Correct and Preferred Usage of Common Words and Phrases
Correct and Preferred Usage of Common Words and Phrases
Correct and Preferred Usage of Common Words and Phrases
- What would become of us if the deleatur did not
- exist, sighed the proofreader.
- José Saramago1
- We not infrequently are compelled to refuse
- publication to an article which contains valuable
- facts, but which is weighed down with so many
- imperfections as to discourage one—as does the
- porcupine—from closer investigation.
The second quote, from a 1904 editorial in JAMA, certainly holds true today, but of course, editors do consider manuscripts that are poorly written but are of good science, although they may feel less confident about a paper’s content if the presentation is sloppy. Also, authors whose first language is not that of the journal should still be given consideration. In particular, editors should not lose the author’s voice, especially in informal usage. Still, scientific writing should be as precise as possible to avoid misinterpretation. This section provides a selection of correct and preferred terms.
A note about the entries: All terms (and pairs of terms) are in alphabetical (not preferential) order.
abnormal, normal; negative, positive: Examinations and laboratory tests and studies are not in themselves abnormal, normal, negative, or positive. These adjectives apply to observations, results, or findings (see also 20.0, Study Design and Statistics). Note: Avoid the use of “normal” and “abnormal” to describe persons' health status.
Results of cultures and tests for microorganisms and specific reactions to tests may be negative or positive. Other tests focus on a pattern of activity rather than a single feature, and hence a range of normal and abnormal results is possible. These tests include electroencephalograms and electrocardiograms and modes of imaging such as isotopic scans, radiographic studies, and tomography.
The physical examination was normal.
Findings from the physical examination were normal.
The throat culture was negative.
The throat culture was negative for β-hemolytic streptococci.
The electroencephalogram was positive.
The electroencephalogram showed abnormalities in the temporal regions.
Serologic tests for Treponema pallidum hemagglutination, which were previously negative, are now positive.
Serologic test results for Treponema pallidum hemagglutination, which were previously negative, are now positive.
Serologic tests for Treponema pallidum hemagglutination, the results of which were previously negative, showed a titer of 1:80.
See also 11.8, Laboratory Values.
abort, terminate: Abort means to stop a process prematurely. In pregnancy, abortion means the premature expulsion—spontaneous (miscarriage) or induced—from the uterus of the products of conception. A pregnancy may be aborted, not a fetus or a woman. The synonym terminate—to bring to an ending or a halt—may also be used.
accident, injury: According to the National Center for Injury Prevention and Control of the US Centers for Disease Control and Prevention, accident should not be used to refer to injuries from any cause. Although accident implies a random act that is unpredictable and unavoidable, epidemiologic studies and injury control programs indicate that injuries may be predictable and therefore preventable. The preferred terms refer either to the external cause (eg, injury from falls, injury from motor vehicle crashes, gunshot injury) or to the intentionality (“unintentional injury” for injuries resulting from acts that were not intended to cause harm and “violence” for any act in which harm was intended).3,4
In addition, accident (and accidental) is considered by the public health community to be imprecise. The injury-causing event can be described as noted above or with other terms, such as crash, shooting, drowning, collision, poisoning, or suffocation.
Note: Do not change accident if it is integral to the terminology being used, for example, an established injury classification system (eg, Fatal Accident Reporting System, International Classification of Diseases).
acute, chronic: These terms are most often preferred for descriptions of symptoms, conditions, or diseases; they refer to duration, not severity. Avoid the use of acute and chronic to describe patients, parts of the body, treatment, or medication.
chronic heroin users
acute administration of epinephrine
chronic aspirin therapy
long-term dialysis (also: maintenance dialysis [query author])
long-term heroin users
immediate administration of epinephrine
long-standing diagnosis of a chronic disease
long-term care [see note below]
long-term aspirin therapy
chronic obstructive pulmonary disease
acute renal failure
acute, severe cystitis
acute, mild pruritus
Exception: Acute abdomen is a specific medical condition.
A note on short- and long-term patient care: According to Kane and Kane,5 “acute care hospital is preferred to short-term care hospital. Long-term care has come to include both an acute component (sometimes called subacute care or postacute care), which effectively provides the care formerly offered in hospitals, and the more traditional chronic component, which includes both medical and social services. As the name implies, subacute care has a shorter time frame and serves patients who are expected to recuperate or die, while the more chronic form provides more sustained supportive services.”
adapt, adopt: To adapt means to modify to fit a particular circumstance or requirement. To adopt means to take and use as one’s own.
As evidence-based medicine continues to evolve and to adapt, it is useful to refine the discussion of what it is and what it is not.
Australia became the first nation to formally adopt evidence-based medicine as a key feature of its health system.
adherence, compliance: Although these terms are often used as synonyms, there are differences. Adherence can be defined as the extent to which a patient’s behavior (for example, taking medication, following a diet, modifying habits, or attending clinics) coincides with medical or health advice. Use of the term adherence is intended to be nonjudgmental, a statement of fact rather than of blame of the prescriber, patient, or treatment.6 Noncompliance connotes a stigmatizing image of rule, enforcement, and control; dominance and submission; and deviance from expected social roles. Whether a patient chooses to adhere to a therapeutic regimen may depend on many aspects of his or her experience with the disease and the medical encounter itself.7
Although incompletely characterized and understood, the association between poor adherence to drug therapy and virologic failure with resistance has been clearly established in HIV infection.
Possible exception: A patient with a severe mental illness may be required to comply with court-ordered therapy.
adverse effect, adverse event, adverse reaction, side effect: Side effect is a secondary consequence of therapy (usually drug-based) that is implemented to correct a medical condition. The term is often used incorrectly when adverse effect, adverse event, or adverse reaction is intended. Since a side effect can be either beneficial or harmful, specific terminology should be used.
A recent study examined the incidence of serious and fatal adverse drug reactions—any harmful, unintended, or undesired effect of a drug—in hospitalized patients.
A side effect of therapy with hydrochlorothiazide is improved bone mineral density.
affect, effect: Affect (a-′fekt), as a verb, means to have an influence on. Effect (i-′fekt), as a verb, means to bring about or to cause. The 2 words cannot be used interchangeably.
