Exploring Language at the Heart of Medicine

The Language of Medicine
Abraham Fuks
Oxford University Press, 2021
Softcover, 240 pp.
ISBN: 9780190944834
MSRP: $42.99 USD
Also available: Ebook

Reviewed by Romayne Gallagher, MD

The Language of Medicine by the late Dr. Abraham Fuks explores the centrality of language in health and disease. This well-researched project by Dr. Fuks, former dean of medicine at McGill University in Montreal, Canada, was written over many years and was clearly of great interest to him. While it offers valuable insights, this book demands considerable effort to read as the language used is often extremely complex, with long sentences of superfluous convolution. 

Most clinicians would agree that the language we use with patients has an enormous impact on them and how they see their future life, especially for those diagnosed with a serious illness. We have all seen the trauma that can result when a patient is referred to palliative care because “there is nothing more we can do for you.” This stands in contrast to the patient who is told that palliative care “helps you live as long and as well as possible.”

His book increased my awareness of how the choice of words frame and reshape the way we think and how society sees people. While words are conveying meaning, they are also creating new meanings. His discussion of the change wrought when a “cancer victim” becomes a “cancer survivor” was particularly insightful.

Four overly long chapters detail the history, problems, and persistence of military metaphors of medicine. Of note, he discusses how the patient’s body becomes the battlefield where the general (physician) uses weapons to destroy the invader. The person living the warfare experience, who is absent from this analogy, feels objectified. While military and other terrifying metaphors (such as, people with dementia spoken of as "the living dead") have been used to drive successful research-funding campaigns, he notes that they have had disastrous effects on how people with these illnesses are perceived in society. The military motif can impact physicians' behavior, when they act as an ally in the “war” because of their values and beliefs, or as a mercenary—a hired gun. 

Dr. Fuks proposes alternative metaphors and explores other cultures' way of viewing the complexity of health, disease, and healing, but this chapter is thin on examples, except for the metaphor of illness as a journey or an imbalance of biopsychosocial factors. A chapter maintaining that placebos are a species of metaphor I found challenging to accept as the physician saying the word is too much of an elephant in the equation to ignore. He concludes with chapters on the patient-physician relationship and our impact on healing. Although the book largely focuses on serious illness, the author waits until page 181 of 191 pages of text to mention palliative care. I find this very disappointing, as so much groundbreaking work on quality of life and whole-person care has come from pioneers at McGill University.

As noted in the Afterword, the book is intended to be read by “clinicians and their current and future patients—that is all of us.” Clearly, Dr. Fuks had a keen academic interest and facility with linguistics, and its effects in medicine. It is a challenging read unsuited for after a hard day’s work, but there are pearls that may make many days less difficult. 

[Reviewed in March 2025]

Dr. Romayne Gallagher is a retired palliative care physician with a keen interest in the treatment of chronic pain in older adults. She founded the palliative care program at the University of British Columbia Hospital.

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