Dropsy became “congestive heart failure” when successful treatment with diuretics was discovered in the late 1930s. This had the very salubrious result in that we physicians didn’t have to counter the common knowledge that dropsy had been fatal within days or months. Our explanations started with the clean slate of “congestive heart failure”. My impression had been that our profession had cleverly changed the name to avoid stirring up unwarranted and unnecessary anxiety in our patients.
At about that same time pernicious anemia had also acquired an even more effective treatment than that of dropsy. In this context I couldn’t understand why it didn’t need a new name for similar reasons. The publicity of the new discovery of liver extract and later vitamin B12 could not have been that effective as reassurance. This puzzle remained with me until last week. More later.
Chronic lymphatic leukemia is a disease much less fatal even without treatment than its name with leukemia in it implies to the general public. I strived valiantly with my coined name “lymphocytic reticulo-endothetliosis”. My colleagues even recognized what was meant absent any explanation. My new name never caught on generally, but my patients benefited from my more effective reassurance in pointing out that such a new name was badly needed.
A couple of generations ago tuberculosis had no definitive treatment and was a dread disease. This is no longer the case. Even cancer is coming under control but piecemeal. We need to look at cancer as if it were scores of different diseases (which is in fact true). Case in point: Lance Armstrong, the bicycle racer, survived famously a previously fatal form of cancer.
The problem is more the quality of communication than the words used. Congestive heart failure replaced dropsy because it was more descriptive, not consciously to avoid anxiety. Pernicious anemia did not upset patients because most Americans don’t use or know the word pernicious. They think it is just another highfalutin’ technical word. Pernicious is plain English and really means subversively, intractably bad. So we doctors need to be careful to perceive just how we are being understood. Patients need to interrupt when they don’t thoroughly understand. I call these behaviors, “avoiding raw material for nightmares”. I try never to let people sleep on important misconceptions. All of us can join in this effort.
John A. Frantz, MD
City Health Officer of Monroe
May 26, 2005
Education of Women
A few weeks ago I dreamt that some quasi-supernatural potentate offered to grant me one wish to be carried out worldwide for the benefit of mankind---but only one wish!
In my dream I chose universal education particularly for women. This will result in doubling the numbers of very nearly fully competent human beings with consequential benefits that will make the original offer like multiple wishes. Example:
The world population problem could be well on the way to solution. How else could Ireland, Spain, and Italy be among the countries with negative population growth? This demonstrates that educating women is more important than educating the Pope.