How a profession speaks to its subjects is always of interest to a writer, sometimes perversely so. Over the past few weeks a persistent problem with my foot worsened and appeared to take charge of things. (This isn’t going to be a piece moaning about ill health, I should reassure you.) The hospital took soundings of the ulcer, now turned into infection: first with a probe, then an X-ray, then an MRI scan, and finally the consultant manifested himself. The infection was in the bone and showed no sign of retreating under the antibiotics. It looked as if an operation was unavoidable, to remove – the consultant paused in his explanation – ‘We’re just going to take a kind of little nibble at the toe,’ he said.
I regarded him levelly. ‘Could you explain,’ I said, ‘the distinction in surgical terms between “a kind of little nibble” and partial amputation?’ The question disconcerted him. Talking to friends afterwards, plenty had their own stories to tell of doctors deciding to explain a medical issue to them in terms apparently designed for a not very clever nine-year-old. These patients were all well-educated, articulate, professional people, and yet one found a doctor telling her what her course of chemotherapy might have done to ‘the naughty cells’. ‘I had to listen to a doctor asking my father about his “wee-wee”,’ another said. ‘My God, he’s written books about Sophocles.’
‘I had to listen to a doctor asking my father about his “wee-wee”. My God, he’s written books about Sophocles’
The prize, for the moment, for the ludicrously infantile goes to the doctor dealing with an elderly but utterly compos mentis friend. He was suffering from an ill–fitting catheter, which was causing a constant and painful intimate irritation. ‘So!’ the doctor began. ‘We’re having a little bit of trouble with our lower tummy, are we?’ ‘I wanted to ask,’ my friend said, ‘is that the bit of the lower tummy that daddies put into mummies when they love them very, very much?’
There has been some interest among students of linguistics for many years about the revoltingly patronising ways in which medical professionals speak to perfectly capable old people; it even has its own technical label, ‘elderspeak’. Related to the babytalk or ‘motherese’ with which adults address tiny children, elderspeak has been found to indulge in excessive use of the first-person plural; to address perfect strangers with inappropriately intimate vocatives such as ‘sweetheart’; to avoid ordinary instructions in the form of the imperative; constantly to use question tags at the end of sentences; a sing-song tone and a raised voice, irrespective of hearing capacity; and to relish a markedly infantilised choice of words. Students of linguistics, since elderspeak was first identified in 1981, generally regard it as a linguistic power play, putting capable people in a position of subordination and removing choice. To an equal, you might say: ‘Stand up now, please.’ Translated into elderspeak, you would say: ‘Let’s see if we can stand up, you lovely man, let’s have a peep at your tootsies, shall we?’
Professional defenders of elderspeak will say, in public, that patients with some cognitive decline need to be talked to like children. Anonymously on online message boards, discussing patients not suffering any decline, they go further: ‘Because the average public [sic] has about three brain cells in total and only two function at a time,’ one semi-literate medic declares on a Reddit thread.
The phenomenon of elderspeak has been studied in a medical context for nearly half a century. It is perhaps only recently that patients in the prime of life, in some cases rather more intelligent and better educated than the junior doctor they’re talking to, have found themselves being addressed about their lower tummies in the first-person plural.
In part, it may be the sign of a growing mania for terminology that is designed to spare somebody’s feelings, and ends up enraging them with insulting and patronising euphemism. The British Medical Association deciding in 2024 that what had been, lucidly, ‘junior doctors’ were now going to be referred to as ‘resident doctors’ was one example. In my nearest hospital, a new department near the entrance has appeared in recent years, labelled ‘Urgent Care Centre: Emergency Care’. That turns out to mean ‘minor ailments’, siphoning off those with bruises, sprains and hiccups otherwise clogging up A&E. But why give it so dishonest a title? For exactly the same reason as a doctor talking about ‘naughty cells’ causing cancer. The working assumption is that patients are, without exception, idiots.
Within living memory, and I dare say even now in pockets here and there, doctors were prepared to speak to patients and their relatives with honest and lucid frankness, always (in my experience) much appreciated. When my late mother suffered a catastrophic brain haemorrhage in 2003, the consultant told us, in so many words: ‘We think it’s quite likely that a second haemorrhage may occur. If that happens, she will die.’ That was an admirable man, to speak so plainly and with such respect for our powers of understanding. A German friend who moved to London in the 1990s was imbued with all his nation’s obsession with minor physical changes, and accustomed to present himself at his surgery asking for help because his tongue felt a bit sticky. After turning up for the third time in a fortnight, he was somewhat surprised when the hard-bitten south London GP told him to ‘fuck off, and come back when there’s something wrong with you’.
Such frankness seems to be on the decline, and with it a certain degree of respect for the patient’s intelligence. The maddening contempt manifested when a medic says to a Regius Professor ‘So, we’re having a little bit of a problem, are we?’ was probably inevitable from the moment we were persuaded to bang saucepans on our doorsteps in awed adoration of what is now technically known as ‘RNHS’. Previously, medicine was one of a number of professions which might contain anyone from the highly intelligent to dutiful plodders – law, planning, politics, architecture, academia, journalism, and so on. These days, particularly among the junior ranks, doctors appear to assume that they are so indisputably brilliant as a caste as to require an entirely new way of talking to outsiders. Let’s take a look at the little problem we seem to be having here, shall we?
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