, remembering that the article was published in 2010. I think it is worth adding the entire epilogue. Areas in bold are mine and refer to points which may not have played out as the author suggests or which I think the author foretells with unfortunate accuracy. 

Even now, nearly 100 years later, the image of the influenza pandemic as “destroyer and teacher” remains a compelling one. For all the greater knowledge we now possess about its genetic makeup and natural history, the influenza virus still retains the capacity to remind us how difficult disease prevention and control remain in modern societies. Do we have any better chance of controlling a “crowd disease” such as influenza in the early 21st century, compared to 1919? 

In some important ways, the answer is probably yes. To begin with, we have a new line of defense that was missing in 1918–1919, in the form of antivirals such as Tamiflu® and the capacity to produce effective flu vaccines. These measures play an essential role in the modern approach to influenza pandemics. Yet they have their limitations: stockpiles of Tamiflu can be quickly used up by physicians seeking to calm panicky patients, and the manufacture of flu vaccine depends on a complicated and in some ways antiquated system of production. Thus, the discovery of flu wonder drugs and vaccines has by no means diminished the need for nonpharmaceutical interventions. As the Centers for Disease Control and Prevention guidelines for pandemic control make evident, they have an essential role to play in slowing down influenza’s spread long enough for these measures to be perfected and distributed.62 

It may also be easier for people to understand the rationale for social-distancing measures now than it was in 1918. First, the proliferation of fictional and journalistic portrayals of killer epidemics has created a popular apprehension of pandemics in general and influenza in particular that did not exist in 1918. Inventive film makers and novelists have spun dramatic scenarios, some entirely hypothetical, some loosely based on real diseases, about the dangers of rapidly spreading plagues. Books and films, among them Michael Crichton’s Andromeda Strain, Stephen King’s The Stand, Richard Preston’s The Hot Zone, Terry Giliam’sTwelve Monkeys, and Francis Lawrence’s I Am Legend, to name only a few, have taught successive generations of movie and TV watchers to fear the microbe. Real-life pandemics, including HIV/AIDS and SARS, have taught their own lessons about the difficulties of disease prevention in modern mass societies. Along with climate change, pandemic disease has become part of an apocalyptic set of worries far beyond what E. O. Jordan’s generation could have imagined.63 

Yet despite our renewed fear of the germ, the implementation of social-distancing measures still faces many challenges today. Public-gathering bans, school closures, and transportation restrictions are difficult to enforce for the same reasons they encountered resistance in 1918–1919. Nor are we any more likely than our World War I forbears to be able to sustain an exacting hygiene of nose/mouth/hand prevention. Consider, for example, the many studies that show the difficulties of getting health-care professionals to practice proper hand-washing protocols, a problem that has helped make hospital-based infections such as methicillin-resistant staphylococcus aureas so common. Like the mayor who let his face mask dangle and the TB expert who coughed into his hand, even people who should know better forget to be careful. Health-care professionals still have to be reminded to wash their hands frequently.64 Studies have also found that men tend to be more careless about hygiene protocols than women, suggesting that the man/boy problem has yet to be solved.65 

Perhaps fortunately for us, the resources of late modern industrial culture will conceivably make it easier for us to tolerate staying sequestered at home at least on a short-term basis. Compared to troop ships and railroads, air travel is easier to regulate from a public health perspective, especially since the terrorist precautions enacted in 2001. With the expansion of the modern welfare state, local and state governments can order employees to stay at home and assure them they will be paid. Businesses serving health-conscious customers may be slightly more willing to conform to public health directives. Our capacities to stockpile food and entertain ourselves at home with cable television, computer games, and the Internet (so long as the electricity holds out) have grown enormously since 1918. We have become far more familiar with sneezing into tissues and wearing face masks while mowing the lawn or using aerosol sprays. 

