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Resident Forum
October 14, 1998

Residents and Patients: What Our Language Tells Us

Author Affiliations
 

Edited by Ashish Bajaj, Department of Resident Physician Services, American Medical Association.

JAMA. 1998;280(14):1226F. doi:10.1001/jama.280.14.1226

"A VERY busy night, and no one was spared pain, with 7 to 8 admissions each on GMS and painful unit transfers. Thank you for all your hard work. The patients certainly appreciate it.
I have 2 potential unit players already. Please send me bump lists when you can."—e-mail message from an admitting physician

When I opened my e-mail and saw this note from a fellow resident, it seemed perfectly normal. It was the usual update from the night before that we send to each other when we rotate as admitting physicians. It is how we keep each other posted, tell the story of the previous night, and plan for the day. As usual, I hit the return key to read my next message but then I thought about what I had read. It didn't matter who it was from because it could have been from any of us. The language in that routine message said a lot about the residency experience. I kept returning to the phrase "no one was spared pain." That phrase expressed the feeling that our job and patients evoke in us.

Our patients evoke many conflicting feelings within us: hope and hopelessness, love and anger, humor and sadness, empathy and confusion, and compassion and pain. Why pain? They elicit pain in us because they remind us of our relative in a hospital bed in some other city, because we cannot stop their pain, because we are tired and anxious, and because we are often overwhelmed by our work.

We share stories daily about our patients and experiences. Many of the stories describe physical and emotional pain. We have made a transition from thinking of "pain" as something that patients go through to something that they cause. This may happen because of the daunting task of trying to connect to and understand all of the stories we hear. It may be easier to think and talk of our own pain than our patients' pain. It is also protective because when we can't relieve someone else's pain or understand their suffering, we become vulnerable to our own pain.

Residency is difficult and even painful at times. However, at nearly 3 years into mine, I realize that being a patient is even more difficult and painful. Although all residents realize and face this every day, we often talk as if we don't. We diminish patients' experiences when our language emphasizes the pain we feel in caring for them instead of the pain they are experiencing, just as we take away part of their identity when we identify them by their illnesses or organs instead of their names.

It is too simple to think that words on a daily e-mail capture all that we do or feel as residents. But it is important to look at what those words reveal. We should try to change our language so we don't diminish our patients' pain. But we should also pay attention to what our language says about what we are going through as residents. We should ask why our own pain has become so central at this moment. What does it mean that we are talking like this? Are there other ways to understand and share our experiences with each other? If we can find answers to these questions, maybe we can start to see how separate our pain and experiences are from the pain our patients are feeling. More important, maybe we can see how connected they are.

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