Viewpoint
From The Chief Medical Editor

Failure to Communicate

Larry E. Patterson, MD

Like most of medicine, ophthalmology is constantly looking for ways to improve its communication within the medical community, as well as outside the profession to our patients. Sometimes it works, sometimes not.

One sort of terminology change makes things more precise, yet unsatisfying. My personal favorite involves the word viscoelastics. Simple term; we all know what it means. Yes, I'm told it's not really elastic, but it's a term we all used, and there seemed to be no real downside (except of course that it was inaccurate). But now I'm told to call it an ophthalmic viscosurgical device. Seriously, that makes it better? How many of you say to your scrub nurse, “Quick, I need more ophthalmic viscosurgical device!” in the heat of a complicated surgery? It's like ordering an EKG. You and I both know there's no K in electrocardiogram, but nobody cares, and no one was really able to make the transition to saying ECG.

Second, there is the attempt to dumb things down.

As an example, there is a lot of confusion about what an ophthalmologist is. The public confuses us with optometrists, and for good reason. Just this month I read, in one of our profession's own trade publications, an article referencing optometric physicians. There are often subtle attempts to mislead. Yellow pages ads by optometrists often make no mention of OD, just “Doctor so-and-so.”

In response to this trend, the AAO came up with the term “Eye MD.” Nevermind that we sort of alienated a small but growing group of osteopathic ophthalmologists who are DOs and not MDs. My main gripe with the term was that it sounded like a cross between “weapons of mass destruction” and an intrauterine device. I just never could use the term without giggling.

Yet a third category amps up the use of medical jargon. I recently read that ASCRS, of which I'm a proud and active member, is encouraging us to use a new term for presbyopia: age-related focus dysfunction. I was pretty sure I'd get an equally confusing stare with this verbose new term as with the old one. In other words, with either term, I'm still going to have to explain what it means. Plus, the acronym sounds like something my dog would say: “ARFD, ARFD.”

So I surveyed my patients, explaining that my profession is trying to come up with a new term for that situation where you can't read anymore without reading glasses. I told them the old term is presbyopia, and the new term is age-related focus dysfunction. Most liked presbyopia better. Plus, starting with the very first person I asked, no one liked being told that they have another “dysfunction.” That's about as pleasant as being told you have a senile cataract.

Doctors' choice of words really do make a difference. George Carlin once did a routine about how the phrase shell shock, to describe World War I soldiers who had trouble coping with their wartime experience, was replaced by the bland battle fatigue for WWII and then the completely unemotional post-traumatic stress disorder for Vietnam. Maybe Vietnam vets would have gotten more support and sympathy, Carlin said, if doctors had stuck with the vivid term “shell shock.”

Channeling my inner curmudgeon, I'll keep calling myself an ophthalmologist, using my viscoelastics and embracing my presbyopia. The last thing I or any of my patients need is another dysfunction.