MEDICAL MATTERS:Do terms like 'killer cells' and 'vaccine shots' actually help the patient? asks MUIRIS HOUSTON
TONY GREGORY, the long-serving Dublin independent TD, has rightly been the subject of many news reports and obituaries marking his passing. But I wonder how comfortable he would have been with some of the military language used to describe his experience of cancer?
“Gregory loses long battle with cancer” and “he fought bravely till the end” are the sort of cliched phrases that rolled off the presses and criss- crossed the airways when the TD died after a long illness.
Gregory will be best remembered for his pioneering work against substance abuse in deprived areas of our capital. In a tribute, the North Inner City Local Drugs Task Force’s Joe Barry said: “Tony Gregory led the way in relation to our country’s efforts to tackle drug misuse and has proved an inspiration to all working to improve the lives of individuals, families and communities most seriously affected by drugs.”
What makes this tribute stand out is the lack of military language used to describe Gregory’s contribution to the drugs issue. Between the war on terrorism and the battle against drugs, the rhetoric of war is firmly rooted in the lexicon of the 21st century. And it has crept into healthcare too: we read of the “collateral damage” of chemotherapy to describe the side effects of cancer treatments.
Yet the term is defined by the US army as “the unintentional damage or incidental damage affecting facilities, equipment or personnel occurring as a result of military action directed against targeted enemy forces or facilities”.
How did we get from this to: “A new strategy in the war on renal cell cancer: hitting multiple targets with limited collateral damage” – the title of a 2008 research paper. Perhaps the author succumbed to the temptation to use military jargon to spruce up his manuscript.
Clearly military life cannot be distanced from the rest of the world, but do we really need terms like “killer cells” and “vaccine shots” when talking to patients? I worry about the effect of such language on patients. We ask them to “beat” illness and to “keep up the good fight”. Doctors talk of building up the person’s “resistance” and of prescribing “magic bullets” to kill off cancer cells, all of which may suit those with determined personalities.
But what of the meek, the mild or those who are depressed? They may be neither inclined nor able to respond to exhortations to fight back. And unable to respond, it is possible that certain people will feel they have “failed” themselves, their families and their medical team.
What about the notion that engaging a fighting spirit will protect you against a cancer recurrence? A large UK study suggests this is a fallacy: a long-term follow-up of cancer patients at the Royal Marsden Hospital found that a high fighting spirit confers no survival advantage on those who displayed extreme fortitude.
There are alternative approaches when we face serious illness. One of the best is to view the process as a journey. There will be bumps along the road; some parts will be downhill while others will take more effort. The journey will offer alternative routes and it may be appropriate at times to rest a while.
Another advantage of the journey analogy is that you can take a travelling companion with you. Tony Gregory died at St Francis Hospice on Dublin’s north side. I suspect he was facilitated on his final journey by the wide range of health professionals who work there. After all, the word hospice is derived from the Latin, hospes, and it originally referred to the tradition of giving shelter to those on a journey.
George Orwell wrote about the powerful role of words. “Never use a foreign phrase, a scientific word or a jargon word if you can think of an everyday English equivalent,” he said. His advice is especially apposite when it comes to the use of military jargon in healthcare. I’d like to think Tony Gregory would approve.
- Dr Houston is pleased to hear from readers at mhouston@irishtimes.com but regrets he is unable to reply to individual medical queries