Ingesting massive doses of ascorbic acid may affect his recovery [influence the recovery in some way].
Affect (′a-fekt), as a noun, refers to immediate expressions of emotion (in contrast to mood, which refers to sustained emotional states). Affect is often used as part of psychiatric diagnostic terminology. Effect (i-′fekt), as a noun, means result.
Ingesting massive doses of ascorbic acid may effect his recovery [produce the recovery].
The patient’s general lack of affect was considered to be an effect of recent trauma.
age, aged, school-age, school-aged, teenage, teenaged: The adjectival form aged, not the noun age, should be used to designate a person’s age. Similarly, school-aged and teenaged are preferred to school-age and teenage. However, a precise age or age range should be given whenever possible. See also 11.5, Age and Sex Referents.
The patient, aged 75 years, had symptoms of cognitive decline.
Routine screening of sexually active teenaged girls during regular physician visits is an effective way to detect Chlamydia trachomatis.
Note: In some expressions regarding age, it is redundant to add of age after the number of months or years, since it is implied in the adjectives younger and older.
Influenza vaccination is not recommended for infants younger than 6 months.
See also 11.2.1, Redundant, Expendable, and Incomparable Words and Phrases, Redundant Words.
aggravate, irritate: When an existing condition is made worse, more serious, or more severe, it is aggravated (also, exacerbated), not irritated. Irritated indicates reaction, often excessive (eg, inflammation), to a stimulus.
although, though: Although and though may be considered interchangeable. However, although is preferable as a complete conjunction, because though in this construction is an “abbreviation” and thus may be less appropriate for formal prose. Though, as an adverb, meaning “however” or “nevertheless,” is correct, as are the fixed expressions “even though” and “as though.”
Although the analysis was done correctly, the fundamental terms of the investigation were too narrow to be interesting.
Basal cell carcinoma of the skin and melanoma are the subjects of an extensive literature. Squamous cell carcinoma, though, remains largely unreported and unstudied.
among, between: Among usually pertains to general collective relations and always in a group of more than 2. Between pertains to the relation between 1 entity and 1 or more other entities. For instance, a treaty may be made between 4 powers, since each is defining a relationship with each of the others, but peace may exist among them.
The patients shared the library books among themselves.
Between you and me, we are certain to find the common factor among those we have examined.
analog, analogue: Use analog when referring to items related to computers or electronic equipment. Use analogue when “something similar to something else” is meant or when referring to chemical compounds. Use visual analog scale (not visual analogue scale).
apt, liable, likely: When apt refers to volition or a habitual tendency, it should not be used of an inanimate object. This restriction does not apply when apt means “suited to a purpose.” Liable connotes the possibility of risk or disadvantage to the subject. Likely merely implies probability and thus is more inclusive than apt.
A child is apt to cry when frustrated.
A polyethylene catheter is less apt to kink than one made of vinyl.
The team must decide on the most apt configuration before the first incision is made.
Patients receiving immunosuppressant drugs are liable to acquire fungal infections.
The computer system is likely to crash if it is overloaded.
article, manuscript, paper, typescript: An unpublished study, report, or essay—that is, the document itself—may be referred to as a manuscript, paper, or typescript. When published, it is an article (also, a study).
The authors thank Frank J. Kobler, PhD, for statistical review of the manuscript.
Nancy MacClean assisted with manuscript preparation.
The content of this article does not necessarily reflect the views or policies of the US Department of Health and Human Services.
The article by Carrozza and Sillke addresses the therapeutic options for a 69-year-old woman with disease of the left main coronary artery.
as, because, since: As, because, and since can all be used when “for the reason that” is meant. However, in this construction, as should be avoided when it could be construed to mean while.
She could not answer her page as she was examining a critically ill patient.
She could not answer her page, as she was examining a critically ill patient [comma used].
She could not answer her page because she was examining a critically ill patient.
Similarly, since should be avoided when it could be construed to mean “from the time of” or “from the time that.”
She had not been able to answer her page since she was in the clinic.
She had not been able to answer her page because she was in the clinic.
association, relationship: Association is a connection between two variables in which one does not necessarily cause the other. Relationship implies cause and effect. See 20.9, Study Design and Statistics, Glossary of Statistical Terms.
assure, ensure, insure: These verbs are used synonymously in many contexts, but there are distinctions. Assure means to provide positive information to a person or persons and implies the removal of doubt and suspense (assure the study’s participants that their test results will be held in complete confidence). Ensure means to make sure or certain (ensure the statistical power of the study). Insure means to take precaution beforehand (insure his life).
The insurance company assured workers' families that their policies ensured that workers with few assets would get a decent (ie, permanent) burial.
By mandating that every relevant paper expressly state that an institutional review board approved the study protocol, journal editors can assure readers that the research itself was conducted ethically.8
attenuate, attenuation: In computed tomographic (CT) imaging, attenuation refers to the absorption of x-rays by the patient’s body. The appearance of the patient’s tissues on the CT scan is dependent on the amount of x-rays absorbed (ie, attenuated) by that tissue. Low attenuation (or hypoattenuation) refers to areas of blackness on the CT scan. High attenuation (or hyperattenuation) refers to areas of whiteness on the scan.
because: see as, because, since
because of, caused by, due to, owing to: These phrases are not synonymous, but the differences are subtle. Due to and caused by are adjectival phrases; owing to and because of, adverbial phrases. The use of due to in both situations can sometimes alter a sentence’s meaning.
Survivors of child abuse tend to enter abusive relationships due to intrapsychic conflicts.
Survivors of child abuse tend to enter abusive relationships that are caused by intrapsychic conflicts.
Because due to is adjectival, “intrapsychic conflicts” describes the relationships. Caused by could be substituted for due to, and the meaning would be retained. That are could be inserted before due to without changing the sentence’s meaning.
Survivors of child abuse tend to enter abusive relationships owing to intrapsychic conflicts.
Because of intrapsychic conflicts, survivors of child abuse tend to enter abusive relationships.
