“What’s in a name?” This utterly simple four-word question in Shakespeare’s play has no simple answer, certainly not in medical specialities, rheumatology included. In general, there are two types of people in the world, like males and females, adults and children, vegetarians and nonvegetarians, tea or coffee drinkers, teetotallers and alcoholics, and those who make simple things complex and those who make complex things simple.
Doctors are notorious for making simple things complex. This may be unintentional subconsciously, or even consciously. It may be a professional hazard to think of ourselves as somewhat “superior” to patients in the subconscious hope that they will readily accept and follow our advice, orders, and diktats. We appear always more knowledgeable than we actually are, and hence the lingo we use must sound profound, verbose, at times bombastic and complex, even if unclear to patients. Isn’t it a joke that a doctor’s handwriting is hardly legible? The contents of what we write, even if pregnant with proven medical knowledge, is not necessarily understood by nonmedicos with ease. For example, a mother came to our clinic with her five-year-old son who had multiple joint pain and swelling. To her anxious inquiry, “What’s the problem, doctor?” I replied sincerely, “juvenile idiopathic arthritis.” Perplexed and more anxious, she posed, “What’s that, doctor?” I was on the defensive; I am still at a loss to explain the term.
This is why we must coin names for what we read, speak, and write that are simple, comprehensible, digestible, assimilable, and then complied with by our patients. After all, we are not almighty gods, even in our clinics.
We rheumatologists seem a lot more humane. We use no complex instruments in our clinical examination. Other specialists may mock us as “primitive,” but I am glad that this is so, for in rheumatology, clinical medicine is supreme. Let’s introspect on medical terms we have coined, designed, and use every day.
What do we have to answer, at the end of our examination, to the patient’s universal question, “Doctor what is wrong with me? Do I have rheumatism or arthritis?” For centuries, the word “rheumatism” was in vogue, derived from the Greek word rheuma. Fair enough. Then, in the 19th century came in the word “arthritis.” Perfect. What are such terms supposed to convey? Do they give a description of the disease, a specific diagnosis that won’t get mixed up with other diseases, legible to patients and to other doctors, to the pharmacist, to healthcare professionals, to insurance agencies, and even, when necessary, to lawyers and magistrates? If this doesn’t happen, we may well be dealing with the anecdotal “six blind men and the elephant,” each one interpreting his way, confusion galore.