Still, should pandemic influenza return in its guise as “destroyer and teacher” we would no doubt have many humbling lessons to learn. Nearly 100 years after the great pandemic, we have no program of national health insurance. Enormous racial and class disparities in health status and access to health care persist. Despite a far greater degree of scientific sophistication, we have been unable to stop the spread of HIV/AIDs, which has generated its own bitter lessons. We still have many reasons to study the great influenza pandemic. To conclude with George Soper’s still-relevant observation from 1919: This may all seem very discouraging but it need not depress anybody. .. To rightly measure a difficulty is often the first step toward overcoming it.”16

 

 

References 

Soper GA. The Lessons of the Pandemic. Science. 1919;49(1274):501-506. doi:10.1126/science.49.1274.501 

Tomes N. “Destroyer and teacher”: Managing the masses during the 1918-1919 influenza pandemic. Public Health Rep. 2010;125 Suppl 3(Suppl 3):48-62. doi:10.1177/00333549101250S308 

I suffer from selective word sensitivity syndrome, otherwise known as lexiphonia. Sufferers of the condition experience strong negative emotions for certain words – emotions that range from dislike right through to hatred. When I hear or read a word that I am sensitive to, I grimace as if in pain, I mutter something like ‘oh for (insert expletive) sake’ and, when particularly moved, I yell.

Before I get myself into trouble, you can close the medical dictionary. Lexiphonia, as far as I know, doesn’t exist. ( And if anyone reading this can tell me otherwise, I’d be glad to hear from you). This is a condition that you can’t have as it hasn’t been invented yet. Can conditions be invented? Hmm. More on that later.

Euphemism is a trigger for this non-condition of mine and that’s unfortunate, because there’s a lot of it about. ‘Euphemisms’ said Quentin Crisp (1985) ‘are unpleasant truths wearing diplomatic cologne’ while Holder I(2008) in How Not to Say What You Mean: a Dictionary of Euphemisms refers to euphemism as ‘the language of evasion, hypocrisy, prudery and deceit’. (For an interesting article about the many uses of euphemism see Richard Nordquist’s piece.)

And yet, where would many people be without euphemism, when death is the topic? In our house, the news that someone has died is delivered plainly and simply: ‘X died this morning’ though I suspect our frankness in matters of death makes us unusual. For many people, such directness is less acceptable than ‘X passed/passed on/passed over/passed away this morning’. I believe that the latter is the form most used in the UK, while I hear all versions used by north Americans. I understand that these euphemisms function to soften and to protect and thus have an important communicative role. They’re perceived to be kinder than their more literal equivalents.

But are euphemisms for death appropriate in journalism? Should TV news readers use euphemism to report a death? Or medical professionals, when communicating with fellow medical professionals? I subscribe to an online publication written for GPs – family doctors. Once a week it pops into my inbox with interesting articles on common conditions (bona fide ones), and news of interest. Covid-19 related news has unsurprisingly featured a lot over the last couple of months. Imagine my surprise when I read the news of GP and healthcare worker deaths being reported with the euphemism ‘passed away’. This was not an announcement to the surgery receptionists but journalism in a professional publication. In my opinion, euphemism has no place in such a context.

In the very same article, I read the following sentence: ‘GPs killed by Covid-19!’ Ok –I’ll come clean: there was no exclamation mark. I added that, to complement the tabloid-vibe the headline was giving off. Can you be killed by a virus? Killed by a knife-wielding patient, ok. But killed by Covid-19? I don’t think so. While the euphemism was inappropriate, the choice of verb just seems wrong.

Tabloid headlines are designed to shock, to lure you in (and often seem to have little relation to the story that follows.) There seems to have been a fair amount of tabloid-style reporting during this pandemic, even from sources considered reputable. The Covid-19 virus has, at times, been imbued with characteristics not associated with other pathogens and the language used, along with images, have been the primary contributors to this. There are currently corpora of the language of Covid-19 being put together and investigated – I look forward to reading the results.

As language teachers and linguists, we spend more time than most considering words – so I’ll leave with one more puzzle to ponder. Is a vaccine invented or developed? I was taught, and thus have always taught, the latter. It appears that in the 21st century however, vaccines can now also be invented, and if you don’t believe me, do a quick internet search. What are your thoughts?

