The osteoarthritis saga continues; the medical appointments in this drama began 3 weeks ago today (first posting here), and the latest was yesterday, with a doctor in Physical Medicine and Rehabilitation at the Palo Alto Medical Center outpost in Redwood City. As before, there are linguistic footnotes to this personal history — one about ordinary language, one about the language of medicine.
The nouning consult. The background: I was expecting that at this appointment I’d be subjected to needle aspiration of my right hip joint, to see if there’s an infection in there (which would have to be cleared up before hip replacement surgery could happen). That sustained me and my friend Ned Deily, who did the driving — through unfamiliar parts of Redwood City, puzzling out how to get to the building.
But no. Instead, I filled out yet another case history form and was examined by the new doc, who agreed that, yes, I was in great pain from an obviously degenerated hip joint — and promised to have his assistant set up a needle aspiration to be done by one of his Physical Medicine colleagues back at Palo Alto. No appointment set up today, nor any hint as to when the procedure might be done. Vexing and infuriating.
As I said to Ned, I was expecting a medical procedure but got a consult (the third so far) instead. The point of linguistic interest here is the nouning consult. As Ned and I say it, this noun has first-syllable accent (cónsùlt), in contrast to the verb (cŏnsúlt), a well-studied V vs. N pattern for Latinate prefix + root that also holds for (among others) conduct and conflict. (AHD5 allows accentual variation for the noun consult.)
The OED (in a “not yet fully updated” entry first published in 1893) has, as its first cites (going back to 1560 and now obsolete) for the nouning, uses with a mass noun; but count uses (‘a consultation’) go back to 1600. Two later cites:
1845 T. Carlyle in O. Cromwell Lett. & Speeches II. 357 What profound consults there were.
1889 Blackwood’s Edinb. Mag. Feb. 247 The consult took place at St. James’s.
Consult is briefer than consultation, and it also seems to have picked up a loose association with the practce of medicine; as AHD5 glosses it, ‘a consultation, especially one involving physicians’ (so it fit into Ned’s and my conversation).
Physical medicine (and physiatry). The medical expression physical medicine is certainly opaque, even more so than physical chemistry (with the pseudo-adjective physical ‘having to do with the science of physics’). Worse, the full technical name of the specialization is the coordination physical medicine and rehabilitation, which will endear itself to no one.
One solution: a brief coining. That’s what gives us physiatry (and its practitioners the physiatrists). From OED3 (March 2006):
Med. (chiefly N. Amer.).
A branch of medicine dealing with the treatment of injury, disability, and disease using exercise, massage, mechanical aids, and various other physical methods (electrotherapy, hydrotherapy, etc.). Also called physical medicine and rehabilitation. [first cite in 1947]
So physical here comes from physical methods (as opposed to treatment with drugs, surgery, diet, etc.).
Now waiting for the physiatrist, or someone like him. I’m guessing next week.
October 10, 2012 at 11:43 pm |
I stumbled across a website, “History and Physical: a resource for students and residents”, that provides tips on “How to correctly do a Consult” (which will allow you to “Look like a superstar physician!”, “Outshine your cohorts!”, and “Be able to bill better!”).
“A consult differs slightly from an H&P. A consultant is usually asked to see a patient for a specific reason and for a problem that the primary physician does not have the knowledge to work up, nor the expertise to know which tests to order nor how to treat the issue. The consultant usually focuses on the problem that they are consulted for and tries not to stray into other areas. […]
The HPI is the history of PRESENT illness. Not a past medical history. Too many times you see students and residents (and even attendings) writing out, “This is a 54 year old asthmatic, diabetic, hypertensive, osteopenic patient that presents with a three day history of shortness of breath”. That is poor form. What if their shortness of breath is positional, and gets worse when they lie down? What if it is heart failure this time and not their asthma? By stating that “this is a 34 year old asthmatic” you have biased your HPI towards thinking it is the asthma. Stop doing this immediately! This is the single biggest mistake seen on H&Ps. There is a section on the H&P called “Past Medical History” that is where their history should go! […]
Please DO NOT list things like “History of UTI” and “History of alopecia” and “History of ORIF of tibia” and “History of C-section” and “History of CABG”. The Assessment and Plan should be a list of CURRENT, ACUTE problems, and what you are doing to fix them. It should not be a reiteration of their past medical history. The current, acute assessment should include things that can only be treated in the hospital, not their history. Unless of course, they had CABG last week, and are in for a NSTEMI today. That would be pertinent to know, but still can be in the PMH, unless you are calling that CT surgeon or consulting them to help with this case.”
A prescriptivist consult?
http://historyandphysical.net/consult.htm
October 11, 2012 at 4:22 am |
Note that this is written by a medical person for a medical audience, so it freely uses technical terms, jargon, and abbreviations (like CABG, chronic artery bypass graft, pronounced “cabbage”.