Because owing to is used adverbially, “intrapsychic conflicts” characterizes the entrance into abusive relationships. Because of could be substituted for owing to, and the meaning would be retained. However, if that are is inserted before owing to, the sentence’s meaning changes.
Clue to usage: The phrase “coughs due to colds” is a good example of correct usage of due to. If “because of” sounds right, use it or “owing to.” If “caused by” is intended, use it or “due to” (or possibly “attributable to” or “that result from”).
between: see among, between
biopsy: Biopsy refers to the removal and examination (usually microscopically) of tissue or cells from the living body. Use of biopsy as a verb was previously considered to be incorrect. However, such use has become common and acceptable.
The lung mass was biopsied.
A biopsy of the lung mass was performed.
Lesions believed to be malignant were biopsied.
Observations are made of the biopsy specimen, not on the biopsy itself.
Biopsy was normal.
The results of the biopsy were normal.
blinding, masking: The statistical term blinding (or blinded review or assessment) is the evaluation or categorization of an outcome in which the person assessing the outcome is unaware of the treatment assignment; blinding is used to avoid bias. The term is also used to refer to peer review, usually to represent cases in which the author’s name and affiliation are concealed from the reviewer. The equivalent term masking (or masked assessment) is preferred by some investigators and journals, particularly those in ophthalmology. See also 20.9, Study Design and Statistics, Glossary of Statistical Terms.
breastfeed, nurse: When referring to human lactation, use breastfeeding. This term is more specific than nursing and prevents any confusion with the profession of nursing.
cadaver, donor: When describing the source of human organs and tissues used for transplantation, avoid cadaver (or dead body). Correct usage is deceased donor (or recovered from deceased organ and tissue donors).
When referring to a deceased person whose body is to be used for anatomical dissection, cadaver is correct (cadaveric as adjective).
can, may: Referring to one meaning of can and may, Bernstein9 in The Careful Writer stated: “Whatever the interchangeability of these words in spoken or informal English, the writer who is attentive to the proprieties will preserve the traditional distinction: can for ability or power to do something, may for permission to do it.”
A second meaning of may refers to likelihood or possibility:
Dehydration may have contributed to the early onset of shock.
The lesion may or may not resolve without treatment.
case, client, consumer, participant, patient, subject: In clinical research, a case is a particular instance of a disease. A patient is a particular person under medical care. A research participant (preferred to subject; see below) is a person with a particular characteristic or behavior, or a person who undergoes an intervention as part of a scientific investigation, usually a case-control study or randomized controlled trial. A control participant is a person who does not have at least some of the characteristics under study, or does not receive the intervention, but provides a basis of comparison with the case patient (see 20.0, Study Design and Statistics). In case-control studies, it is appropriate to refer to cases, patients in the case group, or case patients; and controls, participants in the control group, or control patients.
Some consider subject (as in study subject) to be impersonal, even derogatory, as if the person in the study were in a subservient role. Similarly, the use of case is dehumanizing when referring to a specific person. For example:
A 63-year-old case of type 2 diabetes…
A 63-year-old man with type 2 diabetes…
Note: Make the distinction between person and patient:
Many persons in the United States have type 2 diabetes [persons with type 2 diabetes regardless of care].
A case is evaluated, documented, and reported. A patient is examined, undergoes testing, and is treated. A research participant is recruited, selected, sometimes subjected to experimental conditions, and observed. (See diagnose, evaluate, examine, identify; and follow, follow up, observe.)
Note: In general, patients should not be referred to as clients or consumers. However, persons enrolled in substance abuse treatment programs, for example, or persons undergoing treatment at a dialysis center are sometimes referred to as clients. Client may also be used by social workers or psychologists and in some research settings where patient or participant is inappropriate. Consumer—one who consumes goods or services—has worked its way into the medical lexicon and may be appropriate in certain discussions. For instance, in the following example, patient would not fit the context:
The Internet has become an important mass medium for consumers seeking health information and health care services online.
case-fatality rate, fatality; mortality, mortality rate: See 20.9, Study Design and Statistics, Glossary of Statistical Terms.
catatonic, manic, psychotic, schizophrenic: These adjectives refer to severe psychiatric disorders. It is inappropriate to trivialize the disorders by using these terms to describe normal variations of individual or group behavior, for which suitable descriptors are available. For example, in common trivial uses of these terms, contradictory can usually be substituted for schizophrenic; strange, disorganized, or senseless for psychotic (depending on the context); overactive for manic; and motionless for catatonic.
Note: It is dehumanizing to refer to a patient as “a schizophrenic.” Use “the patient with schizophrenia” or “the schizophrenic patient.” See also 11.10.4, Inclusive Language, Disabilities.
caused by: see because of, caused by, due to, owing to
cesarean delivery, cesarean section: According to the American College of Obstetricians and Gynecologists, the preferred terms are cesarean delivery (or cesarean birth) or abdominal delivery (to differentiate it from vaginal delivery). Cesarean section is incorrect, as are the spellings Caesarean and caesarean.
chief complaint, chief concern: Chief complaint has been traditionally used by physicians when taking a patient’s history. However, chief concern may be a better description because complaint may be construed as pejorative and confrontational.
chronic: see acute, chronic
classic, classical: In most scientific writing, the adjective classic generally means authentic, authoritative, or typical (the classic symptoms of myocardial infarction include angina, dyspnea, nausea, and diaphoresis). In contrast, classical refers to the humanities or the fine or historical arts (the elements of classical architecture can be applied in radically different architectural contexts than those for which they were developed).
Classical lissencephaly may be caused by mutations of genes in chromosome bands 17p13.3 and Xq22.3-q23.
The classical and alternative pathways of complement components are described in 15.8.3, Nomenclature, Immunology, Complement.
