Monthly Archives: July 2013

In defense of “the poetry of the people.”

Credit: Grant Barrett

Grant Barrett
(Photo by Jesse Winter, http://jessewinter.com)

Slang: the stepchild of language that too often gets dealt a bad hand. It is fun, lively and full of character but maybe its wild side is what threatens the traditionalists who are quick to criticize it.

Like fashion, slang has its season. What is trendy today may sound out of place in a year, but then could make a revival several years later. Think of terms like “groovy” and “jive.”  Let’s see how long “swag” stays in fashion.

This week as we continue to explore slang, jargon and acronyms, Collaborative Services spoke with local linguist and defender of slang, Grant Barrett. Barrett is the current co-host of the nationwide public radio show A Way with Words, public speaker, lexicographer, journalist, and serves at the Vice President of the American Dialect Society. Barrett talks with us about whether or not San Diego has local slang, why he is an adamant defender of slang and some of his favorite slang terms. We welcome his insights.
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What is slang? Is there a precise definition?
Walt Whitman called it an “attempt to escape from bald literalism,” which is as good a definition as any. It’s also been called “the poetry of the people.”

But really, there’s no precise definition of slang, even among linguists, because it’s not really a linguistic term of art. Linguists and dictionary editors tend to be careful, and would refer to “nonstandard” or “informal” language, which helps correct the common person’s misconception of slang as strictly ungrammatical or being made entirely of taboo words connected to naughty deeds and thoughts.

In general, though, slang is:

  • Used in contrast to formal or prestige modes of speech.
  • Often employs new synonyms or reframing for things which are already well lexicalized in mainstream speech.
  • Most often created and used by those who have little social, financial, political, or other power.
  • Tends to be age-graded and to be closely associated with a time and place, and with a body of similar people.
  • Closely associated with a particular subset of a society, in both large and small groups.

Earlier this year you hosted a public presentation in San Diego called “A Lively Defense of Slang.” Where did the idea come from and why did you feel it was necessary to defend slang?
That it’s where the fun is to be had is the best reason for defending it!

Credit: The Slate Group, LLC.

Credit: The Slate Group, LLC.

There’s so much new slang it’s impossible to keep up, and if we can find it and define it, we can peer into subcultures and learn a little bit more about other ways of life.

Slang is a key part of the language of surfers, soldiers, schoolkids, surgeons, and it’s a good on-ramp for learning more about language overall.

But as far as defending it, it’s also because I think it’s been done a disservice. Once I began looking into the history of the study of slang, what I found were old white men with East Coast educations and a lot of money and power criticizing the speech of the poor, the uneducated, the powerless, those with non-Eastern regional accents, and people of color.

It became clear pretty quickly the word “slang” was — and is — used as code, and that criticizing it is a stand-in for the critiques they really wanted to make but couldn’t because that would too obviously show their elitism, classism, ethnocentrism, racism, and pure snobbery.

Just one of zillions of examples:

“The use of slang … as a substitute for differentiated specific expressions is at once a sign and a cause of mental atrophy.” — Oliver Wendell Holmes.

So, a decent jurist, but talking out of his element when it came to language.

By sticking up for slang, I help recognize this form of speech as valuable and brush away some of the complaints and really look at slang for what it is: a colorful mode of speech practiced by everyone at some point in their lives. It’s as harmless as any other kind of language.

Without it, we’d all talk like the fine print on a home loan.

Does San Diego have its own slang? What are some local slang words that may sound strange to visitors?
It doesn’t have very much of its own slang, but there are several larger influences here that overlap and create a kind of “slang voiceprint”:

  • Hybrid English/Spanish combinations show the influence of multi-generational Chicano English, as well as the direct cross-border influence of the variety of Spanish spoken in Northern Mexico. “Spanglish” is here, too: a kind of fast codeswitching that serves temporary speech goals to get around gaps in vocabulary and understanding but isn’t really a language, dialect, or pidgin in the whole.
  • In the Southeast of San Diego, decades of gang activity has left a large amount of “Bloods” slang, which is sometimes so pervasive that its speakers don’t even know its origins and don’t have any gang affiliation themselves.
  • Just as in the rest of country, television shows like South Park continue to leave their mark.
  • Surfer slang is less remarkable than it was, which is pretty great considering how unusual it had been. But it’s still here, still in use, and shows up in the coastal communities.
Credit: Oxford University Press

Credit: Oxford University Press

You edited the Oxford Dictionary of American Political Slang. What fascinates you the most about this type of slang?
Any domain where folks are working intensely toward a common purpose generates its own insider language, much of it jargon or slang (which are different things). It’s pretty great to dive into this stuff and try to determine what they mean and to get it on the record once and for all. Politics are a large part of what we consider the history of this country, so making dictionaries to understand it is useful.

