Why do women have an “incompetent cervix” and a “blighted ovum”, Justine van der Leun wondered in a recent Guardian feature, while men merely have “premature ejaculation” and “erectile dysfunction”, not “inadequate testicles” and “futile penis”?
Medical language can be sexist, outdated, insensitive and sometimes downright confusing. I would like to add to van der Leun’s list of medical terms that need updating, or retiring. Here are my candidates:
“Threatened abortion”, “missed abortion” and “septic abortion” are alarming terms used in the context of miscarriage. For example, a missed abortion is when the foetus has died, but a miscarriage hasn’t occurred yet. Loss of a pregnancy is a sad event. Why make patients sadder?
Cretinism is a stigmatising term that is still used to describe congenital hypothyroidism. I doubt that a clinician would use this term in front of a patient, but it is still seen in the books.
Diabetes should be retired because it is no longer specific enough to be useful. Previously, we had diabetes mellitus and diabetes insipidus. Then we divided diabetes mellitus into types one and two. The Norwegians now tell us that in fact there are five different types, each distinct from one another.
Dement is an informal term used by some medical people to refer to a person with dementia. As with cretinism, it is a stigmatising term. It should be removed from the medical lexicon.
5. Hartnup disease
Hartnup disease was named after the patient, not the doctor who first described it, so it breaks patient confidentiality. The condition was named in 1956, a more deferential time when it was easier to persuade a patient that having a disease named after oneself was a great honour, even if it means lifelong diarrhoea, skin rashes and psychotic behaviour.
I can see why the discoverer of the disease – Dr Baron – did not wish to have it named after himself, but I doubt that young master Hartnup had any choice in the matter.
6. Bovine cough
This one should be retired because it’s not a useful metaphor. Increasing urbanisation and improved animal health mean that new entrants to the medical profession are unlikely to have heard a cow cough. Indeed, the non-explosive cough of recurrent laryngeal nerve palsy sounds nothing like a cow coughing.
This ageist term describes the inability of a frail elderly patient to cope at home. It is a lazy term, often used in lieu of a proper diagnosis, which may include stroke, Parkinson’s, dementia or other age-related illnesses.
I would also like to get rid of all three-letter abbreviations (TLAs) with multiple meanings. I recall a patient telling me that she had GBS. She was getting very annoyed because I didn’t instantly know that she was referring to her vaginal group B streptococcus infection, rather than Guillain-Barré syndrome, which is a frightful neurological affliction. Consideration of gay bowel syndrome and the Glasgow-Blatchford score for gastrointestinal bleeding would have inflamed matters.
Finally, I would like to banish informal terms compounded by foul language that insult the worried well or those with whom one’s consummate consultation skills have had little effect. PRATFO (patient reassured and allowed home) and TTFO (told to go home) are two examples that spring to mind. I know that some people can be frustrating to deal with, but these terms must not appear in the patient’s notes under any circumstance for fear of a lawyer getting hold of them.
None of this means that we should lose touch with the richness of our past. Eponymous conditions, named after the historic figures from whom we have learned so much – Colle’s fracture, Parkinson’s disease, Cock’s peculiar tumour – should be kept to remind us of a past from which so much progress has been made. Some terms are simply too delightful to lose, such as borborygmi, the gentle gurgling sounds of the bowel, reminiscent of a babbling brook in springtime. Ah, now that would be a loss to medicine!