The Semantics of Medicine

I went to the Doctor last week. It was not my usual doctor, as it was a Sunday, and I had realised that I was out of one of my scripts.

I went to the Doctor last week. It was not my usual doctor, as it was a Sunday, and I had realised that I was out of one of my scripts. So, I went to a Medical Centre. The doctor was very pleasant. He took a brief history. However, he did something that is one of my pet hates. He asked questions as if they were a statement.

  • “You don’t have any Allergies?” “Well yes I do actually.”
  • “You don’t take a preventer for your asthma?” “Yes I do, I take Pulmicort”.
  • “You don’t have any other medical conditions?” Yes I do I have blah blah blah”.

I felt like I was constantly in the wrong, having to correct this very nice doctor. I had often wondered how patients felt when they were questioned in this way, and I got to experience it first hand.

I started to notice this strange phenomenon of history taking after I did the AMEE Certificate in Medical Education. One of the points that they make very strongly in the course, is at the end of any presentation, you should say

“What questions do you have for me?” not “Do you have any questions?”

The rationale is that if you ask “Do you have any questions” it can make the audience feel stupid, because you have just explained everything to them. If you say “What questions do you have for me?” the assumption is that there will always be questions, and the audience feels more comfortable asking them. Very subtle, but a significant difference.

I started noticing subtle differences in language after this. I was doing an assessment for the 2nd year Medical Students at UOW on history taking, and this questions as statements started to really annoy me, once I had noticed it.  Most of the students were doing it.

I mentioned it to one student, suggesting it was more appropriate to ask a question directly ie “Do you have any allergies?” Rather than “You don’t have any allergies?” To my surprise, the patient volunteer jumped in and agreed with me, saying that it made her very uncomfortable when doctors asked questions starting with “You don’t have…?” She said that there was a power gradient between the doctor and the patient, and the patient did not like disagreeing with the doctor. In some instances the patient may agree with the doctor just because they didn’t want to upset them or disagree with them. By the end of the session, I didn’t have to do anything, the patient was giving all the feedback for me.

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A/Prof Stephen Barnett

Stephen is GP Supervisor, Medical Educator, GP academic and Medical Director of Medcast. He has completed a PhD on Virtual Communities of Practice in GP Training.

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