The biggest surprise for me was finding that “political football,” a hot potato issue that gets passed around without being resolved, was 150 years older than anyone thought. It even predates American football. It originally meant any kind of ball that you could kick around, not the American sport.

Why is knowing the history and meaning of slang words important?
By defining the language we use we understand ourselves and our history. Slang words are simply more language. No worse, no better. They’re worth recording because, without some attempt to explain them, a complete understanding of historical writing will gradually become impossible.

A cronut (Credit: Dominique Ansel Bakery as shown on NBC's Today Show)

A cronut
(Credit: Dominique Ansel Bakery as shown on NBC’s
Today Show)

How do you keep up with the latest slang terms? Are there certain resources you use or that you would recommend?
I read, watch, and listen, then make notes. That’s the bulk of it. I have giant files of stuff I’ve collected over the last 15 or so years, in various states of disarray, but all of it is worthy of a little more exploration.

What do you consider the best new slang word or phrase for 2013 and why?
I think it’s going to have to be “cronut,” a pastry that is a cross between a croissant and a doughnut, or “sharknado,” after the cheesy film, about a tornado of sharks, that recently made a splash on television. They’re fun, they represent something a lot of people might experience and they’re likely to go stale fast so they’ll retain a strong scent of 2013 for decades to come.

What is your favorite slang word and why?
All my favorites are naughty! Though I must say, “muffin top” for the bulge of fat that appears over a waistband has so far withstood the tests of time and seems to be in it for the long haul. It’s a near-perfect slang term in that it is a more interesting synonym for something that otherwise isn’t all that welcome of a discussion topic.

– – –

To learn more from Grant Barrett click here or follow him on Twitter at @GrantBarrett.

Liz Faris, Associate
Collaborative Services, Inc.

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Ask Me 3 and if you still don’t understand ask some more

Have you ever left your doctor’s office feeling confused after a visit? Perhaps the doctor’s explanation of your diagnosis or recommended course of treatment went right over your head? You are not alone. Unfortunately many people don’t understand everything their doctor explains to them and too often people don’t speak up to let their doctor know this. This month, as we explore slang, jargon and acronyms, we wanted to tackle one of the most widespread and confusing types of jargon: medical jargon.

Credit:  Jan Henderson/ The Health Culture

Credit: Jan Henderson/ The Health Culture

This week Collaborative Services spoke to Dr. Richard Senelick about the importance of interpreting medical jargon. Senelick is a neurologist specializing in neurorehabilitation, the medical director at HealthSouth RIOSA, a lecturer, and an author who has contributed to the Huffington Post, The Atlantic, AOL Healthy Living, and WebMD. Dr. Senelick has written on the use of medical jargon and offers advice on what patients can do to improve their health literacy.

We spoke with Dr. Senelick about the use of medical jargon, his ideas for teaching medical professionals to be better communicators and what patients can do if they find themselves not fully understanding an explanation from their doctor. We welcome his insights.
– – –
You’ve written that jargon can be pervasive in all professions, but it may have the biggest impact when it occurs between doctors and patients. Why?
Every profession has its own special language, but medicine seems to have more than its share.  I always tell people that “if you knew the meaning of all the big words I couldn’t make a living.” From an educational standpoint, medical professionals have no choice but to learn the complicated names that come along with anatomy, physiology, chemistry and medications.  If you are going to learn  the names of all of the muscles in the body, you must learn their formal names so that you can communicate in a precise way with your colleagues and the rest of the medical world.  The same is true with the long list of medications.  I can’t just go to the hospital chart and order “that small round yellow pill for blood pressure.”  I think the problem is that the field of medicine has so many words and terms that are not known to the general public and that medical professionals are never taught how to communicate effectively with their patients.  It is like going to a foreign country and not speaking the language.  The medical professional needs to learn to speak in a manner that their patient and other professionals understand.  It is not just patients.  Physicians may speak to nurses in terms they do not understand, but the nurse is too embarrassed to say they do not understand.  It is a medical disaster waiting to happen.

