7 minute read
President’s Message
PRESIDENT’S MESSAGE to Members
By Dr. Jessica Triche 2020–2021 NCAFP President
Do You Know Your Patients' Dialect?
Patient 1 Me- “Hey..how have you been?” Patient-”Well, pretty good except for Mr Arthur paying me a visit.”
Patient 2 Me-”How’s everything going?” Patient- “Well, ok except that Arthur hit me last week.” Wow, who the heck is this Arthur guy? Do I need to call Adult Protective Services?! Practicing my entire career in Eastern North Carolina, it didn’t take me very long to realize that Arthur was not some evil person preying on the elderly in the cold winter months.
Dr. Triche attended UNC-Chapel Hill for undergraduate studies and attended medical school at the Brody School of Medicine at East Carolina University. She completed her residency training at Moses Cone Family Medicine in Greensboro, NC, where she served as Co-Chief Resident. Dr. Triche is married and has two sons and enjoys life on the water in Bath, NC. She is currently working at Vidant Family Medicine-Chocowinity located in Chocowinity, NC. She enjoys seeing a variety of patients as well as teaching medical students. She is a graduate of both Vidant's Physician Leadership Institute as well as the North Carolina Medical Society Foundation's Leadership College and completed their Health Care Leadership and Management (HCLM) Program in 2018. Dr. Triche is currently involved in several leadership roles within the Vidant system. She also serves on the Beaufort County Board of Health.
Arthur was osteoarthritis-or arthritis, which really can attack the elderly during wintertime. No matter where we practice, we will encounter many phrases, sayings, and cultural practices unique to the area. It is very important to become familiar with these in order to relate to our patient population and build trust within the community.
North Carolina is a diverse state with residents from many different nationalities and backgrounds. Across the state there are several different dialects and many accents. To clarify, an accent involves pronunciation differences. Dialect includes phrases, vocabulary, and idioms. When I first moved to North Carolina as a kid, I was confused when my teacher asked me to get the “bale”. I was trying to figure out why she was asking me to get a bale of hay in the middle of a school day. She said “bell”. I was definitely not used to the Southern accent yet! The first time I had the pleasure of caring for a Hoi Toider, I thought they were from another country. But, really, it was just Pamlico Sound dialect! There are at least 5 known regional dialects in North Carolina. I recommend becoming familiar with the dialects around where you live. It’s also probably worthwhile to learn the dialect where your in-laws live especially if you are playing the game Taboo. FYI- ”holler” is “hollow” in Appalachia dialect. I just learned this while preparing for this article. I spent 3 months trying to figure out why my mother-in-law was using words like ‘yell’ and ‘loud’ to describe the clue “hollow”!
Understanding dialect is important in the clinical setting. During my first year of practice, my nurse wrote “piles” under chief complaint. Now, these were the days of paper charting so Epic didn’t give her the choices it does now. She handed me the chart and I asked her “piles of what??” I was then educated about the Eastern North Carolina term for hemorrhoids. Out of curiosity, while writing this article, I did learn there is an ICD-10 code for piles. It’s K64.9 for inquiring minds-go ahead and try it. I have since encountered piles numerous times, more often than I encounter hemorrhoids. I no longer have to clarify with the patient what they mean.
Over the years I have learned about many more ailments that afflict the Eastern North Carolina population. Every few weeks or so, I have to lance a “risin”. For those that do not know, in Eastern North Carolina, a “risin” is an abscess or boil. To save us time, my nurse and I know to go ahead and prepare the room ahead of time for an I&D whenever we see that the reason for visit is “risin”, which improves our workflow. For the record, there is no ICD-10 code for “risin”. Another, non ICD-10 ailment is a “pone”. This is pronounced like “hone” but with a “p”. This is not nearly as common as a risin but is still found around the eastern part of the state. This a bit harder to describe, but involves a soft, raised area under the skin. It is not an abscess nor is it an area of
Executive Officers President Jessica L. Triche, MD President-Elect Dimitrios “Takie” P. Hondros, MD Secretary/Treasurer Shauna Guthrie, MD, MPH Immediate Past President David A. Rinehart, MD Executive Vice President Gregory K. Griggs, MPA, CAE
At-Large Directors
Talia M. Aron, MD
Elizabeth B. Baltaro, MD
Jewell P. Carr, MD
Garett R. Franklin, MD
Nicole Johnson, MD, MPH
Brian McCollough, MD
Mark McNeill, MD
Ying Vang, MD
Academic Position Mark L. Higdon, DO (Novant FMR)
Resident Director Clayton Cooper, MD, MBA (Duke)
Resident Director-Elect Ryan Paulus, DO (UNC)
Student Director Hannah Smith (ECU)
Student Director-Elect Morgan Carnes (Wake Forest)
AAFP Delegates & Alternates
AAFP Delegate AAFP Delegate AAFP Alternate AAFP Alternate Karen L. Smith, MD Robert L. Rich, Jr., MD Richard W. Lord, Jr., MD, MA Tamieka Howell, MD
2501 Blue Ridge Road, Suite 120, Raleigh, North Carolina 27607
swelling due to injury. It is not a lipoma. I honestly do not know what it is, but I have seen it. It is just a “pone” and only requires reassurance to the patient that it is nothing to worry about. Understanding local terms saves you time in the clinic. I no longer have to clarify what a “whelp” is. It is not what my brother says when the TarHeels lose as in “Whelp, there goes the season”. Whelps are really welts, or hives. Understanding local terminology is also helpful when documenting review of systems. It is much more efficient to go ahead and document phlegm when a patient says they are coughing up “cold”. Admittedly, it took me several attempts with patients to clarify what they meant when they only coughed up cold. I have now incorporated this term when asking some patients about upper respiratory symptoms. “Are you coughing up colored stuff, blood, or just cold”?
Why am I even bothering to write about this? As I mentioned above, understanding local terms, phrases, and dialect may help with clinic efficiency. I think, more importantly, patients realize that you are a true part of the community. They may feel more comfortable relating to you in their own terms knowing you understand them. This can lead to learning things about your patients that you may not have learned otherwise. Another reason I share this relates to my Winter speech about mentoring. It is important to teach our students and residents local dialect and culture. I will never forget trying to explain a “pone” to a first year medical student. He looked at me like I was crazy. He returned to rotate with me later in his medical school career and, one day, came running out of the room, laughing. “She has a pone!!” He could not believe it, but understood what the patient meant when she told him she had a pone. If students truly feel like they are part of a clinic and community, they are more likely to remain or return to the area to practice. We all need to do our parts to introduce them to the community. I look forward to hearing about other terms, phrases, and dialects from your clinic in the future.
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