Medical terms are a product of tradition, habit, experience, personal views, and professional background. Given the strong influence of thoughts, emotions, and behaviors on musculoskeletal symptoms and limitations, it’s important that both scientific and lay writing use the most positive, hopeful, and adaptive words and concepts consistent with medical evidence. Patient reported outcomes are affected by attention, bedside manner, empathy, positive regard, compassion, hope, and enthusiasm. The terminology used by healthcare providers can alter what patients think and feel about their illness and their treatment options. The use of words that might reinforce misconceptions about preference-sensitive conditions (particularly those associated with age) could increase symptoms and limitations and might also distract patients from the treatment preferences they would select when informed and at ease.
One of our studies examined the questionable use of specific terminology by reviewing 100 consecutive papers published in 2014 and 2015 in six orthopedic surgery scientific journals. We counted the number and proportion of journal articles with questionable use of one or more of the following words: tear, aggressive, required, and fail. It was found that eighty percent of all orthopedic scientific articles reviewed had questionable use of at least one term (1). Tear was most questionably used with respect to rotator cuff pathology. The words fail and require were the most common questionably used terms overall.
People increasingly search the Internet for information about common medical problems such as trapeziometacarpal (TMC) joint arthritis. However, this information can be biased, inaccurate, and misleading. Medical professionals should be aware of what patients may be reading about their condition, because concepts and beliefs can affect symptoms, limitations, and decision-making. Another study sought factors associated with the quality of design and content of health information websites about TMC arthritis. It was found that online information on TMC arthrosis is difficult to read, often biased in favor of a particular treatment, and influenced by profit (2).
Inconsistent or questionable terms in medical writing are ascribed to misunderstanding of the definition of the word, lack of a consensus definition, and underappreciation of the emotive content of the terms. The use of questionable words and concepts is common in scientific writing in orthopedic surgery. Hand surgeons should prepare to gently correct misconceptions established or reinforced, in part, by material found on the Internet. It’s worth considering whether traditional ways or referring to musculoskeletal illness merit rephrasing.
Our research on variations in care is focusing on several areas:
- We are further measuring the impact of negative or questionable terms in orthopedic surgery and the benefit of using alternative more positive, optimistic, and hopeful terms.
References
- Connor CM, Menendez ME, Hughes K, Ring D. Questionable Word Choice in Scientific Writing in Orthopedic Surgery. Arch Bone Jt Surg. 2017 Jul;5(4):231-234. PubMed PMID: 28913380; PubMed Central PMCID: PMC5592364.
- Ottenhoff JSE, Kortlever JTP, Teunis T, Ring D. Factors Associated With Quality of Online Information on Trapeziometacarpal Arthritis. J Hand Surg Am. 2018 Oct;43(10):889-896.e5. Doi: 10.1016/j.jhsa.2018.08.004. PubMed PMID: 30286849.