Pennsylvania 6-5000 and 867-5309 (Jenny!)

There’s a Massachusetts nurse practitioner I sometimes encounter in the course of my work who always closes her reports with, “If you have any questions about this dictation, dial . . .” and she gives a number. “Dial?” To judge from her voice, which is really all I have to go on, at most she is very early middle age, probably in her thirties--does she even REMEMBER rotary phones? I’m pretty slow to adopt new technology, but even I had a touch-tone phone back in the days when there was still an extra charge for it on the phone bill--1980s. Has she ever “dialed” a telephone number?

Then again, I’ll still have people ask that a “carbon copy” be sent somewhere. “Carbon copy?” I think I last used carbon paper in typing class in the mid-1970s. Photocopiers pretty much ended “carbon copies.” The “cc” at the bottom of a document or piece of correspondence now pretty much means “courtesy copy.” Granted, some of the doctors, etc., doing the dictating are long enough in the tooth to remember “carbon copies,” although I’m sure none of them have seen such a thing in more years than they can remember, aside from maybe some forms (but even those are mostly “NCR”--no carbon required--these days). That doesn’t really explain why, say, a medical resident born in the mid to late 1980s would ask for a “carbon copy.”

What I suspect is that at some point they learned that “cc” was an abbreviation for carbon copy; having no reference point, really, to them, “carbon copy” means simply, “copy.”

I get the same feeling sometimes about all the acronyms we use, or that medical professionals use--it is as if the acronym has become the de facto “name” of a given disease entity. COPD--chronic obstructive pulmonary disease--is perhaps my favorite example because I’ll often hear people talk about “chronic COPD,” apparently forgetting what the C in the acronym stands for. As transcriptionists, of course, in certain sections of reports--diagnosis, etc.--we have to expand all abbreviations, and we are also supposed to transcribe “verbatim.” Somehow I’ve never managed to convince myself that it would be okay, even preferable, to type “chronic chronic obstructive pulmonary disease.”

I cannot remember ever hearing a psych professional refer to post-traumatic stress disorder as anything but PTSD, or attention deficit hyperactivity disorder as anything but ADHD, although I’m sure it happens.

I suppose that it really doesn’t matter, in any real sense, whether something is called “CLL” or by the polysyllabic mouthful, “chronic lymphocytic leukemia” (although there are other expansions of that particular acronym, which could conceivably lead to confusion): The physician presumably knows what he’s talking about, and calling it one thing versus the other won’t alter his treatment plan.

Still, sometimes the increasing use--and, to my mind--overuse and over-reliance on acronyms threatens to reduce “medicalese” to a kind of pidgin English, in the same way that a similar process has reduced much “on-line” communication to the same.

I first went on-line in 1996, about a month before AOL (anybody remember AOL?) went “unlimited”--that is, started charging a monthly flat rate rather than a per-minute charge for on-line usage. All the acronyms so widely used now, all the “wtf” and “lol” and “roflmao” and “fml” and so on, were born in the days of per-minute charges. People held on to that language even after the advent of “unlimited use,” when you no longer had to worry about every character you typed into an “instant message” or a chat room costing you money. It evolved somehow from “necessity” to “cool.”

Medicalese seems to have followed a similar progression. What makes me think that is that I hear so many “lay” people--people who are not medical professionals--slinging the acronymic lingo, as if it makes them part of the medical crowd, or something. The “medical crowd” reinforces it by talking to lay people--you know, “patients”--in the same lingo, the same pidgin. Interestingly, nurses seem to be some of the worst offenders. While the nursing profession has gone to great lengths, or so nurses have told me, to develop a language “separate” from that of physicians--a “laceration” becomes an “disruption of skin integrity,” or something like that, a nurse practitioner once told me--once they become advanced practice nurses, they embrace the medical pidgin with gusto, and speak in nothing BUT acronyms unless it cannot be avoided.

This is sometimes problematic from a transcriptionist point of view, of course, especially when so many spoken sounds can be so difficult to distinguish from each other (“f” and “s,” for instance, “m” and “n” to a slightly lesser extent; c and e and d, falling in the middle of a hastily blurted acronym, can be virtually indistinguishable from each other--sometimes all you can really hear is a sort of an “eee” sound).