The authors suggest how to present results of data analysis under each of 3 statistical paradigms: classical frequentist, information-theoretic, and Bayesian.
clinician, practitioner: Depending on context, these terms can be used to describe persons in the clinical practice of the health fields of medicine, nursing, psychology, dentistry, optometry, and podiatry (as well as occupational and physical therapy and veterinary medicine, for example), as distinguished from those specializing in laboratory science, research, policy, theory, or writing and editing. When referring to a particular type of clinician or practitioner, it is preferable to use the more descriptive term (eg, physician, nurse, dentist, optometrist). The plural forms of clinician and practitioner may be appropriate to refer to a group of such professionals from different fields. See also provider.
compare to, compare with: One thing or person is usually compared with another when the aim is to examine similarities or differences in detail. An entity is compared to another when a single striking similarity (or dissimilarity) is observed, or when a thing of one class is likened to one of another class, without analysis (ie, one entity is comparable to another).
Compared with patients receiving only routine medical care, patients in both active treatment groups had greater improvements from baseline in psychosocial functioning and intermediate markers of cardiovascular risk.
Few medical discoveries can compare to the discovery of penicillin.
compliance: see adherence, compliance
compose, comprise: Although these 2 verbs are often used interchangeably, compose is not synonymous with comprise. Comprise means to be composed of or to include (the pituitary gland comprises the adenohypophysis and the neurohypophysis). Compose means to make up or be a constituent of (the adenohypophysis and the neurohypophysis compose the pituitary gland; the pituitary gland is composed of the adenohypophysis and the neurohypophysis). The phrase comprised of is never correct.
The chemotherapeutic regimen is composed of several toxic ingredients.
The chemotherapeutic regimen comprises several toxic ingredients.
consumer: see case, client, consumer, participant, patient, subject
continual, continuous: Continual means to recur at regular and frequent intervals. Continuous means to go on without pause or interruption.
His labored breathing was eased by a continuous flow of oxygen through a nasal cannula.
contrast, contrast agent, contrast material, contrast medium: Distinguish between contrast (ie, blackness and whiteness on an image) and contrast material (or contrast agent, contrast medium) (ie, a substance administered to enhance certain structures on an image).
A suspension of barium injected into the intestine was used as the contrast agent for radiological examination.
criterion standard, gold standard: See 20.9, Study Design and Statistics, Glossary of Statistical Terms.
describe, report: Both patients and cases are described; only cases are reported. (See case, client, consumer, participant, patient, subject; management, treatment; diagnose, evaluate, examine, identify.)
diabetes mellitus: The types of diabetes currently recognized by the American Diabetes Association are as follows:
juvenile diabetes, juvenile-onset diabetes, insulin-dependent diabetes mellitus
type 1 diabetes mellitus
maturity-onset diabetes, adult-onset diabetes, non–insulin-dependent diabetes mellitus
type 2 diabetes mellitus
chemical diabetes, borderline diabetes, latent diabetes
impaired glucose tolerance (nondiagnostic fasting blood glucose level, glucose tolerance abnormal)
gestational diabetes mellitus
For other specific types, consult Table 1 (“Etiologic Classification of Diabetes Mellitus”) in Diabetes Care.10
diagnose, evaluate, examine, identify: Diagnose, evaluate, and identify apply to conditions, syndromes, and diseases. Patients themselves are not diagnosed but their conditions may be diagnosed. Patients are also examined. Patients may be evaluated for the possibility of a condition (eg, The patient was evaluated for possible cardiac disease). (See also case, client, consumer, participant, patient, subject; and management, treatment.)
The patient was diagnosed as schizophrenic 4 years ago
The patient’s schizophrenia was diagnosed 4 years ago.
die from, die of: Persons die of, not from, specific diseases or disorders.
He died of complications of disseminated intravascular coagulation.
dilate, dilation, dilatation: Acccording to the American College of Obstetricians and Gynecologists,11 dilate is a verb meaning to expand or open. Dilation means the act of dilating. Dilatation means the condition of being stretched or expanded.
The patient’s cervix dilated over a period of 12 hours.
The patient was treated by dilation and curettage.
After 4 hours of labor, cervical dilatation was 3 cm.
disc, disk: For ophthalmologic terms, use disc (eg, optic disc); for other anatomical terms, use disk (eg, lumbar disk).
In discussions related to computers, use disk (eg, floppy disk, disk drive, diskette) (exceptions: compact disc, videodisc). (See also 24.0, Glossary of Publishing Terms.)
disinterested, uninterested: Although these 2 words are increasingly treated as synonyms in written and spoken language, their differences in meaning are sufficiently useful to be worth preserving. To be disinterested is to be unbiased or impartial; to be uninterested is to be unconcerned, indifferent, or inattentive. A disinterested judge is admirable; an uninterested judge is not. As with many “word pairs,” context is key.
She was uninterested in a career in basic research.
He was a disinterested observer of the complex procedure.
doctor, physician: Doctor is a more general term than physician because it includes persons who hold such degrees as PhD, DDS, EdD, DVM, and PharmD. Thus, the term physician should be used when referring specifically to a doctor of medicine or osteopathy, ie, a person with an MD or a DO degree (also FRCP, MBBS, ScD, etc). (See also clinician, practitioner; provider; and 11.4, Jargon.)
donor: see cadaver, donor
dosage, dose: A dose is the quantity to be administered at one time, or the total quantity administered during a specified period. Dosage implies a regimen; it is the regulated administration of individual doses and is usually expressed as a quantity per unit of time.
The usual initial dosage of furosemide for adult hypertension is 80 mg/d, typically divided into doses of 40 mg twice a day. Dosage should then be adjusted according to the patient’s response.
due to: see because of, caused by, due to, owing to
effective, effectiveness; efficacious, efficacy: Efficacy and efficacious, used especially in pharmacology and decision analysis, have to do with the ability of a medication or intervention (procedure, regimen, service) to produce the desired or intended effect under ideal conditions of use. The determination of efficacy is generally based on the results of a randomized controlled trial.
Effective and effectiveness, however, describe a measure of the extent to which an intervention produces the effect in average or routine conditions of use, or a measure of the extent to which an intervention fulfills its objectives.
See also 20.9, Study Design and Statistics, Glossary of Statistical Terms.
Persons in risk groups for endemic disease (eg, tuberculosis in immigrants or homeless persons, histoplasmosis in residents of the Mississippi and Ohio River valleys) warrant special consideration.