Credit: Medication Advisors, PLLC

Credit: Medication Advisors, PLLC

Medical jargon is one of the most commonly used  misunderstood types of jargon. What is it about medical jargon that makes it difficult to be broken down into terms everyone can understand?
I don’t think it is that difficult to fix, once you understand that you are the problem and learn how to communicate effectively. There was a widely read satirical comic strip, Pogo, who’s main character was a philosophical possum who famously remarked in 1953, “We have met the enemy and he is us.”  We just don’t make enough of an effort or teach our students how to be more effective in their interactions with their patients.  I suspect there is also a sense of “self importance.”  Physicians may want to show us how smart they are.  It reminds me of a parent telling their child to, “use your big words.”  I know a physician who speaks with so much jargon that half the time I don’t have a clue what he is saying.  I wonder if he knows.

Credit: Etsy, Inc.

Credit: Walt Kelly as seen on http://www.etsy.com

I suspect that most health care professionals don’t realize how much they need to simplify their language.  The government’s Health Literacy Fact Sheet  points out that nine out of 10  individuals lack the health literacy skills to manage their health and prevent disease.  The average doctor may tell their patients, “Your hypertension is negatively impacting your cardiac risk factors and puts you at a higher risk for a cerebrovascular event.” For the doctor, these are simple words, but they have no idea that their words fell on deaf ears.  How hard would it be for the doctor to say, “If we don’t do a better job of getting your blood pressure down, it is going to hurt your heart and you may have a stroke?”  Now I have their attention.  The average American reads at about the 6th or 7th grade level.  The problem is how do I measure the way I speak or write so it matches that standard.  Unless someone tells me, either in school or later in my career, how would I know where to “place the bar?”

In an April 2012 blog you wrote for the Huffington Post’s Healthy Living section you describe your own experience having trouble interpreting a doctor’s medical jargon during a visit with your wife. You are a neurologist and author and yet said that you didn’t have a clue what the doctor was talking about. You called yourself the “poster boy” for inadequate “health literacy.” What is “health literacy?”
I used a  quote in my blog, “Health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information and devices needed  to make appropriate health decisions” Wow, do you  understand that?  That is the government’s Fact Sheet definition. I think they just broke their own rule.  How about, health literacy is the basic information that a person must obtain in order to understand the medical people they meet and then be able to take care of their own health and make the right decisions?  It is kind of embarrassing that we can’t even use the proper language to explain the problem.

Credit: Consumer Health Information Corporation

Credit: Consumer Health Information Corporation

Is there a relationship between inadequate health literacy and poor overall health?
There is no question that people with poor health literacy don’t do as well as those people who have a clear understanding of what their doctors and nurses are telling them.  I also wrote a blog on the “Healing Power of Story Telling” that referred to a study where people with high blood pressure who received their information from other people with high blood pressure had better outcomes.  Those people knew how to explain the information in terms the people could understand.

In addition people with low health literacy:

  • Use more medical services to treat their disease than to prevent it.  In other words they may take more pills to treat their high blood pressure instead of  using other methods that would lead to a healthy lifestyle.
  • End up in the hospital and emergency room more often because they do not have the knowledge  to manage their disease.

In fact an article in  The Journal of the American Medical Association (JAMA) noted that “poor health literacy is a stronger predictor of a person’s health than age, income, employment status, educational level, and race.”  That is powerful statement.  As a country we cannot afford to remain illiterate about our health.

In the same Huffington Post blog you state that the use of jargon begins in medical school. What do you think medical schools can incorporate into their curriculum to help medical professionals learn to communicate more effectively and become as you state “medically bilingual?”

Credit: Dr. Shock MD PhD

Credit: Dr. Shock MD PhD

First, we need to teach the teacher.  How many times do you hear someone, including doctors and lawyers, say  “She and me went to movies together last night?” It’s like hearing fingernails on a blackboard, but these “educated” people don’t realize they are using poor grammar.  Somewhere along their educational path no one took the time to correct them.  So, once we have the medical educators on board, they can stop their students when they are speaking to their patients in jargon.  Role playing sessions and practice can go a long way in this regard. I stop students, nurses and therapists in their tracks and ask them, “how could you say that so that anyone would understand?”  My “Gramps” was one of my heroes-  30 years after his death, he is still is.  He came from Poland in steerage class, unable to read or write.  I ask myself,” How would I explain this to Gramps so he would understand?”  There is so much that a medical student needs to learn that no one is going to create a formal course on jargon, but it can take place at the bedside. But, first the role models (teachers) need to get it right.  No more “She and me’s!!”

Why are people so afraid to speak up and let their doctor know they don’t understand the jargon they are using?
Most patients are intimidated by the doctor-patient relationship.  When I read the comments to my blogs in the Huffington Post and The Atlantic, I am impressed by the anger and frustration people have towards their doctors and the health care system. Many people are afraid that if they are too strenuous in their questioning of their doctor, they will make them angry and negatively impact their relationship. A good friend of ours who lives elsewhere just had surgery.  My wife went there to be an advocate for her and it made a big difference. She was a second set of ears and was able to ask the questions our friend could not.

