Argue the Toss: Necessary Specialist Terminology or Mysterious Confusing Language
NECESSARY SPECIALIST TERMINOLOGY
Of course professions need to use specialist language. It is a sort of necessary shorthand, for complex ideas, or a 'tight-definition' of things which need to be clearly identified. It would be chaotic, if professionals used everyday language, when discussing their work.
This is so obvious, that it doesn't even need anyone to argue the case for it !
MYSTERIOUS CONFUSING LANGUAGE
Professionals in health and social care are talking to service users who are usually normal people - it is blindingly obvious, that if the professionals keep using words and phrases 'which have got some sort of specialist meaning attached', that confusion will be the end result. The professionals are supposed to be supplying information, not confusing people - they should explain things using everyday words, with their everyday meanings !
This is so obvious, that it doesn't even need anyone to argue the case for it !
THIS IS A FALSE DEBATE
This isn't really a useful debate.
Two people who both knit, need to use 'knit' and 'purl' when talking to each other about knitting: two mathematicians, need to use terms like sine, natural logarithm, etc.
But, page 9 of the executive summary version of the report 'What's important to me. A Review of Choice in End of Life Care' explains (using the word 'explains' very loosely, in my opinion) the meaning of the word 'palliative' [care] like this:
'Palliative care - The World Health Organisation has defined palliative care as follows: Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care provides relief from pain and other distressing symptoms; affirms life and regards dying as a normal process; intends neither to hasten or postpone death; integrates the psychological and spiritual aspects of patient care; offers a support system to help patients live as actively as possible until death; offers a support system to help the family cope during the patient's illness and in their own bereavement; uses a team approach to address the needs of patients and their families; enhances quality of life and may also positively influence the course of illness; is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, and includes those investigations needed to better understand and manage clinical complications. Palliative care can be provided by a range of health and social care staff and may be done alongside treatment intended to reverse particular conditions.'
You simply don't need, that type of 'stuff' !
If I am a patient, all I need to do is to ask the doctor treating me a series of questions in normal language, and to get answers in normal language:
'Is this treatment curing me, or is it just relieving the symptoms ?'
'Am I dying, and if I am dying, how soon will I die ?'
If I'm a doctor, all I need to tell a terminal patient about 'care objectives' is something like:
'If you are being troubled by anything - pain, indigestion, trouble sleeping or whatever - tell me and I'll do my best to sort it out. If you - or your family - have got problems, tell me and I'll see if I can help, or perhaps suggest someone who might be able to help. We are all trying to help you'.
Etc !
You SIMPLY DO NOT NEED strange 'explanations' such as the one above for 'palliative'. Notwithstanding some 'weirdness' in there:
'is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, and includes those investigations needed to better understand and manage clinical complications'
The 'and includes those investigations needed to better understand and manage clinical complications' is in my view crackers: applying the word 'palliative' to an investigation [as opposed to a 'treatment'] is a step too far !
I know that 'when you are thinking the issues through' you DO need to 'have in mind' all of the types of thing that 'definition' of palliative [care] mentions - but once you have understood the problem, you almost always should be able to find a way of expressing the thing in everyday language. If you cannot explain things in everyday language, it is quite possible that 'you are using 'fancy words' to hide your own lack of understanding'.
The House of Commons health select committee report into what has replaced the Liverpool Care Pathway was published yesterday:
http://www.publications.parliament.uk/pa/cm201415/cmselect/cmhealth/805/805.pdf
The emphasis within the NHS, has tended to be on 'advance care planning' (ACP) as opposed to the approach I prefer (proper interpretation of the Mental Capacity Act, and properly trusting the relatives of end-of-life patients, and accepting the relatives as 'full members of the patient's support team'). One long-standing issue I have with ACP, is muddle and confusion over things such as the difference between an instruction from the patient, and the much 'woolier' 'trying to indirectly work out the likely wishes of a patient who has lost mental capacity' which is required by section 4 of the Mental Capacity Act - so I'm very pleased with the honesty and bluntness of this section of the report:
79. Dr McShane, giving evidence for NHS England, commented on the confusion that exists around advance care planning: "I must admit that I have been trying to work out the lexicon around this and I am not sure it is entirely helpful: an advance care plan could lead to an advance statement and an advance decision to refuse treatment, and I think we are confused."
This - problem such as the one Dr McShane is talking about - is what this 'Argue the Toss' is about !
There is a book, 'Do No Harm', by Henry Marsh, who is a neurosurgeon - it is a 'surprise best seller', although it isn't 'light reading'.
There is something in it, which is on the theme of this piece.
There is an early morning meeting, when the doctors get together to discuss the patients who have arrived on the ward since the previous day. One of the junior (in effect, close to the start of on-the-job medical training) doctors was describing a 72 year old woman who had 'collapsed at home'. This junior doctor said:
'Apparently she lived on her own and was self-caring and self-ambulating'.
'Self-catering as well ?' Henry Marsh asked. 'And self-cleaning like an oven ? Does she wipe her own bottom ? Come on, Speak English, don't talk like a manager. Are you trying to tell us that she looks after herself and can walk unaided ?'
Henry Marsh's book is a fascinating read, although I wouldn't recommend it to anyone who 'is a worrier'.
This problem is discussed in The Times today on page 4, under the headline 'Experts' ideas get lost in a fog of impenetrable jargon'.
Someone called Daniel Lewis was quoted:
"It is extremely hard to follow ideas outside my own speciality," he said. "And, in some cases, within my speciality".
Which is the problem with 'discussing expected/unexpected death', as I analysed at: