Many of the people we speak to on our aircraft radios are pilots, and even if they are not, they understand what it means to be in a metal or plastic tube thundering through sometimes dark, turbulent, and complex skies. They understand us and we understand them. We all get the idea of a standardized cockpit communication protocol; and we know when and when not to speak, what words and abbreviations mean, and how to address various entities—clearance delivery, ground, tower, center, and so on. Why do we not have a similar protocol for talking to another professional group, our doctors? Misunderstandings on aircraft radio can have profound implications and so can miscommunication about health issues, so let’s review a few of these and consider ways to mitigate risk.
1. I always view a checkride as a chance to learn, and one instructor taught me the most powerful word in aviation: "unable." When ATC asks you to climb to FL 250 in your Cessna 172, the response is easy: "unable." When approach tells you to keep your speed up on final and you deem that unsafe, trot out the magic word. And if tower tells you to make the next taxiway off 27L in 50 yards and you are still barreling along at 80 knots? Unable. You are the boss. So why not keep "unable" at hand when interacting with the medical profession? Yes, we doctors and the hospitals are busy, but so are you. So when they tell you to come for an appointment at an inconvenient time? Think ATC and say in a clear and confident voice, "Unable." When asked for a urine sample having peed five minutes ago? You got it, unable!
2. When told by approach that you can descend at pilot's discretion from 12,000 to 6,000 feet, it is acceptable to respond with "5 Lima Foxtrot twelve for six thousand, PD." This is where we, as pilots, are clearly a higher form of life than mere doctors (okay, I am both!). Why? Because the medical profession cannot agree on standardized abbreviations and in this example PD can mean "per diem" (take a medicine once or twice per day), Parkinson's disease, peritoneal dialysis, or Peyronie's disease (a rather disconcerting condition where the penis has a bend which can cause all manner of interesting situations). If your doctor uses an abbreviation in relation to you, take the time to find out exactly what he or she is talking about and ask that the full words be entered into your notes—you do not want someone in the future assuming a different PD applies to you!
3. Every human enterprise has a special lexicon, a secret language that says "I belong to a select group and if you don't know what I am talking about, you are not a member!" Pilots are no better than others—we talk about TCAS, WAAS, FIKI and Wx Brief with knowing winks and nods. Doctors do it the whole time. Some examples? My favorites include these:
"Conservative": This is a doozy. "We are going to institute conservative therapy" is medispeak for, "We aren't going to do a darn thing."
"Watchful waiting": I love it when people have multiple ways of saying the same thing. This one? Same as conservative—but we get to charge more.
"Idiopathic": To tell a patient we do not know why something happens is a bit embarrassing, so we came up with this chestnut—it is a fancy way of saying, "We don't know why this happens."
Latin: When I trained as a doctor, although Latin was no longer mandated as a high school subject, the medical schools certainly appreciated if you had it and would ridicule you if you did not. Why? Because it allows one to play a number of games, such as this: "Doctor I have this red, itchy rash—a bunch of raised blotches, darker in the middle than the outside. What is it?" Whereupon our trusty medic peruses the lesions and opines, "Hmmm, it seems you have Erythema rotunda pruritica centrifugatum."You respond, "Oh my goodness, what does that mean?" and our brave healer replies, "It means you have a red, itchy rash, raised blotches, darker in the middle than the outside." Make sure your doctor speaks to you in plain English.
4. When professionals speak to one another they use their secret language, as noted above. Aviators do it for sure; yet when we have nonpilots on board with us we go to great lengths to reassure our passengers that the strange noises they hear are nothing to be concerned about, and a good briefing will include a heads-up to avoid conversation to preserve life and limb during critical phases of flight such as takeoff and landing. We should expect no less from our medical professionals. For instance, if your physician wishes to refer you to a specialist, it is not inappropriate to ask for a copy of the referral letter and to ask what it means. Sometimes pilots say daffy things to ATC or each other and physicians are no different. One of my favorite stories relates to a radiologist who, when asked to shoot an X-ray always made it clear that he expected a full description of the patient's condition so that his interpretation of the film could be guided by all the available data. One rather lazy referring doctor failed to do this when requesting a chest X-ray, so the radiologist's report was brief and to the point. It merely read: "Chest present."
5. When my airplane has an oil change, I send a sample for analysis, compare the results with prior runs, and keep the documents in an organized file. Similarly, when any part is the subject of scrutiny during an annual or other inspection, I ask my mechanic to show me what is wrong. I trust Martin who looks after my airplane implicitly—he is solid as a rock and incredibly knowledgeable—so why do I ask? Simple, I am the geezer in the wild blue yonder, and the more I understand about the machine I am flying the safer I feel; it is a teachable moment. I therefore encourage you to do the same when your doctor orders blood, urine, radiology, or other tests. Ask to see the results, field questions about what the results mean, and keep them on file—they are, of course, your results.
6. At the moment we have three classes of medical certification with varying intervals between visits. Of course, we are all under the obligation to self-assess every time we fly so the more we know about our health, the better able we are to make go/no-go decisions. I fervently hope we can move away from the third class medical as I think it is of questionable value, causes a lot of headaches and administrative burdens, and imposes a financial toll on pilots and FAA who could be better occupied with other activities. But while it still exists, make sure you tell your regular doctor, if he or she is not also your AME, that you are a pilot. There may be aeromedical implications for any new diagnosis, test, or therapy, and before letters are placed on file with FAA, seek Pilot Protection Services guidance so that inappropriate language does not cause you problems.
In medicine as in aviation, speaking the same language es todo razonable!
