Code Switching: In Defense of "Unprofessional" Communication

Code switching is a linguistic phenomenon that describes how speakers change the way they communicate on the basis of the intended audience. For example, a college student speaks differently to a professor than to friends at a bar. An adult uses different speech at a job interview than at dinner with friends. Code switching can be purposely used by groups to demonstrate unity, as for example use of certain slang and grammatical concepts by various racial groups.

Sometimes healthcare professionals need to do it to meet patients where they are, to show solidarity, to indicate we are willing to, literally, speak their language. Sometimes if we don't, we literally can't get through. And we need to communicate effectively with our patients. I was taken to task recently for swearing too much, so I have been paying attention to swearing at work (verdict: I don't swear any more than anyone else). I paid attention initially because I was irritated at being singled out, but then I became interested. People swear judiciously at work. Physicians even swear to patients. Note I did not say they swear at them. Why? Because it levels the communication field.


  • Young intoxicated combative patient with severe injury: "This is fucked up, man! It ain't right! Look at it! It's all fucked up!" Doctor: "Hold still so we can start an IV and help you." Patient: "No, man, it's too fucked up!" Doctor: "Look, man, hold still for a minute and we'll make it less fucked up." [Patient pays attention and lies still.]
  • Triage patient: "I'm here because shit is fucked UP." Me: "Can you tell me more?" Patient: "I'm telling you, shit is fucked UP." Me: "OK, how is shit fucked up, exactly?" Patient: [goes on to describe chief complaint.]
  • Frequent flier: "I guess I really did overdose that time, huh." Nurse: "Yeah, you really did it this time." Patient: "What?" Nurse: "You really caused some damage." Patient: "What?" Nurse: "You fucked up." Patient: "Oh, yeah, that's what I thought, man."

Swearing aside, I also note adeptness in grammar changes. I heard a well-educated nurse talking to a dirty barefoot farm kid about an IV and saying, "This needle will go in your arm one time and then it won't hurt no more." This kind of thing removes barriers between caregivers and patients.

I don't think we notice how much we do this, and not everyone goes to extremes with it, but it can be done with subtlety. I suggest that before "unprofessional" communication is condemned across the board, perhaps it should be examined with a more sophisticated eye. It may be more professional than meets the eye.