With 95% power and a 2-sided significance level of 5%, the study had statistical power to detect a significant odds ratio of 0.76 (ie, a 24% reduced risk) for individuals in the highest quartile of intake.
endemic, epidemic, hyperendemic, pandemic: Endemic conditions or diseases are prevalent in a particular place or among a particular group of people. Epidemic conditions occur abruptly in a defined area and are usually temporary. A hyperendemic condition is one that has a high prevalence. A pandemic condition is one that is epidemic over a wide geographic area, even worldwide.
Cowpox is an orthopoxvirus infection endemic in European wild rodents but with a wide host range, including human beings.
Public health officials feared an epidemic of infectious disease after Hurricanes Katrina and Rita in 2005.
The researchers used remote sensing and geographic information system technology to identify individual high-risk residences in Westchester County, New York, where Lyme disease has been hyperendemic since 1982.
Internationally, between 20 million and 40 million people died in the 1918–1919 influenza pandemic.
ensure: see assure, ensure, insure
epidemic: see endemic, epidemic, hyperendemic, pandemic
erectile dysfunction, impotence: Erectile dysfunction is the inability to develop and maintain an erection for satisfactory sexual intercourse or activity (in the absence of an ejaculatory disorder). Erectile dysfunction is the preferred term rather than the less precise term impotence.
etc: Use etc (or and so on or and the like) with discretion. Such terms are often superfluous and are used simply to extend a list of examples. When, in other instances, omission would be detrimental, substitute more specific phrasing such as and other methods or and other factors. Etc may be used in a noninclusive listing when a complete list would be unwieldy and its content is obvious to the reader.
Gelatin is made from animal ligaments, tendons, bones, etc, that have been boiled in water. It is often used in confectionery, ice cream, and other dairy products.
Note: It is redundant to add “etc” at the end of a list introduced by “include” or “including” or a list introduced by eg.
ethnicity, race: These terms are not equivalent. See 11.10.2, Inclusive Language, Race/Ethnicity, for a discussion of usage.
evaluate: see diagnose, evaluate, examine, identify
examine: see diagnose, evaluate, examine, identify
fasted, fasting: These derivatives of the verb fast are often used in the scientific literature. Fasting may be a present participle (verbal adjective), as in “the fasting mouse,” or a gerund (verbal noun), as in “the effects of overnight fasting.” Fasted may be the simple past tense form of the verb, as in “patients who fasted regularly,” or a past participle, as in “12 fasted rats.” Either word, when associated with 1 or more auxiliary verbs, can form part of a compound verb: “she had fasted since midnight,” “he had been fasting since midnight.”
fever, temperature: Fever is a condition in which body temperature rises above that defined as normal. It is incorrect to say a person has a temperature if “fever” is intended. Everyone has a temperature, either normal or abnormal.
The patient has a fever of 39.5°C.
The patient has a fever (temperature, 39.5°C).
The patient is febrile (temperature, 39.5°C).
The patient has an elevated temperature (39.5°C).
fewer, less: Fewer and less are not interchangeable. Use fewer for number (individual persons or things) and less for volume or mass (indicating degree or value).
Fewer interventions may not always mean less care.
The authors evaluated fewer than 100 studies yet still reported more support for the conventionally prescribed therapy.
spent less than $1000 (not: spent fewer than $1000)
reported fewer data (not: reported less data)
film, radiograph: These 2 terms are not interchangeable. In radiography, film is an outdated term that refers to an image obtained when actual film is exposed to x-rays (rather than when a digital technique is used). Film should be reserved to refer to actual film that is exposed and then developed into a resultant image. When referring to resultant images, use the specific name of the image, eg, arteriogram, mammogram, radiograph.
follow, follow up, observe: Cases are followed. Patients are not followed but observed. However, either cases or patients may be followed up (eg, the maintenance of contact with or reexamination of a person or patient, especially after treatment). Their clinical course may be followed.
In a study, case or control participants may be lost to follow-up (eg, the investigators were unable to locate them to complete documentation on participants in the initial study groups) or unavailable for follow-up (eg, they could not be contacted or the investigators were unable to persuade them to complete the study).
gender, sex: Sex is defined as the classification of living things as male or female according to their reproductive organs and functions assigned by chromosomal complement. Gender refers to a person’s self-representation as man or woman, or how that person is responded to by social institutions on the basis of the person’s gender presentation. Gender is rooted in biology and shaped by environment and experience.12
In most instances, authors of articles in biomedical publications intend the word sex.
The authors assessed whether shifts in the ratio of males to females born in 1950–1994 in Denmark and the Netherlands, defined as the sex ratio, constitute a sentinel health event.
Many studies indicate that women are less likely than men to undergo cardiac procedures after an acute myocardial infarction, which has raised concerns of sexual bias in clinical care. However, no data exist about the relationship between patient sex, physician sex, and use of cardiac procedures.
Responses to pain and pain therapies differ between men and women. Whether this difference is related to sex-based factors (physiological), gender factors (psychosocial), or both has not been determined.
See also 11.5, Age and Sex Referents.
global, international: Global relates to or involves the entire world; an equivalent term is worldwide (a global system of communication, global climate change).
Tuberculosis is a global public health problem.
International affects 2 or more nations (international trade, international movement).
Researchers conducted an international survey, with respondents selected from Australia, China, France, Korea, and the United States.
But: global amnesia, global aphasia, global congnitive function, global pain relief, Global Assessment of Functioning Scale
glycated hemoglobin, glycosylated hemoglobin: The preferred term is glycated hemoglobin. Glycohemoglobin is also acceptable13 (David E. Bruns, MD, email communication, May 17, 2006). See also 15.10.2, Nomenclature, Molecular Medicine, Molecular Terms: Considerations and Examples.
gold standard: see 20.9, Study Design and Statistics, Glossary of Statistical Terms
health care: Express this term as 2 words. It is not necessary to hyphenate health care in its adjectival form. See also 8.3, Punctuation, Hyphens and Dashes.
health care professionals
health care organizations
health care insurance
historic, historical: Although their meanings overlap and they are often used interchangeably, historic and historical have different usages. Historic means important or influential in history (a historic discovery). Historical is concerned with the events in history (a historical novel).
