One of the more benign conditions I saw in the ER last week, was a 3-month baby with a hair tourniquet. A strand of someone’s (usually the mother’s) hair becomes entangled around a toe such that blood-return through the veins is impeded. The toe swells up, and becomes acutely painful. Thankfully, it’s usually recognized, easy to treat, and rarely causes permanent damage. The ER physician used a magnifying glass and forceps to carefully remove the offensive hair. With no further risk of blood-flow restriction, swelling decreases in the toe over a period of a day or two. Perhaps some readers will have heard of this condition before, since I’m told it’s fairly common.

Today we talked about Learning Disabilities (LD). The discussion was led by a Kingston Paediatrician who has since risen to the rank of demi-god in my personal reverence! The rest of this post comes directly from him – I have no claim to its originality.

What is a learning disability?

• Difficulty reading (dyslexia)
• Difficulty with written expression (dysgraphia)
• Difficulty with mathematics (dyscalculia)

The following are NOT learning disorders:

• Visual or auditory impairment
• Attention deficit hyperactivity disorder
• Emotional disturbance
• Motor (movement) disability
• Developmental delay (e.g. down syndrome)

Here was the first eye-opener:

People often say about children with learning disability that they lack motivation, or are uninterested in school work. These children are accused of not producing enough effort. Closer to the truth, however, is that children with learning disability produce enormous effort that fails to yield a positive result. The result is immense frustration, and a decline in motivation since failure is a poor motivator. The chain of causation is crucial to appreciate: children with learning disabilities don’t do poorly because they lack motivation, rather they lack motivation because they do poorly.

Another interesting fact: language-related learning disabilities are more common in English-speaking countries. The most common type of dyslexia is phonetical dyslexia, which is the difficulty or inability to translate letters or words into sounds. In the English language, the same letters and letter-combinations can make a variety of sounds! Take the following (stolen) verse, for example. How confusing for a child with phonetical dyslexia!

When the English tongue we speak
Why is ‘break’ not rhymed with ‘freak’
Will you tell me why it’s true
We say ’sew’ but likewise ‘few’?
And the maker of a verse
Cannot cap his ‘horse’ with ‘worse’
‘Beard’ sounds not the same as ‘heard’,
‘Cord’ is different from ‘word’.
‘Cow’ is ‘cow’, but ‘low’ is ‘low’,
‘Shoe’ is never rhymed with ‘roe’.
Think of ‘hose’ and ‘dose’ and ‘lose’
And think of ‘goose’ and yet of ‘choose’.
Think of ‘comb’ and ‘tomb’ and ‘bomb’
‘Doll’ and ‘roll’, and ‘home’ and ‘come’.
And since ‘pay’ is rhymed with ’say’,
Why not ‘paid’ with ’said’, pray?
We have ‘blood’ and ‘food’ and ‘good’,
‘Mould’ is not pronounced like ‘could’,
Wherefore ‘done’, but ‘gone’ and ‘lone’
Is there any reason known?
And, in short, it seems to me,
Sounds and letters disagree!

-Anonymous 

Perhaps the most meaningful part of the material we covered this morning, was the library of evidence indicating that school failure is a good predictor for behavioural problems in adolescence, school drop-out, teen pregnancy, drug abuse, and even criminal activity. The convicting realization is that there is considerable opportunity to have a dramatic impact on the course of a child’s life by identifying learning disabilities early, and arranging for adequate accommodation. In nearly all cases, these children just need a little bit of extra, devoted attention to help them overcome the particular difficulty they are having.

Thursdays (tomorrow) are clinical skills days, which means that we all dress up like doctors and try out our skills at interviewing patients. In preparatory reading for tomorrow, I learned something cool and new:

The individual words that we choose to communicate with are very important! Much of the time, I think I opperate under the principle that as long as my overall message is accurate, the individual words that I use to convey that message don’t matter much. Evidence has shown that that’s not the case.

For example, a particular study done with pediatricians, their patients, and their patients’ moms found that one specific word choice impacted how the moms answered questions. (Reference for this study to be added soon). When asked “What are you worried about?” the moms were likely to respond with “I’m not worried!”. However, when they were asked “What are you concerned about?”, almost every one had an answer that illuminated information surrounding their child’s health. That single word choice made such a difference!

Another example, is the word “should”, which carries immense power. When used carefully, it is forceful and compelling. But it also has the potential to turn people off, due to its aggressive, critical nature.

To become a good clinician, it will be important to be very concious about word choice and how different words are percieved. What are some of the words that you find to hold power?