Why Medical Language Matters

Let me start out by saying that I’m not categorically opposed to the notion of linguistic drift. I get that language changes over time, and that much of this is in line with the progression of society. I find it of particular value when used colloquially, or for comedic effect.

I bristle more when it happens, shall we say, for intellectual laziness. Even if an alarmingly large proportion of the population is using a term incorrectly, that doesn’t mean that everyone else should throw in the towel and go along with it. For instance, we seem to be in the process of killing the word “literally” (It’s a pet peeve of mine, I’ll spare you my rant on the subject.)

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It’s very helpful, if not a necessity, that when you say something, others know what you mean. There’s a reason so much of education and training boils down to the learning of vocabulary. Specialized fields such as medicine particularly depend upon having well-defined concepts. One might therefore think they’re relatively protected from such dumbing-down of their terminology.

So I have to admit to feeling a little smug when I watched Idiocracy, and saw its depiction of healthcare in the dystopian future. Surely, even if the rest of society devolves into a drooling mess, we docs won’t go tumbling off the IQ-cliff with them so easily?

Sometimes I’m not so sure, as we collectively take baby-steps in that direction. The terminology that we depend on to precisely and accurately communicate our expertise is allowed to drift, and sometimes such drift is even formally accepted into the professional lexicon. That is, the field determines that enough of its denizens are using the wrong words, so it’s better to officially declare that what was once wrong is now right, or at least acceptable.

Maybe I’m just being a stick in the mud and not getting with the times, but a shining example of this is the relatively-recent determination that there would no longer be a “superficial femoral vein.” I’m not going to go digging into the history of anatomy, but it’s probably been recognized for centuries that the deep-venous drainage of the lower extremity ultimately comes down to the common femoral vein, fed by the deep femoral and superficial femoral veins. Simple enough, right?

Except it seems that a lot of healthcare folks didn’t remember their anatomy (or didn’t learn it well enough in the first place), and weren’t properly considering the superficial femoral veins as part of the deep-venous system. Hardly a capital crime; a layman could certainly be forgiven for thinking that “superficial” means superficial, and “deep” means deep.

Still, these healthcare-folks weren’t laymen. Presumably, they had gone through adequate education and training, and maintained their knowledge-base with ongoing reading, CME, etc. Kind of a paradoxical thing, then, that when they failed to remember that the superficial femoral vein was actually part of the deep-venous system, the Powers That Be decided to throw in the towel and just rename the vessel.

The evident philosophy, and dangerous precedent being set: If enough people can’t be bothered to get something right, change the answer so they’re not wrong anymore.

And if you think about it, there’s still plenty of room left for confusion. If someone refers to “the femoral vein,” the same clueless individuals who couldn’t remember that this vessel was part of the deep venous system might just as easily fail to recognize the distinction between the various veins that have the word “femoral” in their names (common, deep, circumflex).

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Other terminological battlegrounds that haven’t (yet) been formally ceded by whoever the heck makes these decisions for us, but I suspect are in line:

• Leg. We learn in anatomy that this refers to the area between the knee and the ankle. If you want to talk about the area above the knee, that’s the “thigh.” If you want to talk about the whole kit and caboodle, that’s the “lower extremity.” But the general population doesn’t reliably draw such distinctions, and unfortunately an increasing number in the healthcare field don’t either. I’ve long since passed the point where I receive a lumbar MRI for “radiculopathy, left leg” and have any confidence as to whether the referrer truly meant that referred signs/symptoms were below the knee. If enough people fail to use terminology properly, others lose the ability to depend upon it.

• Medial/lateral. I specifically refer to the upper extremities. Anatomic position means that the thumb and radius are lateral, and the pinky and ulna are medial. But the general population doesn’t walk around in that position. Think about yourself standing with your hands at your sides: Your thumbs are on the inside. An awful lot of healthcare personnel have allowed themselves to forget their anatomic positions, if indeed they ever really learned them. I no longer feel particularly confident that I know what they’re talking about when they send me an x-ray for “medial hand pain.”

• Tenderness vs. pain, dizziness vs. vertigo, etc. There are a whole lot of specific, useful terms that got developed in medicine to describe signs and symptoms that patients might have. (Heck, the waters between “signs” and “symptoms” have gotten muddied.) Every time these terms get blenderized to the point where we really can’t be sure of which meaning is intended by their usage, we lose another increment of definition, and things get dumbed down that much more.