But: A historical novel might have a historic impact.
This historical review of pain management gives particular emphasis to the 20th century and to chronic pain and cancer pain.
hyperendemic: see endemic, epidemic, hyperendemic, pandemic
hyperintense, hypointense: In magnetic resonance (MR) imaging, hyperintense refers to areas of whiteness on an MR image. Hypointense refers to areas of blackness. Synonyms include high intensity and low intensity and high signal intensity and low signal intensity.
-ic, -ical: Merriam-Webster’s Collegiate, Stedman's, Dorland's, and American Heritage dictionaries are resources for determining the appropriate suffix for adjectives. In some cases, the “-ical” form is more remote from the word root and may have a meaning beyond that of the “-ic” form. Although, for example, “anatomic” may be used in the same sense as “anatomical,” the latter is preferred as the adjectival form. The important guideline is that the use of terms must be consistent throughout an article or chapter, and preferably throughout the entire publication. Usually the “-al” may be omitted unless its absence changes the meaning of the word. Examples of such differences in meaning include biologic, biological; classic, classical; economic, economical; empiric, empirical; historic, historical; periodic, periodical; physiologic, physiological.
identify: see diagnose, evaluate, examine, identify
ie: see eg, ie
immunize, inoculate, vaccinate: Immunize means to induce or provide immunity by giving a vaccine, toxoid, or preformed antibody. Inoculate means to introduce a serum, a vaccine, or an antigenic substance. Vaccinate refers to the act of administering a vaccine.
To immunize the newborn infant of an HBsAg-positive woman against hepatitis B, the patient should be inoculated with both hepatitis B immunogloblin and vaccine.
All participants were inoculated intranasally with influenza A/Texas/36/91(H1N1) virus.
Ten vaccinia-naive participants were vaccinated with undiluted smallpox vaccine.
impaired, intoxicated: These related terms are used in the United States to define impairment in driving performance attributable to the use of alcohol or other drugs. For instance, in some jurisdictions, a blood or breath ethanol concentration of 0.08 g/dL is considered to be legal evidence of impairment for driving. By extension, some injury prevention researchers have considered this concentration of alcohol to be scientific evidence of impairment in other potentially hazardous activities. However, cognitive and other functions may be impaired at even lower concentrations of alcohol, particularly if other psychoactive drugs, including prescription drugs, have been taken. No specific blood or breath concentration of alcohol may be considered to be scientific evidence of intoxication or impairment for all persons in all settings and activities. Authors should explain, justify, and define the use of these terms, preferably in the Methods section of the manuscript.
imply, infer: To imply is to suggest or to indicate or express indirectly. To infer is to conclude or to draw conclusions from facts, statements, or indications.
These results, though cross-sectional, imply that physical fitness is related to fewer coronary risk factors.
Our study relied on cross-sectional data, which restricts our ability to infer the causal relations underlying the observed associations.
See also 20.9, Study Design and Statistics, Glossary of Statistical Terms (inference).
impotence: see erectile dysfunction, impotence
incidence, prevalence: See 20.9, Study Design and Statistics, Glossary of Statistical Terms.
injecting, injection drug user; intravenous: The terms injecting drug user and injection drug user are not necessarily the same as intravenous drug user. Injecting or injection drug users can inject drugs intravenously, intramuscularly, or subcutaneously. Do not substitute one term for the other. If intravenous is used, ascertain that the route of administration is through a vein. If injecting or injection drug user is used, specify the type of injection (eg, intravenous, intradermal) at first mention, unless all types are meant.
injury: see accident, injury
inoculate: see immunize, inoculate, vaccinate
in order to: In order can often be removed from the phrase in order to without changing its meaning (see also 11.2.1, Redundant, Expendable, and Incomparable Words and Phrases, Redundant Words). However, in some cases such a deletion may be awkward, change the meaning, or create a dangling infinitive.
Our students must have the learning opportunities that they need in order to acquire not just facts but true understanding.
If “in order” is removed, the syntax is disrupted (“need to acquire” would seem to apply to “opportunities”).
The sentence might be reworded as “to be able to acquire” instead of “in order to acquire.”
insure: see assure, ensure, insure
international: see global, international
intoxicated: see impaired, intoxicated
irregardless, regardless: Irregardless—most likely a blend of irrespective and regardless—is incorrect, regardless of context.
irritate: see aggravate, irritate
less: see fewer, less
liable: see apt, liable, likely
likely: see apt, liable, likely
lucency, opacity: In radiography, lucency refers to areas of blackness on an image. Opacity refers to areas of whiteness.
malignancy, malignant neoplasm, malignant tumor: When referring to a specific tumor, use malignant neoplasm or malignant tumor rather than malignancy. Malignancy refers to the quality of being malignant.
Pancreatic cancer is a type of malignancy that eludes early detection.
Pancreatic cancer is a type of malignant neoplasm that eludes early detection.
management, treatment: To avoid dehumanizing usage, it is generally preferable to say that cases are managed and that patients are cared for or treated. However, constructions such as “the clinical management of the seriously ill patient” and “the management of patients with AIDS” are acceptable when used to refer to a general treatment protocol. Management is especially applicable when the care of the patient does not involve specific interventions but may include, for example, watchful waiting (eg, for prostate cancer). Management may also be used to refer to the monitoring or periodic evaluations of the patient.
manic: see catatonic, manic, psychotic, schizophrenic
manuscript: see article, manuscript, paper, typescript
masking: see blinding, masking
may: see can, may
militate, mitigate: These 2 words are not synonymous. Militate means to have weight or effect and is usually used with against. Mitigate means to moderate, abate, or alleviate.
The constraints of nationalism militate against state conformance with global health norms.
Tests of sprinkler systems in full-scale simulated fires indicate that such sprinklers can be expected to mitigate the risk of fatality in residential fires.
mortality: see case-fatality rate, fatality; mortality, mortality rate
negative: see abnormal, normal; negative, positive
normal: see abnormal, normal; negative, positive
nurse: see breastfeed, nurse
observe: see follow, follow up, observe
-ology: This suffix, derived from the Greek logos, meaning “word,” “idea,” or “thought,” denotes science of or study of. Terms with this suffix, like pathology, morphology, histology, etiology, and symptomatology, are general and abstract nouns and should not be used to describe concrete physical entities.