If you do not understand what your doctor is saying, immediately stop them and ask them to use simpler language. Don’t pretend that you understand when you do not. Here: are some more tips

  • Be assertive, but friendly.  Let them know if you still have questions.
  • Tell the doctor what you think they said to be certain that you understood them. This is called a “teach back.” ( see below)
  • If you feel you need more time, ask to schedule another visit in the near future.
  • If the doctor is very busy, ask if there is a nurse or assistant who can answer your questions.
  • Take a friend with for another set of ears and always take notes.
  • Ask who you can call if you still have questions when you get home.

What is the “Ask Me 3” program and what makes it effective in cutting through medical jargon?
Ask Me 3,” is a terrific program that encourages patients to ask three basic questions to improve communication between themselves and the people caring for them.  The three questions you need to ask your doctor or nurse are:

  • What is my main problem?
  • What do I need to do?
  • Why is it important for me to do this?

    Credit: National Patient Safety Foundation

    Credit: National Patient Safety Foundation

This program is directed toward helping people understand the instructions that their health care team is giving them. As I noted in my article on medical jargon, my wife and I have walked away from a doctor’s visit and asked each other, “what did he say?” The problem with “Ask Me 3,” is that it only works if the health care professional speaks in terms the person understands.  If the doctor uses jargon, it will not matter what three questions the patient asks or how many times they ask it.

You often hear about nurses helping interpret medical jargon to patients. Why is this is becoming a larger part of their role?
I am not as optimistic as you are that nurses are stepping in as effective translators.  I underwent hernia surgery three months ago.  It was an uneventful day surgery, but when it was time to go home, the nurse handed me a stack of pre-printed instructions for a patient with a heart condition! I just wrote an article for The Atlantic on “Teaching Doctors How to Think.” People are getting better at asking questions, but they need to get better at telling doctors and nurses that they do not understand them.  I think nurses, aides and  therapists need as much education as the doctors.  They are just as guilty as the doctors.  It is a system wide problem.  I think this is why you see all the programs like “Ask Me 3” that are aimed at educating the patients.

As a neurologist, do you find yourself slipping into jargon when explaining something to a patient? What tips do you use to remind yourself not to use jargon when you find this happening?

I lecture and write a good deal. That has helped me with my patient interactions, since I am constantly going back to my rule,” Would my Gramps understand me?”  Here are some simple rules for all health care professionals to follow:

  • Repeat essential information. It is called the “Teach Back Method.” Patients forget 80% of what they are told and 50% of what they retain is incorrect.  We shouldn’t ask, “Do you understand?” Teach Back instructs us to ask, “ I want to make sure I explained things well so please tell me in your own words what is wrong with you, how will you take your medications, etc.”
  • Use plain language. Constantly ask yourself, “did I say it without using technical words?” A big part of the problem is that doctors do not think words like hemorrhage, biopsy, rectal, and tissue are jargon words. Remember, “What would Gramps think?”
  • Consider cultural and socioeconomic status. We are a diverse community of immigrants and many of our patients are bringing an entirely different set of ears to the conversation.

Here are Some Examples

( From one of my lectures)

ProblemWord_ConsiderUsing

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To learn more about health literacy visit these resources:

U.S. Department of health and Human Services- Quick Guide to Health Literacy

Joint Commission- “What did the doctor say?: Improving Health Literacy to Protect Patient Safety

NIH Introduction to Plain Language

Health Literacy: National Network of Libraries of Medicine

To learn more from Dr. Richard Senelick you can purchase his books and DVDs here.

Liz Faris, Associate
Collaborative Services, Inc.

OMG! Collaborative Services’ next deliverable is all good – slang, jargon and acronyms. TYFYS!*

Credit: University of Leicester Student Slang

Credit: University of Leicester Student Slang

This month we are moving from word choice to looking at words and phrases we are often told to avoid. We are diving into the world of slang, jargon and acronyms. These words provide character and animate conversations. You can learn a lot about a person by listening to them speak.

You can find out where someone is from and their attitude when they use slang. But you may not learn as much as you hope because slang is also used by people to be secretive. Think secret societies, students and prisoners.

Credit: http://nwamotherlode.com

Credit: nwamotherlode.com

Speaking of being secretive, jargon often sounds like a secret language to those outside of the special group in which it is used. Jargon can tell you about someone’s profession, skill or hobby. But when those in the special group try to use it to communicate with the rest of us, we are often left feeling confused and frustrated. Have you ever left your doctor’s office dizzy and scratching your head from the diagnosis or course of treatment they have “explained” to you?

