“It’s metoprolol! m-e-t-o-p-r-o-l-o-l.”

The nurse on the other end of the phone sighs as she listens tolerantly to my well-worn tirade on pronunciation. My colleagues all know that I am particular about such things.  And for good reason. Metoprolol is neither metoclopramide nor metolazone—the difference could be life altering.

I live in a world of words, trained in a language created to efficiently and accurately parse pertinent details. Dysarthria or dysphagia? Paroxysmal nocturnal dyspnea…dyspnea on exertion…or orthopnea?

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Each variant pictures a spectrum of different scenarios. Each variant is a morsel chewed, swallowed and digested into its basic parts, to be rattled off in staccato sentences between physicians.  It is a precise way to convey complex information to bring like minds to similar conclusions—a common language among colleagues to tell a story (with the assurance that it will be accurately understood) in order to solve a mystery and make a plan of action.

My patients’ words carry similar weight. An accent on a particular syllable, even if done unconsciously, is significant and draws attention to hidden information. An atypical descriptor can push the diagnostic engine toward a path it might not have traveled down if an alert physician had not caught the subtlety and explored it. So too, the absence of context and words carelessly unspoken must not be ignored.

My patient’s future hangs precariously on such ambiguities. My ability to interpret separates effective medical care from chaos. So you will have to excuse me if I occasionally get caught up on words, if I harp on pronunciation or am a stickler about meaning.

I gently correct the cardiologist as we pass in the hall. It’s Rothberg, not Rothschild.  R-o-t-h-b-e-r-g.   

And she died two nights ago.

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