Wednesday, February 14, 2007

Let Me Re-Phrase That...

Language is the capital that drives the economy of human communication. Each social or professional culture presides over its own unique lexicon. The observer will also note further subdivisions related to slang or specific specialty.

Nurses and physicians often use abbreviated terms among ourselves. We do this for two reasons:

1: It saves time;
2: The other person knows what we are saying (as long as the speaker is not just making something up in order to sound cool, which happens from time to time).

But I was reminded this week about how easy it is to fall into the terminology rut in front of patients, and about how important it is to communicate clearly and understandably with my patients. It was a simple matter, really, and not life-threatening at all; but the misunderstanding between the patient and her nurse (yours truly) might not have happened had I been more careful. And I would not have become fodder for the comic enjoyment of my fellow nurses.

The patient came in during the "dinner rush" (between 6PM and 11PM) complaining of bilateral lower abdominal pain. She was well within childbearing age. She was also suffering from a self-care deficit which was related to her lifestyle choices. She had a poor grasp of basic concepts related to her health and hygeine (namely, bathing). Her ability to communicate her chief complaint and her history was poor. Her education level was poor.

The standard practice related to any woman of childbearing age who presents in the ER with a complaint of lower abdominal pain involves ruling out female disorders such as ovarian cysts, pelvic inflammatory disorders, and so on by means of a pelvic examination. (We also perform other tests and draw blood to rule out other possible differential diagnoses.) In my ER, we have many beds available than are designed to facilitate pelvic exams. Unfortunately, my patient was not on one of them. I finished my nursing assessment of the patient and then called an ER Tech over. Then I spoke the words that set the scene about which I now write.

I told the tech, "The patient needs a pelvic stretcher."

In front of the patient.

The patient's lack of understanding related to my terminology was evidenced by her sitting straight up in bed and bellowing, "THE H*** I DO! YOU AIN'T GONNA STRETCH MY PELVIS!

The following silence was oppressive. I heard a snicker from the nurse's station.

I turned to the patient and calmly explained to her what a pelvic stretcher was. She straightened her blankets, tossed her hair, and said, "Well, alright then."

I had a very hard time summoning the courage to exit the patient's room and walk red-faced to the nurse's desk, where I was greeted by hoots of laughter.

I don't know if this could have been avoided, but it reminds me that I need to be more careful about what I say in front of my patients. Very humbling, indeed.