“If You Don’t Stand for Something…”

Did you see the latest episode of X-Files season 11 on Wednesday this week? Were you puzzled about the quote that Fox Mulder attributed to Malcolm X? Two reviewers of the episode seemed to accept it at face value. The quote “If you don’t stand for something, you’ll fall for anything” probably didn’t originate with Malcolm X although there’s no good reason to doubt he said it. I occasionally consult Quote Investigator about things like this. That’s not to say they have final authority–although I kind of like the idea that the adage might have started in an Iowa newspaper in 1926. It turns out a lot of people said it. It’s not clear who originally coined it.

An interesting viewpoint article in JAMA also caught my attention, ostensibly about the importance of grammar (Patel JJ. The Things We Say. JAMA. 2018;319(4):341–342. doi:10.1001/jama.2017.20545). Dr. Patel begins by mentioning his favorite grammarian, N.M. Gwynne, who wrote Gwynne’s Grammar. I might add that a substantial part of Gwynne’s book is a reproduction of my favorite grammar by Will Strunk and E.B White, The Elements of Style. This reminds me of my grade school English teacher, Ms. Piggott, who was a stickler for grammar rules. On all my report cards she said I was “too exuberant.” She was right.

Dr. Patel talks about standing on principle just as much as he talks about grammar. He outlines linguistic pitfalls when talking with patients that amount to failing to stand up for the primacy of humanistic communication in medicine. For example, saying “I understand” to patients being given a devastating diagnosis of a fatal or life-limiting disease. Another example is the leading question (“You don’t have any problems with chest pain do you?”). He also takes aim at “poor historian” and “unremarkable” lab results. I have mentioned my own objection to the notorious “stone cold normal” in a previous post.

Which reminds me of another aspect of doctor-patient communication–the electronic health record. I gnash my teeth about it, but others have confronted the issue head on and come up with what they believe might be a solution to the computer interfering with establishing a working relationship with patients in the clinic or in the hospital. They’ve even created a curriculum for teaching the method. They obviously stand for something–humanism in medicine.

Another place where the principle of standing for something is The University of Iowa. This month marks the one year anniversary of the Iowa Neuroscience Institute. A lot of people in Iowa believe that “If you don’t stand for something, you’ll fall for anything.”

One thought on ““If You Don’t Stand for Something…”

  1. Jim,

    Also did English with The Elements of Style.

    Agree with you on the importance of correct communication. I have seen many patients offended by a physicians quirky way of speaking. In some cases I think the reflective “empathic” statements taught in medical school don’t hold up too well in the real world. People want a doctor who knows how to communicate and does it well. Docs also make the mistake of thinking they have to come up with something clever to say and they don’t.

    The first time I read a note recorded on an EHR template I could not believe it. It consisted of about 50 lines with a very simple question on each line followed by a yes-no answer.

    Flash forward about 15 years. I recently saw a patient transferred from another facility. I typically cringe at the prospect of reading EHR scanned in from another EHR. In this case, the first page was a letter written by the attending psychiatrist. The information content in the two paragraphs of that letter exceeded the content of all the pages that followed. It even included psychodynamic/psychoanalytic commentary.

    Seems like a good place to comment on the best consultant notes I have ever seen. I marveled at the consult notes written by one of the Cardiologists I used to work with. They read like fine literature! I could not even begin to emulate them, but I do try to keep cranking out information dense and readable notes.

    Long live docs who know how to communicate!


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