As Covid-19 takes hold on our lives, we rely on medical professionals who continue working in a challenging environment ignoring by necessity that many health systems globally were already facing nurse shortages, an ageing workplace and a shrinking health budget. By examining previous crises such as the 1918 Influenza pandemic and the 2014-15 Ebola epidemic, the importance of personal and organisational resilience emerges as an essential arm in the fight against the relentless Covid-19 opponent.

In her article, ‘What the COVID-19 pandemic tells us about the need to develop resilience in the nursing workforce’, Deborah Duncan presents us with a list of how tos . They are interesting not least because of their simplicity. They are actions which are achievable by all of us. They are actions we should be practising each day, virus or no virus. I was drawn to the final suggestion, that of journal writing and self-reflection. As nurses we are tasked with writing a personal reflection journal which becomes part of our re-validation evidence every three years – evidence that we think about the consequences of our interactions with patients and colleagues and reflect on the effect they have on us. It appears that this is also an essential ingredient in the development of personal resilience.

Duncan’s summary of actions which promote personal resilience is worth reading and not exclusively by healthcare professionals. It is a tool kit for us all during the current pandemic and beyond.

Develop personal resilience.

  • Practice of healthy coping strategies (Hudgins 2016)
  • Encouraging hopefulness (Hart et. al. 2014)
  • Using positive language and supporting self-efficacy (Hudgins 2016)
  • Supporting positive emotions (Bonanno 2004)
  • Development of a mentoring relationship (Jackson et al 2007)
  • Developing strong social support (Tsai et al 2012, Kalahar-Levering 2019)
  • Journal writing and self‐reflection to enhance emotional insight (Giordano 1997)

I work two days a week at the University of Birmingham these days (generally, I mean, not just because of covid), so I am spending those two days working from home. I can tell you that the back garden is looking lovely, the quince blossom has come and gone, the next door neighbour had a parcel delivered this morning, and the fields where we go walking are full of the sound, and sometimes the sight, of larks.

Other than that, our Med School is wrestling with the issue of how we graduate students we’re confident are safe without actually giving them the full range of exams we normally do, what with the University being shut at present … How are others dealing with this issue? I’m Head of Education Quality for our MBChB Programme, so have to be interested in this.

One of the things we’re doing is giving an online viva exam – in fact, a case-based discussion – to the bottom students of our final year. I’m involved in giving practice sessions for these, so have three students lined up for today and tomorrow. And I’m discussing how we manage clinical exams (ie, exams with touching) for our Physician Associate students in August. And I’m doing character references for the General Medical Council for students.

My big question for all of us is this: will the current crisis utterly and completely change the face of education? Or will it all somehow just disappear, and we’ll go back to what we were doing this time last year? (And for those of us in universities, structured and financed to deliver face-to-face teaching, will we be able to charge our students the present level of fees if we move to a more distance-oriented programme? And will they accept this? Will we so arrange things that each student gets as many contact hours, but more of them one-to-one or in small groups, delivered online?)

Within EALTHY, I’m working with our much-admired Head, Catherine, as co-editor of a special issue of the journal ESP Today.

Other than that, I’m working on a paper on language and philosophy for a colleague in the Netherlands, who works closely with a former PhD student. We’ve recently published a paper on an aspect of this (Great fun! Don’t miss it! Read all about the beetle! … at Veen, Skelton, de la Croix). I did an online tutorial with them on Monday with about twenty students, mostly Dutch but with representatives from UK, Sweden and the US as well. Good fun! Actually, yes, it was – much as I dislike Zoom, Skype and so on.

Also, I noticed during lockdown that the piece I did for our friends in Castelló has recently been published. It’s part of Discourses at the edge of life. If anyone wants a copy of “Montaigne, the essay and the end of life”, let me know. It’s so flipping long – between you and me, it goes on forever – it will last you well past the current crisis.

I live in Stratford (Shakespeare’s birthplace), hence the walks in the open countryside. A walk of about a mile, and then I can go and listen to the birds, and fail to identify most of them, and admire the improbably clear skies.