LANGUAGE IN EMERGENCY MEDICINE:

A VERBAL SELF-DEFENSE HANDBOOK

by Suzette Haden Elgin, Ph.D.
Copyright © 1999 Suzette Haden Elgin, Ph.D.
All rights reserved

CHAPTER ONE

THE AUNT GRACE SYNDROME

CASE HISTORY

Mrs. Henderson is a woman in her early thirties who has been brought to the ER with chest pain. She is pale and sweating, and in obvious distress. You suspect an MI. But the friend who brought her in didn't stay to talk to you, there don't seem to be any family members you could call, and Mrs. Henderson is being no help at all. Instead of answering your questions so that you can start her care, she just keeps talking about how her Aunt Grace had this very same thing happen to her, and she's sure she's not having a heart attack because Aunt Grace's problem turned out to be her gall bladder. You don't want to hear about Aunt Grace; you need the answer to your questions, right now: WHAT SHOULD YOU DO?

TECHNIQUE -- USING MILLER'S LAW

Miller's Law (from psychologist George Miller) goes like this:

"In order to understand what another person is saying, you must assume that it is true, and try to imagine what it could be true of."

(In an interview with Elizabeth Hall; Hall 1980)

That is: The proper response when someone says, "My toaster is talking to me!" is "What is your toaster saying?", followed by very careful and attentive listening.

You don't have time to argue with Mrs. Henderson, and it's clear that it wouldn't be much use anyway. She's in no condition to be reasonable. You know what will happen if you keep trying to force her to stop talking about Aunt Grace and speak for herself. She'll get angry with you, you'll probably become irritated in return, and that will escalate, making an already bad situation worse.

Instead of wasting precious minutes trying to change the patient's language behavior -- when the two of you are already communicating under stress and your efforts would increase that stress -- use Miller's Law. Assume that what the patient says is true; assume that her experience is just like Aunt Grace's experience. Then question her like this:

"Remember when your Aunt Grace had this pain, Mrs. Henderson? Tell me...

...when did her pain start?"

"How long did her pain last?"

"How often did she have this pain?"

"How bad was it? What kind of pain was it?"

"Did anything make her pain worse?"

And so on through your standard set of questions.

This will get you the information you need quickly, and it won't tie you up in a wasteful and undignified verbal struggle with the patient.

At some point in the questioning Mrs. Henderson may switch strategies and start talking about her own problem. If there are differences between what she remembers about Aunt Grace's difficulties and her own, you can rely on her to point them out to you. She'll explain, saying things like this:

"When this happened to my Aunt Grace, she used to be in pain for hours, but with me it never lasts more than a couple of minutes."

"When Aunt Grace had this pain it was on her right side, but mine is more in the middle."

When this happens, you should switch your strategy, too, right along with her. Just match your response to the language data that she presents.

Everywhere I go, I see people applying not Miller's Law but a principle that we can most accurately refer to as "Miller's Law In Reverse." They hear someone say something that they find unacceptable or outrageous; they immediately assume that what was said is false; and then they try to figure out what's wrong with the person who said it. As in:

"That's crazy. She's only talking like that because she's old."

"That's ridiculous. He's only saying that because he's been drinking."

"That's all wrong. She just says anything that comes into her head."

When people do this, they stop listening and leap to conclusions, making misunderstanding and communication breakdown inevitable. That's poor strategy. Always begin by applying Miller's Law. Don't make the additional mistake of thinking that this will slow you down. The danger of wasted time and effort is in failing to listen, misunderstanding, and then having to untangle the resulting mess and set it right. Miler's Law will save time.

The source of the problem in these situations is usually not in the person but in the language. If it really is the other way around, that will become clear to you soon enough, and you can then take whatever steps are necessary to deal with it.

* * *

ADDITIONAL INFORMATION

Listening

It will be obvious to you that the most essential skill for the application of Miller's Law is the skill of listening. Listening is hard for busy people, and hard for people with a thousand things on their minds, but it really is the first and most basic skill of communication. Without it, nothing else in a language interaction can function properly. However, in my experience medical professionals are not taught how listening works; they appear to believe that it is largely a matter of either good manners or taking notes. This may have some relevance, but it's not the information you need.

When you listen, you don't hear a word, recognize it, find its meaning in your long term memory, and then move on to the next word. The language mechanisms in your brain don't work that way. This has nothing to do with manners, and everything to do with neuroanatomy. It is neurophysiologically impossible to do that and understand what you hear. By the time you got to the end of an average sentence -- recognizing each word and extracting its meaning, combining words into phrases and phrases into clauses as you went along and extracting their meanings -- you would be hopelessly behind.You would never catch up. When you listen to a sequence of your native language, what happens is that you generate in your own mind a set of sentences that match the meaning of the sentences you're hearing; you do this based on your knowledge of the language, of the situation, of the person speaking to you, and of the context. Only when you hear something that clashes with your own internally-generated sequences do you stop and try to extract meaning in a mechanical fashion. We have a way to do that; as quickly as we dare, we say, "Wait a minute! What did you just say?"

The human brain is fully capable of carrying out this astonishing task. What it can't do is generate two sets of sequences -- one to match the speaker's words and another to create your internal self-talk -- at the same time. If what you're doing while someone talks to you is thinking about something else entirely, you can't listen. It's that simple.

Elgin's Corollary To Miller's Law

In order for other people to understand what you are saying, you must make it possible for them to apply Miller's Law to your speech.

People can't assume that what you're saying is true if you talk so quickly, or so vaguely, or in such impenetrable medical jargon, that they can't even begin to understand what you're trying to tell them. They can't assume that it's true if your body language contradicts your words. They can't make a commitment to comply with language they have doubts about and don't understand. They won't make an extra effort to figure out what you mean if you've made them feel stupid or threatened. Remember that the outcome of your care is at least as heavily dependent on their understanding your language as it is on your choice of procedures or medications.

The short-term memory (also called working memory), which people use to keep track of incoming perceptions, has a limited capacity. It can only handle about seven chunks of information at one time; and anything that isn't processed within roughly thirty seconds goes straight into long-term memory unindexed -- meaning that it's not retrievable except by chance. You can help your listener process your language more effectively by signaling what's ahead, whenever that's possible and appropriate. Say, "I want you to remember three things" or, "There are three things that it's important for you to remember." Then mark each one of those items off as you present it, with "First...," "Second...," and so on.

[End of Chapter One]

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Table of Contents

Introduction: This Is An Emergency

Chapter One: The Aunt Grace Syndrome

Chapter Two: Sensory Mode Lock

Chapter Three: Satir Mode Lock

Chapter Four: Summary and Review

Chapter Five: Verbal Attack Patterns, Part One

Chapter Six: Verbal Attack Patterns, Part Two

Chapter Seven: The Complaint That Has To Be Made

Chapter Eight: Out of Control

Chapter Nine: The Reluctant Physician at 3 A.M.

Chapter Ten: The Communication Barriers

Chapter Eleven: More On Touch Dominance

Chapter Twelve: Body Language Backup

Appendix I: Definitions of Terms

Appendix II: Case Study

Bibliography & Suggested Reading

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Copyright © 1999-2001 Suzette Haden Elgin, Ph.D.

All rights reserved

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[For more information, contact Elgin directly at ocls@madisoncounty.net.]


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