Two of the commonest complaints about doctors are that they write in an indecipherable scrawl and they don’t speak plain English. You emerge from an appointment with your GP or hospital consultant, clutching a clinical case summary that seems to have been written by randomly inserting incomprehensible ancient Greek and Latin words throughout the text (I’m assuming here that it was a printed document and not handwritten, in which case you wouldn’t have been able to read it at all). I’m not going to cover doctors’ handwriting in this post. My own is a perfectly legible, calligraphical script that is a veritable ocular pleasure to read. We’ll stick to language.

There are so many Greek and Latin words in medical jargon, which we shall call ‘Medicalese’, that medical students could be forgiven for thinking they’d mistakenly enrolled on a classical history degree course during their first few weeks of study. Patients could be forgiven for thinking that medical jargon exists solely to keep them in the dark. That isn’t the case – most of the time. When doctors use jargon, they are usually talking to each other rather than trying to mystify everyone else. However, confusion and worry may result if jargon is used thoughtlessly when talking to patients and their relatives.

So why do doctors converse in another language? Why don’t they simply use plain English all of the time and be done with it? It’s probably true that doctors could and should use plain English more often. Patients deserve explanations they can understand. However, technical language has its advantages, and all professions speak their own lingo. Law. Teaching. Engineering. Science. Flying an aircraft. Medicine is no exception. Medicalese exists because it is succinct, precise and unambiguous. One doctor can communicate with another, knowing they will be perfectly understood and avoid any confusion. This may not be the case when talking in plain English. A long-winded explanation of exactly what message you are trying to convey may then become necessary.

For example, one doctor speaking to another on the phone about your heart condition might say you have atrial fibrillation while turning to you and explaining that your heart rhythm is irregular. Both are true descriptions. However, the plain English version is imprecise and could be interpreted in several ways by another doctor. It does have the virtue of being easily understood by a patient, but a further explanation would be required if the patient wanted a more complete understanding of their condition.

Medicalese and plain English both have their place. Good doctors are fluent in both languages and can easily flip between the two as suits their audience.

So far, so reasonable, but I can tell that you’re still wondering why so much Medicalese is Greek or Latin – or even both at the same time. This isn’t quite as weird as it sounds, though. For example, the word television derives from the Greek word tele, meaning distant, and the Latin verb videre, meaning to look at. To understand why doctors persist in conversing in Latin and Greek, we need to know a tiny bit of history.

Medicine has been around for almost as long as mankind has. If you had travelled to ancient Greece around 400 BC, you might have sought medical advice from Hippocrates himself. Many of the earliest scientific discoveries, including the study of medicine, were written in Greek. Centuries later, the physician Galen expanded the body of medical knowledge, also writing in Greek. And everyone has heard of such titans of ancient Greece as Pythagorus, Aristotle and Archimedes. All of their published experimental findings and scientific theories were recorded for posterity in Greek. So were the concepts and terms they defined, as well as the organs and diseases they named.

Then the Romans pitched up, and Latin became the principal language of medieval European academia and scholarship until the 19th Century. Universities taught in Latin long after it became extinct as a spoken language. Medical textbooks were written in Latin. Prescriptions were written in Latin. Anatomists labelled every part of the human body in Latin. Diseases were given Latin names.

The end result of this mishmash was that, over hundreds of years, doctors inherited both Latin and Greek as the two base languages used to describe the principles and practice of medicine. It developed in an organic, haphazard way such that a given organ or disease might have a name derived from Latin, Greek, or both. Sorry, but that’s the way it is. Don’t blame me. Blame Hippocrates. Him and his bleeding oath – which I never took, by the way. It wasn’t the done thing when I studied at Manchester Medical School. If you’ve ever read it, you’ll probably agree that it’s a load of old tosh. For example, the Hippocratic oath bans the use of surgery!

As well as numerous words taken from ancient foreign languages, the world of medicine is full of specialist terminology, contractions, abbreviations and TLAs (Three-Letter Acronyms). Long ago, when I was nervously awaiting my A Level examination results to see if I’d made it into medical school, I read an article in the local paper that said medical students have to learn more than 20,000 new words before becoming doctors. Phew! That’s as many words as the average native English speaker uses.

Even if the reason why doctors speak Greco-Latin gobbledegook today isn’t primarily to make them appear clever and superior, Medicalese sometimes does have that effect. Let me give you an example. You have gone to see your GP because you have noticed your muscles are always sore and aching, and you don’t know what’s causing your symptoms. Your GP takes a full medical history from you, gives you a thorough physical examination, and takes a blood sample to send to the lab for a battery of tests.

You see your GP again two weeks later, and he informs you that you are suffering from something called idiopathic fibromyalgia. The treatment is to take daily exercise, as well as paracetamol on days when the pain is at its worst. Unfortunately, the condition can’t be cured, and you are just going to have to live with it.

You leave the surgery disappointed that there is no curative treatment for your debilitating condition but relieved that you’re not going mad and it’s not all in your head. You have a genuine medical condition. Even the name is quite impressive. Idiopathic fibromyalgia. Marvellous. You have a diagnosis that will impress your friends and ensure that your employer cannot possibly object the next time you have to take time off work to recuperate.

You, your friends and your employer might not be quite so impressed if they knew that idiopathic (Greek idios = peculiar, pathos = disease) fibromyalgia (Latin fibra = fibre; Greek myo = muscle, algia = pain) simply means you are suffering from generalised muscular aches and pains, and that your doctor hasn’t the foggiest idea what’s causing them, nor what to do about them. In other words, your GP knows no more about what ails you than you did before you saw him. He’s just given your symptoms a fancy name.

