Watch Your Language! (Part 2)

Posted by Jeremy Windsor on Feb 05, 2021

Following on from Andy Luks' recent post on our misuse of medical language, here's something from Dr Lawrence Way to get you thinking a bit more...

"The following are examples of incorrect English usage commonly found in medical work-ups and case presentations. Although dictionaries may allow some of the criticized examples, please remember that these are not meant to be usage guides...

The patient cannot be diagnosed; only the disease can be diagnosed. It is incorrect to say The patient was diagnosed as having... Correct: The illness was diagnosed as appendicitis

Patients cannot do any of the following: raise their hematocrits; normalize their lab tests; or perforate an ulcer. A patient cannot fail therapy any more than he can succeed therapy. And how about "the patient grew E. coli out of his..." An eccentric gardener?

Patients obviously cannot be resected. Nevertheless, you occasionally hear someone refer to the resected patients..., or say the patient was resected ... Similarly, if you do an ileostomy, it is incorrect to say the patient was diverted. The bowel was diverted, not the patient. Finally, the patient cannot arrest

A patient can give consent, but he cannot be consented. Wrong: The patient was consented for an appendectomy

In 1947 Barbara Hepworth was invited by the surgeon Norman Capener to sketch a number of surgical procedures at the Princess Elizabeth Orthopaedic Hospital in Exeter. Over the course of two years she produced around 80 works in pencil, ink and chalk. Each demonstrates an extraordinary precision - something that’s often lacking in our use of language*

You can operate upon a patient, but you cannot operate a patient (he is not a machine). 

It is impossible to Ambulate the patient, as the order sometimes reads. There is no transitive form of this verb. Anyway, forget the word ambulate (and ambulatory), and when the time comes write an order to please have the patient walk. Tell someone else, he is walking (not, ambulating)

The patient was ruled out for..., makes no sense. The disease can be ruled out, but not the patient! 

The patient was explored times two...or the patient vomited times two... is improper English. 

If you intend to say that the white blood cell count was normal, don't do it by saying The patient had no white count. That would not be true.

Do not begin presentations by saying The physical exam was significant for (or remarkable for)... Just say On physical examination... Eliminate the phrase significant for from case presentations.  

Don't tell us that The abdominal exam was positive for bowel sounds. Just say Bowel sounds were present. You wouldn't say The crosswalk was positive for pedestrians or The sky was positive for stars. The word positive is unnecessary in case presentations except in reference to a test result. 

Don't say to a patient that an x-ray will be taken after he has been given dye. Don't ever tell a patient that you found bugs in his urine. Not surprisingly, patients can't make sense of such jargon.    

Don't use silly noun-verbs such as coumadinize; surgerize; etc. 

Saying that GI continuity has returned or the patient has recovered GI continuity postoperatively is not what you really mean. Peristalsis can return and ileus can resolve, but continuity was never lost in the first place. 

When the patient leaves the ICU, he is not transferred to the floor, but to the ward or nursing unit. 

The patient is never transferred from an outside hospital (one without walls?), but rather from another hospital.  

Surgery is not a synonym for operation; a patient cannot be said to have had a surgery. Surgery is a broader word that refers to a specialty within medicine, a process, or even a suite of operating rooms. It is not, however, an item of work produced by surgeons. That is an operation. Whenever the word operation appears to be appropriate, surgery would usually be inappropriate

The following words are often misspelled:  pruritus, anastomosis, haemorrhoid, dehiscence and diverticula (the plural of diverticulum). There is no such word as diverticuli. Also, remember that mucous and calculous are the adjectives and mucus and calculus the nouns. Anastomosis comes from the Greek ana- (meaning through) and stoma (meaning opening). If you remember that you are making a stoma, you will not misspell this word. 

Visualize means neither to see nor to make visible. It means to have a mental image. The tumor may be opacified or imaged by angiography but not really visualized. You would never think of saying that you visualized the cars in front of you as you drove to the hospital, but equivalent statements are commonly heard within the hospital. Bad: The laparoscope gave good visualization of the gallbladder. Good: The laparoscope gave a good view of the gallbladder. Bad: We opened the abdomen and visualized the stomach. Good: We opened the abdomen and inspected (looked at; saw) the stomach. 

