MUSINGS * MATIERE A REFLEXION

An appeal for simpler medical terminology

David Gunn, P. Eng., MBA

texts, I started to keep a journal of older than we thought, so old that his
Resume: Apres avoir peine en the words I had looked up. parents had lived during the Roman
anatomie, en physiologie, en This began as a practical aid to Empire and Latin was his first lan-
pathologie et en microbiologie, 'a remind me what a word meant guage? No, it seemed that the con-
chercher des centaines de mots this 'need often arose within a half- spiracy to train us to speak in ancient
dans un dictionnaire medical, un hour but soon the words them-
- tongues was more far reaching than
futur medecin canadien a com- selves began to intrigue me. Many this.
mence a se demander si la multi- seemed to have little to justify their Much of human anatomy was
tude de termes medicaux 'a existence; they were complicated completely new to us. Mother had
racines grecques ou latines sont and convoluted ways of expressing never taught us about the amygdala,
encore utiles a la profession simple things. I felt compelled to the fovea, or the -xiphoid process,
medicale. II plaide en faveur start a new section in my word jour- and so a Latin word seemed as good
d'une terminologie medicale sim- nal: Totally Unnecessary Medical as any to learn. But so many parts of
plifiee qui, pense-t-il, aiderait les Terms. the body did have perfectly good
medecins et ameliorerait la com- A large part of first-year med- English names that we had all been
munication avec les patients. ical school is devoted to learning the using since early childhood. I dearly
parts of the human body. Fair wanted to call a shoulder blade a
enough, but why were we learning shoulder blade, and not a scapula,
I recently finished my third year them in Greek and Latin? Kingston, which only made me think of a
of medical school. Many nights Ont., is a university town and does kitchen utensil. I longed to speak of
as I sat in the library, struggling have an interesting cultural diversity, a knee cap, not a patella, and to
to digest yet another paragraph of but how many Greek or Latin speak- identify the ear drum as the ear
medical text, I felt as though I had ers could we really expect to en- drum, not the tympanic membrane.
entered a language-studies program. counter in a Thursday afternoon or- As for body parts that were new
Had my registration form somehow thopedics clinic? Or was it that our to us, was Latin really the language
been misdirected by the administra- well-loved anatomy professor was to learn those names in? I think not.
tion?
The library keeps a medical
dictionary open in the study area and
I, along with most of my student col-
leagues, became a regular user. After I longed to speak of a knee cap, not a patella, and to
a few weeks of looking up the
strange words that seemed so irre- identify the ear drum as the ear drum, not the
sistible to the writers of medical tympanic membrane.
David Gunn is a fourth-year medical student
on leave from Queen's University in
Kingston, Ont.

NOVEMBER 15, 1993 CAN MED ASSOC J 1993; 149 (10) 1553
The early anatomists, when naming
things they saw, used simple, de-
scriptive terms. The widest muscle
of the back was appropriately named
latissimus dorsi, from latus (broad),
mus (most), and dorsi (back); why
didn't we call it "widest back mus-
cle"? Or "straight abdominal" for
rectus abdominis, or "oval opening"
instead of foramen ovale? Although
Latin lost its role as the official lan-
guage of medicine at some point late
in the 18th century, these anatomical
names have stubbornly persisted. To
me, they scream out for translation.
Ancient languages seemed to
have been particularly popular in the
formation of adjectives referring to
anatomy. The cells of the liver are
Those darn bugs - Trichinella, Trichomonas,
Treponema, and Trypanosoma. No wonder I found
microbiology difficult.
not liver cells, they are hepatic cells.
(Actually, and even worse hepa-
- Syncope means fainting? Concretion
tocytes). Heart enzymes become car-
diac enzymes. Consider the anxious
patient who, when asked about his
renal condition, interrupted the
young resident to explain that he
really wanted to discuss his failing
kidneys. Or the frail old woman who
was alarmed to learn that in addition
to her blood disease she now had
hematologic dyscrasia!
Some body parts seem to have
merited adjectives derived from not
one, but two, languages. Unfortu-
nately, neither language was Eng-
lish. A wart (verruca) near a finger-
nail might be described as
periungual or paronychial. Genio
(from the Greek geneion) might be
used to refer to the chin, as in the ge-
nioglossus muscle, but so might
mental (from the Latin mentum), as
in the mental nerve. Have pity!
1554 CAN MED ASSOC J 1993; 149 (10)
Physiology was only slightly
better: pensive people mentated; un-
comfortable people voided, urinated,
or micturated (perhaps depending on
their mood); readers' eyes accom-
modated rather than focused; things
were brady or tachy, not slow or fast.