Like jargon, acronyms can feel like a secret code we have to crack. A short-hand puzzle of letters. Almost every profession has their own.

Credit: reviews.in.88db.com

Credit: reviews.in.88db.com

From military leaders to the U.S. Text Messaging Champion, acronyms are becoming more of a phenomenon as our world continues to expand and our language continues to shrink to fit Twitter’s 140 characters or less constraint. As we learned last month LOL and OMG have already been added to Merriam-Webster’s Collegiate Dictionary proving that acronyms are quickly becoming a part of every day language.

We are dedicating a month to learning all about slang, jargon and acronyms because they are what makes language fun, unique and personal. We’ll hear from some leading experts who will break it down and help us understand why knowing how to interpret slang, jargon and acronyms should be a no-brainer.

Liz Faris, Associate
Collaborative Services, Inc.

* Headline translation: Oh My Gosh! Collaborative Services’ next topic is all good – slang, jargon and acronyms.Thank you for your support!

So, Do Words Really Matter?

In the past month, the Collaborative Services blog talked about words and word choice.  Obviously, as professional communicators, we’re big on words. But words by themselves are just tools. The best screwdriver in the world can’t accomplish anything by itself.  It needs someone to turn it, and it requires at least a tiny bit of skill to do so effectively.

Credit: Industrial Distribution/Advantage Business Media

Credit: Industrial Distribution/Advantage Business Media

That’s why word choice is key. It’s so important, in fact, that we would go as far as saying that words – by themselves – don’t matter. It’s context that matters.

Words only take on power when we string them together in meaningful ways. A word by itself is just a combination of letters. A code.  But words in the right kind of sentence can suddenly become anything we want them to be: persuasive, compelling, inspiring, moving, disturbing, fun, right.

Use the words “dinner” and “six” for example:

“The homeless man always ate dinner at six.”

Not the most scintillating sentence. But use the same two words in another context and they take on more significance:

“For the homeless man, dinner consisted of six M&Ms.

All of this is to say, words can only provoke an emotion when they are put into some kind of context. And the cool thing about word choice is that this works with just about any word. Even the word “word,” the most generic unit of language, can take on nuanced meanings depending on how it is used.  Take these examples, based on the entry for “word” in Wordnik.com:

It can mean a favorable recommendation: I put in a good word for him.

Or imply a personality trait: He’s a man of few words.

It can refer to news: I just received word from the front.

Or just a rumor: Word has it, Billy failed his driver’s test.

Then there’s slang. The Urban Dictionary has no fewer than 87 “definitions” for the word “word.”  Most of them stopped being hip at least 10 years ago, so use them at your own risk.

Credit: Urban Dictionary

Credit: Urban Dictionary

They generally refer to utterances of agreement or affirmation, a kind of “gangsta’s amen.” For example:

“That band was tight.”

“Word.”

The Online Slang Dictionary notes that you can also use “word” as a question, or challenge of veracity:

“I just met Beyonce!”

“Word?”

Helpful hint: “Word” can also serve as the proper response after it is used as an interrogatory:

“I just ate 12 hamburgers!”

“Word?”

“Word!”

Some believe that the root of this slang usage comes from the phrase “My word is my bond.” When used in that context, it basically means: “I speak the truth,” or “You can take what I tell you at face value.”

Interestingly, not everyone agrees on the origin of that phrase.  It is often first cited as the motto of the London Stock Exchange beginning in the early 1800s. We’re skeptical, but intrigued, by Urban Dictionary’s theory that it was originated by inmates in U.S. prisons.

Credit: nierocks.areavoices.com

Credit: nierocks.areavoices.com

So, in the end, do words matter? Well, they do up to a point, about as much as a hammer sitting in a toolbox matters. But take that hammer out, put it in the hands of a skilled carpenter, add nails and wood, and it can help build a house (or as the Urban Dictionary would call it, a crib).

It’s the words that you choose, and how you use them, that matter.

And to that end, we want to thank the experts of word choice who contributed to our blog this month. They are:

Speechwriter, author and professor Robert Lehrman.

Editor at Large at Merriam-Webster Peter Sokolowski .

All of this brings us to next month’s topic, which is “Acronyms, Jargon and Slang,” and how they can get in the way of communicating your message.  Acronyms can be inscrutable, jargon can be eye-glazing and slang, well, you don’t want to sound unhip, do you?

Just take our word for it.

Jonathan Heller, Director of Communications
Collaborative Services, Inc.

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