Here are three words that are frequently misused in a similar way. Symptomatology is not synonymous with symptoms. Symptomatology is the entire catalog of symptoms in a given disease. That is not what a patient experiences; he or she has symptoms. If the patient's condition gets worse, the symptoms worsened but not the symptomatology. Aetiology is not synonymous with cause.  The aetiology of death was a bullet through the head is an example of etiology misused. Aetiology refers to all possible causes of a disease. The use of symptomatology or aetiology might be appropriate during a discussion of a disease, but rarely during a case presentation. Pathology is not synonymous with lesion or condition. Bad: The pathology was excised. Good: The lesion (or tumor, etc.) was excised. 

Technical miscues should not be described as inadvertent. Although you may intend to say they were unavoidable or accidental, inadvertent really means careless and inattentive.

A laparoscope should probably not be called a telescope, because the Greek tele- means far away. A telescope allows one to see something far away

Cachexia means severe malnutrition and weight loss. As with words like unique or pregnant, it does not entail degrees of severity. Thus, a patient cannot be slightly cachectic. In extremis is another example. It means at the point of death, not just severely ill. Moderately in extremis contains a contradiction    

When you ask the nurse over the telephone to do something for a patient, you may report that you gave her a verbal order, intending to distinguish it from a written order. A written order, however, is also a verbal order. The correct term would be an oral order. Verbal (and verb and verbatim) come from the Latin for word. Anything that contains words is verbal and vice versa. 

stent is a device used to hold soft tissues in a specific configuration.  A bile duct stent, for example, keeps the duct open despite the presence of a stricture.  A stint is a period of time allotted to a specific job: He had a two-year stint in the Army. Don't confuse these two words. 

One often hears in oral presentations that The patient denies .... some symptom or another (e.g., The patient denies vomiting). But the word deny implies that an accusation has been made and is inappropriate in this context. Just say the patient has not vomited, or whatever. There is no place for deny in presentations or workups. 

Every clinical abnormality is not a complaintComplaint is an expression of pain or dissatisfaction; a symptom for which the patient seeks medical attention.  Normal postoperative discomfort, an itchy incision, incomplete return of appetite, an abnormal CT scan, and so forth are not complaints.  

Instead of noting that the patient is eating, we more often say he is tolerating a diet. Why? If a group of residents had breakfast before coming to the operating room, would we say they had tolerated breakfast? Is this ridiculous, or what? 

There is no such word as cosmesis.

Purulent material is a euphemism for pus. Just say pus.

The term melanotic stool contains two errors. First, the adjective form of melena is melenic, not melanotic. The term melanotic is derived from melanin, and melanin is not involved here. Secondly, the word melena has its color imbedded in its definition. Therefore, just say the patient had melena.  By the way, colicky pain is also a redundancy; colic means pain — intermittent pain. Can you guess the etymology of the word colic

The patient who is experiencing nausea should be referred to as nauseated, not nauseousNauseous actually means sickening or causing nausea!  

It is much better to call your treatment plan a regimen than a regime

The leg extends from the knee to the foot; the lower extremity extends from hip to foot. 

Bleed can be used as a verb but not as a noun; hemorrhage can be used as either a noun or a verb.  A patient who bled had a hemorrhage, not a bleed

Male and female should be used as adjectives; man and woman are the correct nouns. The patient should be presented as A 51-year old man with..., not as  A 51-year old male ... Avoid using gentleman or lady when referring to your patients. These words are anachronisms from a previous class-conscious world, where the gentlemen were the educated wealthy; the poor were considered less than genteel. 

Itching and pruritus are synonyms, the former from Old English, the latter from Latin. A proposal several years ago to make a distinction between them did not catch on. 

Likewise, icteric and jaundiced are synonyms. Both just mean yellow, the former from Greek, the latter from Latin. Some people have been taught to use icteric for the sclera and jaundiced for the skin, but medical dictionaries disagree. The words are interchangeable. 

And, lastly, in case you have forgotten, fex is the singular of feces; and pura is the plural of pus."

Thanks Andy for highlighting Lawrence's piece. I think it will make us all think about how we communicate in the future!

*The works reproduced in this post are from the Hepworth Collection. Many of these can found in a wonderful book - Barbara Hepworth - The Hospital Drawings.


The Birmingham Medical Research Expeditionary Society (BMRES) and the British Mountain Medicine Society (BMMS) have joined forces to organise the 2021 Altitude Research Conference. The face-to-face event will take place in Birmingham on the 11th September. Speakers will include Peter Bartsch, Jo Bradwell and Chris Imray. There will also be presentations from members of the UK's leading research groups as well as ample opportunity for researchers, young and old, to present posters and short talks about their work.

Further details can be found here.

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