In our second year we were in-
troduced to disease - I should say
pathology - and the number of ur-
gent trips to the dictionary grew so
quickly I had to break down and buy
my own. How many times would I
have to look up epistaxis before I re-
membered that it means nosebleed?
Or that pruritus means itchiness? Di-
aphoresis means perspiration? Hir-
sutism means hairiness? Alopecia
means hair loss? Exanthem means
rash? Halitosis means bad breath?
or calculus means stone? Lithiasis
means stone formation? My word
journal goes on and on.
It seems that the medical vo-
cabulary employs fancy terms for
even the simplest of concepts. Imag-
ine how Beaver Cleaver might have
sounded coming home to his mother
June had he lived in a world infected
with medicalese: "Oh, Beaver! You
present with an avulsion on the ante-
rior inferior aspect of your jeans and
erythematous lesions on the volar as-
pect of your hands. I'm going to
have to take a history!"
"Gee, Mom ... you know I'm a
poor historian. ...."
"Now Beaver, I want to know
what transpired, stat!"
"Well, okay. Wally and I were
on our postprandial break, and we
went down by where the innominate
stream bifurcates, and gee . since
our mouths were pretty xerotic, we
decided to go down and drink some
water. I tripped over a tuberosity on
the path, and impacted the ground in
the prone position."
"Well, Beaver, you seem to
have a real mishap diathesis this
week. Your incidents are supernu-
merary to any Wally ever had at
your age. You know the sequelae of
being ectopic, especially peri-
stream. You really should take more
prophylactic measures. I don't want
to see a recrudescence. Now here, let
me palpate your genu."
Our hospitals need more people
who remember how to talk like the
real Beaver.
Then there are the sound-alike
names, the bane of all medical stu-
dents. (When it comes to drug names
practising physicians also fall victim
to this problem, as the Letters pages
of CMAJ have indicated on many
occasions.) Am I the only one to
confuse melanoma with myeloma,
peroneal with perineum and peri-
toneum, arthralgia with dysarthria,
arteritis with arthritis, and eye drops
with hydrops? And those spotty dis-
eases! Rubella, rubeola, and roseola
- did their original researchers all
consult the same book of girls'
names? How about nephrotic syn-
drome versus nephritic syndrome?
Someone could have used a little
more imagination in creating names
that would help us distinguish be-
tween the two. Or those darn bugs
- Trichinella, Trichomonas, Tre-
ponema, and Trypanosoma. No won-
der I found microbiology difficult.
There are a couple of sound-
alikes whose everyday use seems to
cause ongoing problems for novices
and veterans alike. Discussion of ab-
duction or adduction of a limb al-
ways results in confusion. Accepted
parlance has become the somewhat
awkward A-B-duction and A-D-duc-
tion. Perhaps the worst offender is
the necessarily carefully enunciated
pair, hypo and hyper, as in hyPOten-
sion and hyPERtension. Frankly, if
it's 1 am on a Sunday morning in the
emergency room, I'd rather be told
LE 15 NOVEMBRE 1993
 that the patient's blood pressure is And let's not forget precocious pu- heritage comes at a huge cost. Ob-
high or low. berty and respiratory embarrass- scure language unnecessarily com-
The last category of medical ment. plicates an already overloaded med-
terms that raises my blood pressure Even relatively common words ical education curriculum. More
- sorry, causes hypertension - is confuse some patients. I recall a important, it perpetuates the mys-
the one in which the words are so middle-aged man who had lower tique that surrounds medicine: ob-
open to misinterpretation by pa- back pain and was told that one rem- scure medical terminology distances
tients. I remember squirming in my edy would be to fuse his vertebrae. doctors from their patients, and be-
seat as a professor discussed with He nodded politely, but his lost look cause medical language intimidates
the class a young paraplegic pa- made me think he was wondering patients, it discourages them from
tient's atrophied muscles. "Look at what kind of explosive would ac- becoming involved in their own
these 'wasted' muscles," he said. It company the fuse. health care. It is precisely because
sounded derogatory, as if he was I don't suggest medical texts be medicine is such a complex field
blaming the young man for not rewritten overnight, but I do think that we need to simplify our commu-
spending enough time pumping up that we sometimes go overboard in nication wherever possible.