Acronyms, in online communication or in the medical field, were originally designed as “shortcuts” that would enable us to communicate more information, faster and more efficiently, and they’ve succeeded.

Still, I cannot help but wonder sometimes if, after passage of a generation or two, we are not shortcutting ourselves out of any ability to communicate meaningfully with each other at all.

Random side-note regarding rotary phones: It occurred to me while pondering this stuff today that songs like Glenn Miller’s “Pennsylvania 6-5000” and Tommy Tutone’s “867-5309” could not be written now. Somehow, “613-814-5000” or “913-867-5309” just wouldn’t have the same, um, ring to them.

Gotta love progress!

Language

As noted before, I'm a medical transcriptionist, or, as they've begun calling us now, a "medical language specialist."  Whether that change came about as a way of trying to describe more accurately what we do--it ain't all about typing fast--or whether it was just another managerial bone tossed to a bunch of dogs in order to make them feel "better" about themselves or "more empowered," I don't know.  Given that the change in title did NOT bring with it more actual income, I suspect it was just a bone.

Whatever we are--medical transcriptionist (MT) or medical language specialist (MLS)--we have to possess some facility with the language.  We are not necessarily all writers, but we all DO--we MUST--pay attention to, and CARE about, words and their meanings, and MUST forever be aware of the context in which they're used.  We HAVE to know, and care about, the difference between "its" and "it's," between "they're" and "their" and "there."  We MUST care about "nuance," how the same word may mean one thing in one context, something altogether different in another.

The majority of people apparently care about none of this, and I suppose that's okay, in everyday life--as long as communication is happening, fine.  With a medical report that's carved in proverbial stone (or computer program, ether, whatever), it DOES matter, and we have to care.

So, we--MTs/MLSs--maybe have a more acute sense of linguistic bullshit than many other people do.

And there is a lot of linguistic bullshit flung about in today's workplace.

"Personnel" offices became "Human Resources" quite a while back--it was an "empowerment" "thing."  "Layoffs" became "downsizing" became "reallocation of resources" (as a nurse manager I used to work with said, it means "you have been reallocated to the unemployment line") became (my personal favorite) "headcount reduction."

A "head" is a person, by the way.  Just in case any of y'all lost sight of that uncomfortable fact.

I can barely remember a time--think 1970s--when corporate bosses used to seem to be honestly sorrowful when economic forces of nature forced them to "lay people off."  It wasn't long after that, though, that they became sort of "matter-of-fact" about it.  Not long after THAT, they began taking pride in how many heads they could count, how many people's lives they could destroy--hell, they got BONUSES for it.

But they're not to blame.  They've invented language to absolve themselves from any of THAT.  For instance, I once-upon-a-time worked at a hospital in Kansas City.  We got a new CEO in about 1992 (with "connections" to the Clintons, everybody said all breathlessly) who promised "NO LAYOFFS."  But there might be, um, "reductions in force" via "attrition," etc.  He wouldn't be personally responsible for that, of course--he would direct his "people" (and he brought a whole herd of them with him) to direct THEIR people to cut their budgets by 10%.  In our section, we'd already carved costs to the bone--our budget was 90-something percent "personnel"--you know, "people"--and we didn't really have as many of those as we needed.  Yes, people saw their jobs disappear.  But the CEO wasn't to blame--the department heads were. 

Sometimes I find it difficult even to fathom what incredibly self-centered, selfish assholes these CEOs can be.  I accept that they must sometimes make hard decisions, and that the decisions may, will hurt real people, but that those decisions MUST be made.  If you're going to MAKE those decisions, at least have the balls to own up to them, and to take the responsibility for them.

Yeah, yeah, I know--it's just business, not personal.  But it can become pretty fucking personal when you're the one suddenly without a job.  The CEOs, and the politicians, too, need to stop hiding behind words and simply take responsibility.  Stop feeding us bullshit.  Tell us the truth:  "I'm here to feather my own nest, and to hell with all of you little people."