Here’s a short list of some other complicated diagnoses made simple:

Onychochryptosis  – ingrowing toenail.

Synchronous diaphragmatic flutter – hiccups.

Borborygmi – stomach rumbling.

Eructation – burp.

Hyperhidrosis – you sweat profusely, even when it’s -10ºC outside. 

Sphenopalatine ganglioneuralgia – brain freeze.

Vasovagal syncope – a simple faint.

Cephalalgia – simple headache.

Hippopotomonstrosesquipedaliophobia – the fear of long words.

The arbitrary, haphazard use of both Latin and Greek is sometimes confusing even to doctors, particularly when both languages are used to describe different aspects of the same organ, tissue or medical condition. A few further examples give the general idea.

When talking about the womb, doctors refer to the uterus (Latin). But when they talk about the surgical removal of the womb, they use the term hysterectomy (Greek). And the doctors who deal most with the womb are specialists in Obstetrics (Latin) and Gynaecology (Greek). 

Kidney stones (renal calculi – Latin) are surgically removed by urologists (Greek) during an operation called a nephrectomy (Greek).

Dermatologists are skin specialists (dermis and epidermis – Greek) who treat cutaneous (Latin) diseases.

Many Medicalese words are Greco-Latin hybrids, like television. For example, hypertension (Greek high, Latin pressure), hypotension (Greek low, Latin pressure), cardiovascular (Greek heart, Latin vessel), gastrointestinal (Greek stomach, Latin bowel), claustrophobia (Latin enclosed space, Greek fear). The list goes on and on.

As well as purloining fancy Latin and Greek words that nobody who didn’t benefit from a classical education can understand (and yes, I do realise that I have used a fancy English word myself that nobody but a nerd like me would understand without a dictionary), doctors love using medical abbreviations, contractions and acronyms. The much beloved TLA (three-letter acronym), of course, takes pride of place in the lexicon of any self-respecting doctor.

A typical conversation between two cardiologists:

‘I wonder if you would see Mr Smith and tell me what you think.’

‘Delighted, old chap. What’s the story?’

‘It’s rather sad, really. He’s been a CHD patient of mine in the OPD for many years. He has a few other things wrong with him – CKD, recurrent UTIs, COPD, NIDDM, several TIAs. Anyway, he was admitted to the CCU two weeks ago with an MI and acute LVF. He had an ICA, and we found that his LAD was obstructed. A TOE showed AS and MR. He underwent PCI to treat his CAD. Then a day later he had a DVT, which precipitated a PE, confirmed on V/Q scan. Then his LFTs and U+Es went off. His USS was normal, and we presumed he’d developed ARF secondary to ATN. He was improving until yesterday when it all went pear-shaped with PAF. That caused him to have a CVA followed by a VF cardiac arrest. We achieved ROSC, but I’m not too sure that did him any favours. Now he’s in the ICU. They think he’s BSD and TLC is all we can do for him. He’s not for CPR, naturally. I really would value your opinion.’

If you know what all those abbreviations mean, you know.

You’ll find older hospital notes littered with all manner of more dubious acronyms and choice phrases, their meanings clear to doctors the world over but indecipherable to the uninitiated. Let’s say they are not entirely politically correct, and no doctor would dare use such terminology these days. However, I often came across them in patients’ medical notes when I first started out. Indeed, I confess to adding the occasional barbed comment myself. While not in any way condoning the ritual abuse of patients, and apologising profusely right now for any transgressions on my part, the practice reflected an entirely different culture during an era when patients didn’t have an automatic right to see what was written about them in their medical notes and doctors, perhaps, were too free in their use of what we might call NHS frontline gallows humour to de-stress after a challenging consultation. Recording this type of entry in a patient’s notes would now be regarded as unprofessional, even offensive. We didn’t think so at the time, although we do now. So with all that in mind…

(Please skip this next section if you are easily offended.)

Crumble – an old person with severe frailty and multiple comorbidities.

Dross – a patient who doesn’t really need to be in hospital because they have a condition that is chronic and untreatable. They are more of a social problem than a medical one. GPs would often refer dross for hospital admission on Friday afternoons so that their golfing weekend wouldn’t be disturbed. That was in the days when GPs actually worked at weekends.

NFB – normal for Buxton (the final letter may be substituted depending on locale). In other words, the patient is as thick as a plank (with sincere apologies to all Buxtonians).

GOK –  God only knows. The diagnosis when you haven’t a clue what’s wrong with someone.

TTFO – told to fuck off. Although not usually literally. The patient is a time-waster with nothing much wrong with them, and you’ve discharged them from further follow-up.

Acopia – there’s nothing at all wrong with the patient. They just have an innate inability to cope with the normal stresses and strains of life.

FLK – funny looking kid. Refers to a child presenting with dysmorphic features, especially physiognomic (affecting the head and face), which lead the doctor to suspect an underlying but as yet unidentified chromosomal or other genetic abnormality. FLKs are often seen in conjunction with FLPs – funny looking parents. In fact, while FLK isn’t at all acceptable in this day and age, it was a genuinely useful clinical term back in the day, encapsulating and communicating a clinical dilemma succinctly and precisely.

O sign, Q sign and Dotted Q sign. These three terms represent a continuum of the increasing cerebral impairment often observed following a stroke. The O sign is when the patient’s (usually edentulous) mouth is stuck open in the shape of an O. The Q sign is said to be present when the patient’s tongue pokes downwards from the corner of an O sign mouth. The dotted Q sign is when a fly settles on the tongue and may be reversible (tongue capable of moving) or irreversible.

That’s it for this post. Hopefully you’ve taken it in the spirit I intended. I always had the utmost respect for all my patients, treating them with dignity at all times.