in the gym. Similar terms that might our quest for erudition. I have noth- At their worst, big words are
have unintended connotations for ing against imposing words per se used to impress the uninitiated or to
patients include thrill - a cardiac - medicine is a complex field and conceal ignorance. But most often,
patient might think the intern was merits its huge proprietary vocabu- they are used simply out of habit, a
enjoying the examination a bit too lary. But when a word adds nothing habit deeply ingrained by years of
much. There is also insult, incompe- to the medical lexicon and could be exposure. I encourage all physicians
tent valves and impotence. That last replaced by a simpler term, why not to break the habit. Catch yourself as
word seems to have achieved public do it? the fifth syllable of that word they
popularity, but it always sounds like Some may revel in the rich her- taught you in medical school is
an all-encompassing comment on a itage that Latin and Greek terminol- rolling off your tongue.
man's character and capabilities. ogy represents, but preserving this Medicine will be better for it.i

* INDICATIONS AND CLINICAL USES: PONSTAN (mefenamic acid) is indicated for the relief of pain of moderate severity in conditions such as muscular
fl AI 1 Ai ~ ~ aches
A and pains, dysmenorrhea, headaches and dental pain. CONTRAINDICATIONS: PONSTAN (mefenamic acid) should not be used in patients who
have previously exhibited hypersentivity to it. Mefenamic acid is contraindicated in patients with active ulceration or chronic inflammation of the upper
(Mefenamic Acid) Capsules or lower gastrointestinal tract. Ponstan should not be administered to patients who have previously experienced diarrhea as a result of taking the drug.
THERAPEUTIC CLASSIFICATION Mefenamic acid should be avoided in patients with pre-existing renal disease. MRNINGS: In patients with a history of ulceration or chronic
Analgesic. inflammation of the upper or lower gastrointestinal tract, PONSTAN (mefenamic acid) should be given under close supervision and only after consulting
the Adverse Reactions Section. Certain patients who develop diarrhea may be unable to tolerate the drug because of recurrence of the symptoms on
subsequent exposure. In these subjects, drug
the should be promptly discontinued. PRECAUTIONS: If rash occurs, the drug should be promptly discontinued. A false-positive reaction for urinary bile,
using the diazo tablet test, may result after mefenamic acid administration. If biliuria is suspected, other diagnostic procedures, such as the Harrison spot test, should be performed. In chronic animal
toxicity studies PONSTAN (mefenamic acid) at 7 to 28 times the recommended human dose, caused minor microscopic renal papillary necrosis in rats, edema and blunting of the renal papilla in dogs,
and renal papillary edema in monkeys. In normal human volunteers, BUN levels were slightly elevated following the prolonged administration of mefenamic acid at greater than therapeutic doses. Since
mefenamic acid is eliminated primarily through the kidneys, it should not be administered to patients with significantly impaired renal function. As with other nonsteroidal anti-inflammatory drugs,
borderine elevations of liver function tests may occur. Meaningful (3 times the upper limit of normal) elevations of SGPT or SGOT occurred in controlled clinical trials in less than 1% of patients. Severe
hepatic reactions including jaundice and cases of fatal hepatitis, have been reported with other nonsteroidal anti-inflammatory drugs. Although such reactions are rare, if abnormal liver tests persist or
worsen, if clinical signs and symptoms consistent with liver disease develop, or if systemic manifestations occur (eg. eosinophilia, rash, etc.), mefenamic acid should be discontinued. Mefenamic acid
may prolong acetylsalicylic acid induced gastrointestinal bleeding. However, mefenamic acid itself appears to be le~s liable than acetylsalicylic acid to cause gastrointestinal bleeding. Mefenamic acid
500 mg and acetylsalicylic acid 650 mg four times a day both caused significant further lowering of the prothrombin concentration (mefenamic acid 3.48% and acetylsalicylic acid 2.75%) in patients in
whom the concentration had been initially lowered by anticoagulant therapy. Caution, therefore, should be exercised in administering mefenamic acid to patients on anticoagulant therapy and should not
be given when prothrombin concentrations is in the range of 10 to 20% normal. Careful monitoring of blood coagulation factors is recommended. It is recommended that estimations of hemoglobin and
blood counts be carried out at regular intervals. Mefenamic acid should be used with caution in known asthmatics. Use In pregnancy and in'women of childbearIng potential: The safety of mefenamic
acid on reproductive capacity and pregnancy has not been established. Thus, mefenamic acid should be used in women of childbearing potential and during pregnancy only when the potential benefits
