Skip to main content

Main menu

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • BJGP LIFE
  • MORE
    • About BJGP
    • Conference
    • Advertising
    • eLetters
    • Alerts
    • Video
    • Audio
    • Librarian information
    • Resilience
    • COVID-19 Clinical Solutions
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers

User menu

  • Subscriptions
  • Alerts
  • Log in

Search

  • Advanced search
British Journal of General Practice
Intended for Healthcare Professionals
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
  • Subscriptions
  • Alerts
  • Log in
  • Follow bjgp on Twitter
  • Visit bjgp on Facebook
  • Blog
  • Listen to BJGP podcast
  • Subscribe BJGP on YouTube
British Journal of General Practice
Intended for Healthcare Professionals

Advanced Search

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • BJGP LIFE
  • MORE
    • About BJGP
    • Conference
    • Advertising
    • eLetters
    • Alerts
    • Video
    • Audio
    • Librarian information
    • Resilience
    • COVID-19 Clinical Solutions
Editor’s Briefing

Language Matters

Roger Jones
British Journal of General Practice 2020; 70 (691): 51. DOI: https://doi.org/10.3399/bjgp20X707729
Roger Jones
Roles: Editor
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info
  • eLetters
  • PDF
Loading

The English poet Elizabeth Jennings has captured, with lucid, lyrical precision, her experiences of illness, both as a surgical and a psychiatric patient.1 In a series of eight poems called Sequence in a Hospital (1964), she evokes the isolation and terror that precedes surgery and, in Night Sister, describes the values of the healing art: ‘ You have a memory for everyone; None is anonymous and so you cure. What few with such compassion could endure.’ In the poem A Mental Hospital Sitting Room from the book The Mind has Mountains (1966), Jennings writes with aching honesty about depression and madness: ‘It is as if a scream were opened wide, a mouth demanding everyone to listen.’

Reading these poems can add immeasurably to an understanding of the experiences of adversity, fear, and loss, and of how they can be absorbed, accepted, and sometimes overcome. At the centre is the accurate and elegant use of language.

The accurate use of language is also at the very centre of the patient–clinician encounter, in which almost nothing can be taken for granted.2 Medical ‘talk’ is often littered with jargon, strange military allusions, and pseudo-scientific archaisms. Safety netting to avoid missing unconsidered and unconfirmed diagnoses needs to be applied with equal energy to check for understanding and misunderstandings.

This in itself is quite a task: the chances of clarity of expression and comprehension leading to mutually satisfactory outcomes are greatly reduced when patient and doctor hold widely divergent ideas about the meanings of symptoms and the nature of illness, which more often than not is probably the case. These problems might look quite tractable when what is at issue is a prescription for an antibiotic or a new antihypertensive. The chances of a successful outcome are less good when, as you will see from some of the papers in this issue of the BJGP, the consultation includes topics such as common mental health disorders and the highly contested territories of persistent but ‘medically’ unexplained symptoms and maladaptive responses to commonplace adversities. Lacking a shared vocabulary and agreed meanings is a recipe for discord and often conflict. Patients can be left feeling short-changed and doctors puzzled and helpless. The doctor dutifully applies the biopsychosocial model and sees possible links to sadness, deprivation, and loss. The patient reports that the doctor said it was all in my mind. Neither is satisfied.

The very phrase ‘medically unexplained symptoms’ is now contested, the biopsychosocial model itself has had a mixed press in the last few years, and the traditional taxonomy of the common mental health disorders is being shaken up with new ideas about psychiatric comorbidity, susceptibility, and the ’p’ factor.3 Commenting on progress in dealing with unexplained physical symptoms a year ago, Malterud and Aamland asked: ‘How can doctors respectfully show their patients that they understand their particular problems and offer specific advice? Moreover, how can such wisdom be elaborated, contested, and shared within scholarly standards for innovative research?.’ 4

Workload and bureaucratic pressures threaten the ability of the consultation to accommodate these essential, personal, considerations. RCGP Chair Professor Martin Marshall has described how, in today’s workforce crisis, general practice consultations are in danger of moving from the personal to the merely transactional.5 Depersonalising the clinical encounter, whether by the application of new technologies or by creating untested new roles in primary care, could turn out to be a false economy.

  • © British Journal of General Practice 2020

REFERENCES

  1. 1.↵
    1. Mason E
    1. Jennings E
    (2012) in The collected poems, ed Mason E (Carcanet Press, Manchester).
  2. 2.↵
    1. Roberts C,
    2. Moss B,
    3. Wass V,
    4. et al.
    (2005) Misunderstandings: a qualitative study of primary care consultations in multilingual settings, and educational implications. Med Educ 39(5):465–475.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Caspi A,
    2. Moffitt TE
    (2018) All for one and one for all: mental disorders in one dimension. Am J Psychiatry 175(9):831–844.
    OpenUrlPubMed
  4. 4.↵
    1. Malterud K,
    2. Aamland A
    (2019) Medically unexplained symptoms: are we making progress. Br J Gen Pract, DOI: https://doi.org/10.3399/bjgp19X701885.
  5. 5.↵
    1. Campbell D
    (Nov, 2019) Martin Marshall: GPs need to do less, but it’s not what patients want to hear The Guardian, https://www.theguardian.com/society/2019/nov/26/rcgp-chair-martin-marshall-gps-do-less-patients-nhs-under-pressure (accessed 6 Jan 2020). 26.
Back to top
Previous ArticleNext Article

In this issue

British Journal of General Practice: 70 (691)
British Journal of General Practice
Vol. 70, Issue 691
February 2020
  • Table of Contents
  • Index by author
Download PDF
Article Alerts
Or,
sign in or create an account with your email address
Email Article

Thank you for recommending British Journal of General Practice.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Language Matters
(Your Name) has forwarded a page to you from British Journal of General Practice
(Your Name) thought you would like to see this page from British Journal of General Practice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Language Matters
Roger Jones
British Journal of General Practice 2020; 70 (691): 51. DOI: 10.3399/bjgp20X707729

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Language Matters
Roger Jones
British Journal of General Practice 2020; 70 (691): 51. DOI: 10.3399/bjgp20X707729
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
    • REFERENCES
  • Info
  • eLetters
  • PDF

More in this TOC Section

  • Shock Therapy — Disaster Remodelling in the NHS
  • The Global Primary Care Crisis
  • Listen to Your Patient
Show more Editor’s Briefing

Related Articles

Cited By...

Intended for Healthcare Professionals

BJGP Life

BJGP Open

 

@BJGPjournal's Likes on Twitter

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Current Issue
  • All Issues
  • Online First
  • Authors & reviewers

RCGP

  • BJGP for RCGP members
  • BJGP Open
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers

MY ACCOUNT

  • RCGP members' login
  • Subscriber login
  • Activate subscription
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP: research
  • Writing for BJGP: other sections
  • BJGP editorial process & policies
  • BJGP ethical guidelines
  • Peer review for BJGP

CUSTOMER SERVICES

  • Advertising
  • Contact subscription agent
  • Copyright
  • Librarian information

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7400
Email: journal@rcgp.org.uk

British Journal of General Practice is an editorially-independent publication of the Royal College of General Practitioners
© 2023 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242