The gradual decline of symptomatology paralleled the resolution of pathology as seen in serial chest films.
The gradual decline of symptoms paralleled the resolution of pulmonary infiltrates as seen in serial chest films.
on, upon: In scientific articles, upon often simply means on and may be changed.
opacity: see lucency, opacity
operate, operate on: Surgeons operate on a patient or perform an operation on a patient. Similarly, patients are not operated but are operated on.
The operated group recovered quickly.
The surgical group recovered quickly.
The group that underwent surgery recovered quickly.
operation, surgical procedure, surgeries, surgery: Surgery can mean surgical care, surgical treatment, or surgical therapy (ie, the care provided by a surgeon with the help of nurses and other personnel from the first consultation and examination, through the hospital stay, operation, and postoperative care, until the last follow-up visit is complete).
An operation is what occurs between the induction of and the patient’s emergence from anesthesia—incision, dissection, excision, and closure—the surgical procedure.14
An operation can also be performed with the patient given local anesthesia.
Surgery is what a surgeon practices or a particular medical specialty. An operation is what a surgeon performs. In this context, there is no such word as surgeries. In the United Kingdom, surgeries are physicians' or dentists' offices.15
over, under: Correct usage of these words depends on context.
Time: Over may mean either more than or during (for a period of). In cases in which ambiguity might arise, over should be avoided and more than used.
The cases were followed up over 4 years.
The cases were followed up for more than 4 years.
The cases were followed up for 4 years.
Age: When referring to age groups, over and under should be replaced by the more precise older than and younger than (see also age, aged, school-age, school-aged, teenage, teenaged).
All participants in the study were over 65 years old.
All participants in the study were older than 65 years.
Note: It is unnecessary and redundant to add of age after the number of years. When the terms older and younger are used, age is implied. See also 11.2.1, Redundant, Expendable, and Incomparable Words and Phrases, Redundant Words.
owing to: see because of, caused by, due to, owing to
pandemic: see endemic, epidemic, hyperendemic, pandemic
paper: see article, manuscript, paper, typescript
participant: see case, client, consumer, participant, patient, subject
percent, percentage, percentage point, percentile: See 19.7.2, Numbers and Percentages, Forms of Numbers, Percentages.
physician: see doctor, physician
place on, put on: The phrase “to put [or to place] a patient on a drug” is jargon and should be avoided. Medications are prescribed or patients are given medications; therapy or therapeutic agents are started, administered, maintained, stopped, or discontinued.
The patient with hypertension was put on hydrochlorothiazide and metoprolol.
Hydrochlorothiazide and metoprolol were prescribed for the patient with hypertension.
The patient with hypertension was given hydrochlorothiazide and metoprolol.
A therapeutic regimen of hydrochlorothiazide, 25 mg/d, and metoprolol, 50 mg/d, was begun.
positive: see abnormal, normal; negative, positive
practitioner: see clinician, practitioner
prevalence: see incidence, prevalence
preventative, preventive: As adjectives, preventive and its derivative preventative are equal in meaning. JAMA and the Archives Journals prefer preventive.
prostitute, sex worker: Epidemiologic studies use the term sex worker (or commercial sex worker) to describe these persons of either sex, rather than the more derogatory prostitute.
provider: The term provider can mean a health care professional, a medical institution or organization, or a third-party payer. If the usage refers to 1 specific provider (eg, physician, hospital), use the specific name or alternative name for that provider (eg, pediatrician, tertiary care hospital, managed care organization), rather than the general term provider. If the term connotes several providers, it can be used to avoid repeating lists of persons or institutions; however, the term(s) should always be defined at first mention.
Increasing pressures for cost control and the spread of managed care create an urgent, shared need for information on health care quality among all health care stakeholders: consumers, public and private purchasers, policy makers, health plans, and health care providers (eg, hospitals, physician groups, and clinics).
The phrase nonphysician provider should be avoided because it is similarly imprecise and can refer to numerous health care professionals licensed to provide a health care service. It is better to specify the type of professional (eg, nurse, pharmacist) or to use health care professional or clinician. If a phrase is needed to describe repeatedly and succinctly the many health care professionals who are not physicians, then physicians and other health care professionals may be acceptable as long as the phrase is defined at first mention. This guideline also applies to other professions (eg, nonnurses, nonpharmacists).
psychotic: see catatonic, manic, psychotic, schizophrenic
race: see ethnicity, race
radiograph: see film, radiograph
radiography, radiology: These 2 terms are not interchangeable. Radiography is an imaging technique based on x-rays passing through tissue and emerging to “hit” film on the other side. Radiology is the medical specialty that uses imaging to diagnose and sometimes treat disease.
regardless: see irregardless, regardless
regime, regimen: A regime is a form of government, a social system, or a period of rule. A regimen is a systematic schedule (involving, for example, diet, exercise, or medication) designed to improve or maintain the health of a patient.
Resistant hypertension is defined as the failure to reach goal blood pressure in patients who are adhering to full doses of an appropriate 3-drug regimen that includes a diuretic.
relationship: see association, relationship
reluctant, reticent: Reticent is becoming more commonly seen in informal usage as an incorrect synonym for reluctant. Reticent means habitually silent or uncommunicative. Reluctant means unwilling or disinclined.
repeat, repeated: Repeat is a noun or a verb and should not be used in place of the adjective repeated. Repeated implies repetition. For precision and clarity, the exact number should be given.
A repeat electrocardiogram was obtained.
Possible but misleading:
A repeated electrocardiogram was obtained.
A second electrocardiogram was obtained.
The electrocardiogram was repeated.
Two successive electrocardiograms showed no abnormalities.
report: see describe, report
respective, respectively: These words indicate a one-to-one correspondence that may not otherwise be obvious between members of 2 series. When only 1 series, or none at all, is listed, the distinction is meaningless and should not be used.
The 2 patients are 12 and 14 years old, respectively.
Kate and Jake are 12 and 14 years old, respectively.