are expected to outweigh the potential risks. Nursing motich: Trace amounts of mefenamic acid may be present in breast milk and transmitted to the nursing infant: thus mefenamic acid should not be
taken by the nursing mother because of the effects of this class of drugs on the infant cardiovascular system. Use In children: Safety and effectiveness in children below the age of 14 have not been
established. ADVERSE REACTIONS: The most frequently reported adverse reactions associated with the use of PONSTAN (mefenamic acid) involve the gastrointestinal tract. The following disturbances
were reported in decreasing order of frequency: diarrhea (approximately 5% of patients), nausea with or without vomiting, other gastrointestinal symptoms and abdominal pain. The occurrence of the
diarrhea is usually dose related. Other gastrointestinal reactions less frequently reported were anorexia, pyrosis, flatulence, and constipation. Gastrointestinal ulceration with or without hemorrhage has
been reported. Hematopoietic: Cases of autoimmune hemolytic anemia have been associated with the continuous administration of Ponstan for 12 months or longer. Decreases in hematocrit have been
noted in 2-5% of patients and primarily in those who have received prolonged therapy. Leukopenia, eosinophilia, thrombocytopenic purpura, agranulocytosis, pancytopenia and bone marrow hypoplasia
have also been reported on occasion. Nervous System: Dizziness, drowsiness, blurred vision, insomnia, nervousness and headache have occurred. Integumentary: Urticaria, rash and facial edema have
been reported. Renal: As with other nonsteriodal anti-inflammatory agents, renal failure, including papillary necrosis, have been reported. In elderiy patients renal failure has occurred after taking
mefenamic acid for 2-6 weeks. The renal damage may not be completely reversible. Hematuria and dysuria have also been reported with mefenamic acid. Other: Eye irritation, ear pain, perspiration, mild
hepatic toxicity and increased need for insulin in a diabetic have been reported. There have been rare reports of palpitation dyspnea and reversible loss of color vision. DRUG INTERACTION:
Protein-bound Drugs. Because PONSTAN (mefenamic acid) is highly protein bound, it could be displaced from binding sites by, or it could displace from binding sites, other protein-bound drugs such as
oral anticoagulants, hydantoins, salicylates, sulfonamide and sulfonylureas. Patients receiving mefenamic acid with any of these drugs should be observed for adverse effects. Anticoagulants and
Thrombolytic Agents. Mefenamic acid enhances the hypoprothrombinemic effect of warfarin, therefore, concurrent administration of the drugs should be avoided whenever possible. If the drugs must be
used concurrently, prothrombin time should be determined frequently and anticoagulant dosage adjusted accordingly; the patient should be observed for adverse effects. In addition, the ulcerogenic
potential of mefenamic acid and the effect of the drug on platelet function may further contribute to the hazard of concomitant therapy with any anticoagulant or thrombolytic agent (eg. streptokinase).
DOSAGE AND ADMINISTRATION: Administration is by the oral route, preferably with food. The recommended regimen in acute pain for aduits and children over 14 years of age is 500 mg as an initial
dose followed by 250 mg every 6 hours as needed, usually not to exceed one week. For the treatment of primary dysmenorrhea, the recommended dosage is 500 mg as an initial dose followed by 250 mg
every 6 hours, starting with the onset of bleeding and associated symptoms. Clinical studies indicate that effective treatment can be initiated with the start of menses and should not be necessary for
more than 2 to 3 days. AVAILABILITY: PONSTAN (mefenamic acid) is available in No. 1 Coni-snap capsule with an ivory opaque body and an aqua blue opaque caP. Each available in bottles of 100
and 500. REFERENCES: 1. Gabka J. Ponstan dental study. Berlin July 9, 1974. 2. Budoff PW. Zomepirac sodium in the treatment of primary dysmenorrhea syndrome. N Eng J Med 307:714-719, 1982.
3. Powell R, Smith RP. Treatment of primary dysmenorrhea with an antiprostaglandin agent. (In) Symposium on `The Role of Prostaglandins in Menstrual
Disorders,' Academy of Medicine, Toronto, Ontario. June 20, 1980, pp 29-37. 4. Rees MCP, Bernard Al et al. Effect of fenamates on progstaglandin E receptor saborh Ontao MiL2N3 GE D
binding. The Lancet 2:541-542, 1988. 5. Smith RP, Powell JR. The objective evaluation of dysmenorrhea therapy. Am J Obstet Gynecol 137(3):314-319, 1980. Ren. T.MWwamer-Lambert Company
6. Ponstan product monograph. IMS, CDTI, September 1991. Product Monograph available on request Parle-Davis Div., Wamer-Lambert
Canada Inc., auth. user CCPP

NOVEMBER 15, 1993 CAN MED ASSOC J 1993; 149 (10) 1555