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Shibboleths
Shibboleth is a Hebrew word meaning ear of grain. It was a word used as a test, in the Bible, by
Jephthah as a test word to identify the Ephraimites from the Gileadites. The Ephraimites couldn’t
pronounce words that had the ‘sh’ sound in them, whilst the Gileadites could. (In case you are
interested, Jephthah was a Gileadite and the illegitimate son of a prostitute, who was driven from
his home land because of this. He became a great mercenary and was welcomed back as a general
and a promise of rule if he rid the country of invaders. He did this, having to sacrifice his daughter on
the way because of a promise he made to God. The battle went well. 42000 Ephraimites couldn’t say
their ‘sh’ and were slain). Over time the meaning of the word shibboleth has changed and is now
used to mean a word, or a formula, or even an article or mode of dress, that identifies followers of
sects, or members of a group. It allows one group to be discerned from another.
It is not quite the same as jargon, which has negative connotations. Jargon is a collection of words
and phrases that have been developed and adopted by groups of people claiming to use language to
clarify communication, but in fact use it to confuse and bamboozle people outside their ‘club’.
Doctors are the worst users of jargon. If you have ever read a letter from one doctor to another, it is
full of obscure words of latin and greek origin, often meaning the simplest of things like red
(erythematous), swollen (tumour), has a fever (pyrexial), relating to the ear (auri or oto) or,
confusingly, golden (auro). There are thousands of these words, and the more specialised the
doctor, the more pleasure they seem to have in using words that even other doctors don’t
understand. The government introduced legislation about 5 years ago that allowed patients to be
included in correspondence between their doctors. At St Wulfstan Surgery we will always let you see
the letters between doctors – you just need to ask the receptionist for a copy. However, the
initiative never really took off in hospitals because they couldn’t agree what a letter was! Was an
email included? What about post-its? But most of all, the objections came from clinicians who didn’t
like the dumbing down of letters and the requirement to avoid jargon. You probably didn’t know you
could read letters about yourself. However, most people I speak to about this don’t want to read
their letters. It surprises me a little given the amount of inaccurate information there is in people’s
medical records. (Whilst on the subject of inaccuracies – if you ever have the need to have a medical
report written about you, do make sure you read it before it is sent. You have a right to see it and it
doesn’t cost anything. Once a medical record contains an inaccuracy, it follows you forever unless
you correct it).
Now, a shibboleths, apart from being a lovely word, is a different matter altogether. In medicine, I
think of these as being everyday words or objects, that everyone would recognise, but only real
doctors know how to say or use.
If we start with the simple ones. Everyone knows what ibuprofen is, but the variations in how it is
said must be legion (as it would say in the Bible). They vary from ibooren, through to amoren with
the commonest being ibubrufen. Luckily we doctors are usually quite good at translating drug
names. I suppose a reverse shibboleth would be ‘the little white pills’. That statement clearly marks
out a non-doctor. Despite what you may read in the press, most doctors do not habitually try out
every make of drug in the market, but I suspect that if they did, by the end of it they wouldn’t
remember what the little white pills were called anyway.
Another of my favourites is Gaviscon, usually mispronounced a Gaveston or Galveston. I like this
because Gaveston has a local tie and it perhaps explains why so many local people mispronounce it.
He was the 1st Earl of Cornwall in the 13th century, the lover of Edward 2nd and was murdered at
Blacklow Hill, on the way to Kenilworth, just outside Warwick, by two Welshmen. Perhaps he
couldn’t say Llandudno. I wonder what the Welsh call Gaviscon. Galveston is a town in Texas on an
island which was initially known as ‘The Isle of Doom’ and has nothing to do with indigestion.
‘Anaesthetist’ and ‘ophthalmologist’ really sort the goats from the sheep. Numerous official papers
mis-spell these words. As a doctor I can tell whether an article or paper is written by a medic.
However, to be fair, a lot of doctors can’t say anaesthetist and perhaps I can only say it because I
used to be one.
Tools of the trade can be shibboleths too, especially if you see how they are used. Everyone knows
what a stethoscope is, and they are not difficult to hold and to look like you know what you are
doing with it. But an auriscope (a fancy torch with a magnifying glass for looking in ears) looks simple
but there is a skill to using it properly. Even medical magazines (which are written by journalists of
course and illustrated by graphic designers) rarely show it being used properly. This is what we
spend 5 years training for.
The internet may give people so much more information than they used to have, but at least we
doctors will never be out of a job using the difficult words. And if that fails, we can always go back to
good old jargon. Or Wales.