The 2 patients' respective ages are 12 and 14 years.
The 2 patients are 12 and 14 years old.
schizophrenic: see catatonic, manic, psychotic, schizophrenic
school-age, school-aged: see age, aged, school-age, school-aged, teenage, teenaged
section, slice: Use section to refer to a radiological image; use slice to refer to a slice of tissue (eg, for histological examination).
But: frozen-section biopsy
sex: see gender, sex
sex worker: see prostitute, sex worker
side effect: see adverse effect, adverse event, adverse reaction, side effect
since: see as, because, since
suffer from, suffer with: See 11.10.4, Inclusive Language, Disabilities, for a discussion of usage.
suggestive, suspicious: To be suggestive of is to give a suggestion or to evoke. To be suspicious is to tend to arouse suspicion. Thus, the 2 phrases are not synonymous, and care should be taken to avoid confusing them. A finding may be abnormal (ie, suspicious) but may not indicate a specific diagnosis (ie, suggestive).
The chest film was suspicious for tuberculosis.
The chest film was suggestive of tuberculosis.
The chest film showed abnormalities suggestive of tuberculosis.
The chest film showed a suspicious lesion, but its nature was unclear.
surgical procedure: see operation, surgical procedure, surgeries, surgery
survivor, victim: In scientific publications, use of the word victim—when describing persons who survive physical, domestic, sexual, or psychological violence or a natural disaster—should be avoided. Similarly, avoid labeling (and thus equating) people with a disability or disease as victims (eg, AIDS victim, stroke victim; see 11.10.4, Inclusive Language, Disabilities).
Victim may imply a state of helplessness.16 Characterizing a person who has experienced abuse or other violence as a victim perpetuates the stereotype of a passive person who cannot recover from the effects of the malady. In such cases survivor may be more appropriate (eg, rape survivor, tsunami survivor, survivor of torture).
If a person who experienced such trauma has died, referring to him or her as victim may be appropriate (victim of a land mine explosion). Victim may also be used in the vernacular (victim of his own success).
teenage, teenaged: see age, aged, school-age, school-aged, teenage, teenaged
temperature: see fever, temperature
terminate: see abort, terminate
though: see although, though
titrate, titration: In clinical medicine as in analytical chemistry, titrate and titration refer to making a series of small adjustments in the quantity or concentration of a substance until a goal or end point is attained—a color change or precipitation in the laboratory, control of symptoms or a therapeutic blood level in the patient. Drug dosages are titrated; patients are not.
toxic, toxicity: Toxic means pertaining to or caused by a poison or toxin. Toxicity is the quality, state, or degree of being poisonous. A patient is not toxic. A patient does not have toxicity.
Dactinomycin is a toxic antineoplastic drug of the actinomycin group.
The drug had a toxic effect on the patient.
The patient had a toxic reaction to the drug.
The patient had a toxic appearance.
The toxicity of the drug must be considered.
transplant, transplantation: Transplant is both a noun (typically meaning the surgical operation itself but also increasingly referring to the overall field) and a transitive verb. Use graft (or allograft, autograft, xenograft, and so on, depending on the level of precision needed) as the general noun for the organ or tissue that is transplanted, or specify which organ or tissue (eg, liver, skin), rather than continue to use the noun transplant in this context. Transplantation is traditionally the noun used to describe the overall field. Never use the plural transplantations.
The patient was transplanted.
The surgeon transplanted the patient.
The patient underwent a transplantation.
Fifteen transplantations were performed.
The patient underwent a transplant.
The patient received a kidney allograft.
The transplanted intestine functioned well.
The surgeon transplanted the deceased donor’s heart into a 4-year-old girl.
Fifteen transplants were performed.
She performed the first successful heart-lung transplant at our center.
Cyclosporine has been used as monotherapy in pediatric liver transplantation [also, transplant].
Islet transplantation [also, transplant] is now a clinical reality at our institution.
The researchers collected transplantation data.
For the adjectival form, use transplant, as well as pretransplant and posttransplant (not pretransplantation and posttransplantation).
The transplantation coordinator described the pretransplantation and posttransplantation data from her transplantation program.
The transplant coordinator described the pretransplant and posttransplant data from her transplant program.
treatment: see management, treatment
typescript: see article, manuscript, paper, typescript
ultrasonography, ultrasound: These terms are not interchangeable. When referring to the imaging procedure, use ultrasonography. Ultrasound refers to the actual sound waves that penetrate the body during ultrasonography.
uninterested: see disinterested, uninterested
upon: see on, upon
use, usage, utility, utilize: Use is almost always preferable to utilize, which has the specific meaning “to find a profitable or practical use for,” suggesting the discovery of a new use for something. However, even where this meaning is intended, use would be acceptable.
During an in-flight emergency, the surgeon utilized a coat hanger as a “trocar” during insertion of a chest tube.
Some urban survivors utilized plastic garbage cans as “lifeboats” to escape flooding in the aftermath of Hurricane Katrina.
Exception: Utilization review and utilization rate are acceptable terminology.
Usage refers to an acceptable, customary, or habitual practice or procedure, often linguistic in nature. For the broader sense in which there is no reference to a standard of practice, use is the correct noun form.
The correct usage of regime vs regimen is discussed on page 401.
Who determines what is correct usage?
Some authors use the pretentious usage where use would be appropriate. As a rule of thumb, avoid utilize and be wary of usage. Use use.
Note: Utility—meaning fitness for some purpose, or usefulness—should never be changed to the noun use. Nor should employ be used for use; reserve employ to mean hire.
vaccinate: see immunize, inoculate, vaccinate
visual acuity, vision: Vision is a general term describing the overall ability of the eye and brain to perceive the environment. Visual acuity is a specific measurement of one aspect of the sensation of vision assessed by an examiner.
A practitioner reporting the examination findings at one specific time would describe visual acuity (20/30, 20/15, etc). However, the practitioner might also refer to the general visual function as vision: “As the vitreous hemorrhage cleared, the vision improved and visual acuity returned to 20/20.” It is possible to have normal visual acuity despite marked vision impairment, eg, when the peripheral visual field is abnormal.