What’s in a name?

Changing syndrome names from the eponymous to the descriptive demystifies medicine, but it also disempowers doctors, argues Dr David Turner

What’s in a name? I considered this question recently after entering a read code for ‘Peyronie’s disease’ and the computer immediately changed the diagnosis to ‘induratio penis plastica’.

In case this was a one-off blip in the technology, I tried a few more eponymous syndromes:

‘Pott’s syndrome’ is coded as ‘tuberculosis of vertebral column’.

‘Baker’s cyst’ becomes ‘synovial cyst of knee’.

And ‘Charcot-Marie-Tooth syndrome’ is simplified to ‘hereditary motor and sensory neuropathy’.

Now, does this matter? The conspiracy theorist in me hates the Big Brother way in which these codes are changed automatically by the computer to descriptive diagnoses, but I guess some may argue that it does make the disorders easier to understand.

However, these conditions were identified by physicians, admittedly long-dead ones, but it was their work that led to the understanding of these diseases. And naming the conditions after them is a way of acknowledging and remembering this.

I also think that it is sometimes easier to remember eponymous syndromes. When someone says Charcot-Marie-Tooth, I immediately think of the typically inverted Champagne-bottle legs of the first patient I saw with this condition as a medical student. ‘Hereditary motor and sensory neuropathy’ is as nebulous as it is imprecise as a diagnosis.

So, how long before we are forced to say, ‘small plastic tube for insertion in tubular viscera’, rather than ‘stent’? Not to forget that ‘Stent’ was a proper noun before it became a noun and then a verb.

While changing codes from eponymous to descriptive is a way to demystify medicine, it also disempowers doctors. We spend our time at medical school learning a language that we can communicate easily to each other – and by its very nature, it excludes the non-medically trained.

I also take issue with the new-style name badges that NHS hospital employees wear: ‘Hello, my name is David’ is both patronising and belittling. They remind me of the badges worn by chain burger restaurant employees, some of whom are probably on a better hourly rate than many junior doctors.

The same could be said about clothing. Hospital doctors being forced to wear scrubs – even if they never enter an operating theatre – seems nonsensical to me. I have yet to be convinced by any scientific evidence that theatre blues are any more hygienic than the white coats we used to wear over our ordinary clothes. When we wore proper clothes and badges with our titles, patients could tell more easily who we were, and some of the charismatic authority of the white coat gave gravitas to what we said and did. ‘The doctor as the drug’, as psychoanalyst Michael Balint referred to it.

I do not suggest that we go back to the old days of the likes of Sir Lancelott Spratt (a paternalistic consultant from The Carry On films). But I do think the pendulum has swung too much the other way.

The bigger picture here is gradual erosion of the status of a profession, which leads to devaluation, poor remuneration and can eventually reach a point where junior doctors do not earn enough to pay their bills…

Dr David Turner is a GP in Hertfordshire. Read more of his blogs here