Careless talk

Last week the phone rang. It was my very worried friend Ron seeking advice. He told me how he had just learned that his elderly mother had developed a life threatening medical condition. For many years she had been taking a blood-thinning drug following a heart operation.  Earlier that evening Nurse X had collared Ron in the corridor of his mother’s nursing home to say that the drug had caused her ‘INR’ (no explanation!) to go sky high and as a consequence she was at risk of dying over the next two weeks from a stroke caused by a blood clot in her brain.

Several elements of Nurse X’s ‘announcement’ seemed odd even to my somewhat rusty medical brain. If her INR (‘international normalised ratio’; the higher it is, the less likely the blood is to clot) was seriously raised it should be possible to lower it in days, not weeks; and anyway, the risk would not be of a clot but of a bleed. Be that as it may, we needed to know the level, and after some phone calls, Ron was told the figure 4.6. Yes, this was raised, but hardly to panic levels. Anxiety over. But the question remains, how could Nurse X have got it all so wrong? How could she be so ready to voice such a muddle?  But, of course, that is what sloppy thinkers (and speakers) can do.

The need for precision in medicine at least was imprinted in my mind at an unforgettable moment as a medical student. We would have revision tutorials to help us prepare for our exams. At one such session the topic was women’s health, and after discussing a particular case the tutor turned and asked me to name the operation the woman might need.  By this stage of our training we were all well aware of the need for accurate communication through the use of precise medical terms – accordingly the correct answer would have been ‘abdominal hysterectomy with bilateral salpingo-oophorectomy’. Instead, my reply was woolly, wrong and in lay language. I felt exposed and ashamed, and, evidently, the experience left an indelible memory. But with the memory came important lesson. I should be precise in what I say, which means being precise in what I think. It is best to confess if I do not know the answer, a corollary of which is that I should be aware of the limits of my knowledge. I should reply in the language context of the questioner. Finally, it is best not to guess. The warning to my friend Ron from Nurse X suggests she was not aware of such ideals.

Such utterances are certainly not limited to medicine. On the very same day, and on a more trivial note, I had been running late for a meeting. I was on the underground and realised that if I could take a short cut a few stops up the line,  swapping from one line to another at Leicester Square, I might arrive on time. Standing opposite me in my carriage was a middle aged, be-suited, man. After a few nods and smiles I asked him if he travelled on this line regularly? “Yes’, then, did he know the particular Leicester Square connection? – “Yes, very well”, and then whether the connection was fast or slow? – “Very slow, long corridors, possibly 5 minutes”. “Thanks”. I stayed put and ultimately was late. I happened to be doing the very same journey next day and tried out the connection for myself. It actually took around 20seconds. What was my man thinking of? How could he misinform me in this way?

There must be hundreds of reasons why people misinform. Indeed, the ideal of the truth, the whole truth, and nothing but the truth, is a rare commodity. Sometimes it will be a matter of expediency. I often think that MPs and civil servants attend special ‘deviousness courses’ to help them to hide their ignorance, or to exert power, or perhaps simply to help them keep their secrets.  But in the ‘caring and trusting’ professions such as nursing (I think we can safely exclude journalists here!), or where nothing is at stake, as when advising a passer-by, being misleading seems perverse, not to say malevolent.

Interestingly, the opposite –  getting things right and being helpful – can give such great pleasure. In Ron’s case, it would have saved him a great deal of anxiety!

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