Doublespeak. William Lutz

has always been pretty bizarre, but, just when we catch on to one of their terms, they change it. Take, for example, “neurosis.” Psychiatrists no longer use the word. Has it become a dirty word? “No,” says Dr. Robert L. Spitzer. “It’s just not a very salient concept anymore.” Instead, psychiatrists speak of “vulnerability,” so some of us are simply more “vulnerable” than others.

      Medical doublespeak is often used to make something ordinary sound complicated. After all, it’s easier to charge those big fees if what you’re doing sounds really difficult. After giving President Reagan a routine physical examination, Dr. Daniel Ruge said that “previously documented decrement in auditory acuity and visual refractive error corrected with contact lenses were evaluated and found to be stable.” That sounds a lot more technical than saying the president’s hearing and eyesight haven’t changed since his last examination and he doesn’t need new contacts or a stronger hearing aid.

      Operating on President Reagan after the president had been shot, Dr. Benjamin Aaron said he had located the bullet lodged in the president’s lung by “very concentrated tactile discrimination.” In other words, he let his fingers do the walking. When the president underwent a medical examination in 1988, he was given a pain-killing drug and a sedative. When asked if the president had been unconscious during the examination, one doctor said no, but such patients are generally in “non-decision-making form for two or three hours after the injection.”

      In 1982 it was reported that Supreme Court Justice William Rehnquist had, under a doctor’s prescription, been taking a sleeping pill called Placidyl for severe back pains. When doctors cut the dosage he was taking, Rehnquist suffered severe withdrawal symptoms, including some perceptual distortions and hallucinations. Dr. Dennis O’Leary of the George Washington University Medical Center said, however, that Rehnquist had not been addicted to the drug. “Addiction is a buzz word, as you know. It carries a negative connotation.” Rather, Dr. O’Leary said, the drug had “established an interrelationship with the body, such that if the drug is removed precipitously, there is a reaction.”

      In the doublespeak of the medical profession, hospitals that are in business to make money are called “proprietary” or “investor owned.” Hospitals and doctors don’t charge for their services, but ask for “reimbursement.” Radiology and orthopedics are called “product lines,” and those services that require physical contact with patients are called “high-touch products.” Patients are called “consumers,” patients who pay with private insurance are called “retail customers,” and getting patients is called “patient accrual.” Any medical treatment that requires cutting, puncturing, or jabbing is called a “procedure” (as in “invasive procedure” for surgery), while treatment requiring talking, thinking, or counseling is called a “cognitive service.” Even general medicine is a specialty now.

      The big word in the medical business these days is “wellness,” as in “Patient failed to fulfill his wellness potential,” a notation made by a doctor on the hospital chart of a patient who had died. The University of California, Berkeley Wellness Letter defines wellness as “optimum physical and mental health. A positive, on-going approach to a robust lifestyle. A preventative way of living that reduces—sometimes eliminates—the need for remedies.”

      Doublespeak can and is used to avoid those harsh realities the medical profession prefers not to acknowledge. At Creedmore Psychiatric Center in New York, a mental patient in a straitjacket died of “inappropriate physical abuse,” said Irene Platt, acting chair of the New York State Commission on Quality of Care for the Mentally Disabled. Don’t you wonder what might constitute appropriate physical abuse?

      Medical doublespeak can have political and moral implications, as well as life-and-death consequences. In his 1987 book, And the Band Played On: Politics, People, and the AIDS Epidemic, Randy Shilts discusses AIDSpeak, “a new language forged by public health officials, anxious gay politicians, and the burgeoning ranks of ‘AIDS activists.’ ” Shilts points out that AIDSpeak was designed to be “politically facile and psychologically reassuring.” AIDSpeak goes to great lengths never to offend the moral or political sensibilities of the public, politicians, and members of the gay community. AIDSpeak never refers to AIDS sufferers as victims. They’re called “People With AIDS,” or “PWAs.” That unpleasant word, “promiscuous,” becomes in AIDSpeak “sexually active,” because gay politicians decided that the word “promiscuous” was “judgmental” and AIDSpeak could never be judgmental. The most used phrase in AIDSpeak is “bodily fluids,” an expression that avoids troublesome words like “semen.”

      But the most pernicious word in AIDSpeak, according to Shilts, is the term “exposed.” Persons who had the HTLV-III antibodies were told they had been “exposed” to the virus, and the term soon became beloved by health workers around the country because it avoided so many problems. Yet this word is doublespeak of the most serious kind, because people who have the antibodies to a virus have been infected by it. They haven’t simply been exposed. As Dr. Bruce Voeller, a San Diego research microbiologist, said, “When people say ‘expose,’ I get the feeling that they think the virus floats around the room, like the scent of gardenias, and somehow they get exposed. That’s not how it works. If you’ve got an antibody, that virus has been in your blood.” AIDSpeak is the doublespeak of life and death.

      In the doublespeak of medicine, doctors addicted to drugs are “impaired physicians.” At least that’s what the American Medical Association says. The doctor who charged Blue Shield for services that were either medically unnecessary or were never performed had “inappropriately received” $750,000. Others might call it theft. Patients don’t experience pain anymore, just “discomfort.” But then, as noted earlier, people don’t die in hospitals anymore, there’s just “negative patient care outcome,” a “terminal episode,” or “terminal living.” In the emergency room, “systems fail.” And when the surgeon at a Philadelphia hospital perforated the patient’s colon during an examination resulting in complications which caused the patient’s death the hospital attributed death to a “diagnostic misadventure of a high magnitude.” Such is the doublespeak of death in the medical world.

       CHAPTER III

       Virgin Vinyl, Real Counterfeit Diamonds, and Genuine Imitation Leather: With These Words I Can Sell You Anything