“63 yo M with a hx of DDKT (2019), ESDR 2/2 membranous nephropathy, DMT2, ischemic cardiomyopathy, HFrEF (EF 30% in 2023), Afib (on apixaban), CAD s/p stent and CAGB who presented with SOB with exertion and orthopnea. Admitted for CHF exacerbation 2/2 rhinovirus and missing medications. Course c/b Afib with RVR and AHRF requiring BiPAP.”

The above is an example of a typical “one-liner” in medicine using a fictional patient. A one-liner is a summary of a patient meant to communicate to other physicians the most important features of a patient’s medical situation. The spelled-out version of the above one-liner may be slightly more comprehensible for non-medical people, but likely not by much:

“63-year-old male with a history of deceased donor kidney transplant (2019), end stage renal disease secondary to membranous nephropathy, type 2 diabetes mellitus, ischemic cardiomyopathy, heart failure with reduced ejection fraction (ejection fraction 30% in 2023), atrial fibrillation (on apixaban), coronary artery disease status post stent and coronary artery bypass grafting who presented with shortness of breath with exertion and orthopnea. Admitted for congestive heart failure exacerbation secondary to rhinovirus and missing medications. Course complicated by atrial fibrillation with rapid ventricular response and acute hypoxic respiratory failure requiring bilevel positive airway pressure.”

I present these patient summaries to illustrate that medicine has its own language. Much like one might learn Spanish if planning to work in Mexico, part of becoming a doctor is learning the language of medicine. What makes medicine even more challenging is that each specialty has its own dialect which comes with unique acronyms and fancy terms. In part, the reason it takes so long to become a physician is the time needed to master medical language.  

Yet, despite so much effort spent understanding medical language, the best physicians don’t just communicate with each other. Physicians also communicate with patients. It’s a unique language mastery to be able to translate complex medical terms and concepts into language that nonmedical people can understand well enough to make informed decisions about their healthcare. Part of the physician’s job is to be a translator between medicine and everyday language. At times, this can be more challenging than one might imagine.

Becoming a physician takes at least 7 (usually more) years of training. And since being a physician is a job, physicians spend their entire work week thinking about medicine. Spending so much time lost in the language of medicine makes it easy to forget which phrases are medical jargon and which aren’t. The seasoned physicians I most admire are those who, despite so much time spent thinking in medical language, can easily code switch (going between different languages and cultures) to everyday language when working with patients. I strive to be like these physicians. Often, it takes a lot longer to explain medical information in nonmedical terms because medical language provides a means of synthesizing information. The extra time is worth the effort to ensure patients understand their medical situation. 

So, to break down the above one-liner into everyday language as an example:

“This 63-year-old man has a complex medical history. He has a condition called ‘heart failure.’ Heart failure is when one’s heart does not pump as well as a healthy heart. He has heart failure because the blood flow to his heart was blocked before he had his heart surgery. When the heart doesn’t pump as well as a healthy heart, fluid can build up in the body. One place that fluid builds up is in the lungs; this causes trouble breathing.  This man came to the hospital with trouble breathing, likely because of a heart failure exacerbation. A heart failure exacerbation is worsening of heart function usually because of a stressor. In his case, he likely had worsening heart function because he got a common cold (caused by a virus called “rhinovirus”). He was at particular risk of severe cold symptoms because his immune system is weaker than normal because of the medications he takes for his kidney transplant. His heart failure also likely got worse because he missed medications for his heart. While he was in the hospital his heart rate was very fast because of an abnormal heart rhythm. He was at risk of developing a fast heart rate because of his history of an abnormal heart rhythm called “atrial fibrillation” (“Afib” for short). Also, while he was in the hospital, his breathing got worse. When his breathing worsened, we placed him on a machine called “BiPAP” which helped him breathe and gave him oxygen.”

I used to code switch often when I was in the Peace Corps. I transitioned between Spanish, Guarani, and English depending on who I was talking to and the topic of conversation. I never expected how much practicing code switching then would help me now. But, every day at work I shift between medical and everyday language. When I forget to switch to everyday language, I’m quickly reminded by the confused look on my patients’ faces. I enjoy being able to explore different worlds. Transitioning between medical language and everyday language is one example of exploring different worlds. The better I get at translating the more I feel like a bridge connecting the medical world to the rest of humanity. It’s rewarding to be an expert in medicine and a guide who helps nonmedical people understand the strange world I’ve spent years mastering.