Numb, Dizzy and Normal: Deceptive Words in Medical Practice
"Doctor, my arm went numb." This sounds like a clear
communication, doesn't it? Most physicians would interpret this
complaint as meaning that the skin of the arm lacked full
sensation. But maybe the patient meant that the arm had extra
sensations, like tingling or shocks. Or even that the arm's
muscles became weak.
In my community-based practice of neurology, I have discovered
that the word "numb" can have any of these three meanings, alone
or in combination. And the medical implications of the different
meanings can be quite different. For example, if the arm became
weak, it might mean the patient suffered a stroke that damaged
the brain. If, instead, the arm tingled, it might have been due
to a disruption of the circulation or peripheral nerves in the
arm itself, as from sleeping on it wrong. So in order to get the
diagnosis right, I need to quiz the patient about the exact
meaning of "numb."
"Numb" is one of three words at risk for medical
misinterpretation. The other two words are "dizzy" and "normal"
-- good, everyday English words, to be sure, but words that
require further explanation when used in a medical context.
The problem with the word "dizzy" is that two patients might
complain of dizziness and mean entirely different things. In
fact, there are four different symptoms that I've heard patients
use the word dizzy to describe:
* spinning or other sense of motion, also known as vertigo
* imbalance/unsteadiness
* lightheadedness
* verging on passing out
The distinctions are not trivial. If I assume, when patients
report dizziness, that they mean a spinning sensation when they
actually mean they're lightheaded, then I'll probably make an
incorrect diagnosis. Lightheadedness (and verging on passing
out) are more likely due to blood pressure or heart problems,
while vertigo is usually about the inner ear and its
connections. If my diagnosis is wrong, then, of course, any
treatment I recommend will be off-target, as well.
So what could be the difficulty with the word "normal," a word
that seems so utterly, well, normal? I'll illustrate the problem
with a patient's question: "Isn't it normal, Doctor, for a
person to be confused at the age of 80?"
The answer is yes or no, depending on what the word "normal"
means. This word's dual meanings often go unrecognized. A usual
non-medical meaning has to do with how common or typical
something is. But, particularly in a medical context, normal can
also refer to whether or not something is healthy. So if the
question is if it's common or typical for an older person to be
confused, the answer is yes. But is confusion healthy? No. The
presence of confusion means something has gone wrong. Examples
include a brain infection, Alzheimer's disease or even
side-effects from a medication, all of which are unhealthy.
So here's a quiz: Is it normal to be numb or dizzy? Hopefully,
you caught the pitfalls in the question. Non-medically the
answer is yes -- these symptoms are very common in a person's
lifetime. But medically the answer is no -- while not
necessarily serious, these symptoms signal an unhealthy
condition.
(C) 2006 by Gary Cordingley