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Editor's Corner: Telling Dildrams and Talking Whiff-Whaff

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Prof Paul A Corris
Senior Associate Editor
ISHLT Links Newsletter

Regional speech has always been a source of fascination and survives via collections of traditional stories, folk songs, poetry and dialect based translations of well-known literary works. In a country like the United Kingdom which has been conquered and held by foreigners of several different nations during its early history, it follows as a matter of course that that a great variety of dialects will be found to prevail in different parts of the Kingdom. The languages that can be found to influence local dialects include Ancient British, Roman, Danish, Saxon and Norman.

One of the characteristics of many dialects is that the same word or at least a word that is pronounced in the same way may have more than one meaning and this is very important to realise when engaging in conversation with a person versed in dialect.

"Good Morning and how are you feeling today?" Im very adle today, Doctor. Any the wiser? Well adle is a corruption of the Saxon word adel meaning disease. The derived word addled indicates a swollen state due to pus or corrupt matter. To describe oneself as "very adle" indicates a strong feeling of malaise and weakness. Easy then. Well not quite because in contrast the verb to addle also indicates the act of rewarding for labour completed as in "to addle his shoon" which indicates the feeding of a working horse with a good volume of oats and in rural parts describes the said horse's antics in rolling from side to side on its back in anticipation of a good feed. Addle indicates a feeling of satisfaction then and whilst variation in the inflection and emphasis of syllables and of course context may provide further clues to the meaning of words with more than one, it is quite possible to misinterpret what is being meant. Of course, our silver-tongued Editor (an American with a southern dialect behind his American English) might sarcastically respond, I'm not unwell, thank you or more likely, I'm good or I feel good.

A "canny lass," for example, can indicate that the female person you are describing is shrewd, frugal with money, good, lucky or pretty depending on intonation and context. Yaping about and swabbling like a trubagully may sound like a serious neurological disorder until one realises that it simply describes the general activity of basic chat from a person who is employed in a rather menial occupation.

Patients then may choose to use words to try and convey how they feel which leave us uncertain as to what is being said. The problem may lie in unfamiliarity with the word itself or choice of a word with more than one meaning. Remember the conversation between Humpty Dumpty and Alice in Lewis Carroll's Through the Looking Glass (1872):

"When I use a word," Humpty Dumpty said, in rather a scornful tone, "it means just what I choose it to mean-neither more nor less."
"The question is," said Alice, "whether you can make words mean so many different things."

The reality, Alice, is that many words do have differing meanings.

History taking remains the corner stone of diagnosis and careful analysis of the language a patient uses when describing symptoms is vital to prevent the potential for misunderstanding. Whilst the correct interpretation of dialect is particularly relevant when practice involves patients from diverse regions, it is equally important to clarify exactly what a patient is trying to tell you when using words in common usage. Remember Humpty Dumpty who chooses a word to mean to what he chooses it to mean. Time spent clarifying what the patient means exactly (and do please remember clarify means both making clear and easier to understand or removing impurities or solid matter as in butter) is generally a more direct and cost effective approach to achieving a correct diagnosis than reaching for multiple investigation request forms in the hope of elucidating what is going on.

Disclosure Statement: The author has no conflicts of interest to disclose.

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