The language of medicine: words as servants and scoundrels

Abstract

-Progress in complex disorders requires clear thinking facilitated by clear language. Clinicians and scientists occasionally become captive to inaccurate language or meaningless terminology and this generates lazy thinking and impedes progress. Has this happened in the case of the functional gastrointestinal disorders (FGIDs), in general, and irritable bowel syndrome (IBS), in particular? FGIDs and, especially IBS, are common illnesses and an important burden on healthcare resources but, in general, have suffered from a lack of progress in the development of safe and effective treatment. Among FGIDs, IBS may be the best defined but significant lapses of accuracy in terminology persist. Among other FGIDs, the situation is more serious; imprecision and lack of consistency in terminology continue to mar progress. This article reviews the chequered history of terminology in this area and concludes that removing the obfuscation generated by poor usage of language should be the first step towards understanding the pathogenesis and improving the management of these, and similar, disorders. KEY WORDS: functional dyspepsia, functional gastrointestinal disorders, inflammation, irritable bowel syndromeThe perils of phraseology Understanding complex disorders requires attention to detail and the precise expression of research questions. Nevertheless, clinicians frequently use terms that they actually do not understand or assume they understand but have never actually questioned. Mere repetition of an incorrect concept or inappropriate term seems sufficient to result in its widespread acceptance as dogma and received wisdom, especially if, in the words of Schopenhauer, one 'constantly repeats it with an air of great solemnity' . Thomas Paine encapsulated the dangers of such unquestioned repetition: 'A long habit of not thinking a thing wrong, gives it a superficial appearance of being right'. For example, in a study of physicians' practices and approaches to the surveillance of colonic dysplasia in ulcerative colitis, it was found that the majority of gastroenterologists did not understand the meaning of the word 'dysplasia' , even though they used it on a daily basis. 1 While such deficits adversely affect decision making at an individual level, a more global problem is the corruption of medical language to a degree that may confound thinking on clinical guidelines and even healthcare policy. As one moves from disorders which have a clearly defined molecular and/or pathological basis towards those where a precise pathophysiology remains elusive, imprecision in terminology becomes more prevalent. The functional gastrointestinal disorders (FGIDs), and irritable bowel syndrome (IBS) in particular, represent an important illustrative example. Irritable bowel syndromeWith an estimated community prevalence of 10-15%, IBS can certainly be regarded as a common disorder. 2 IBS is chronic and has a significant impact on quality of life. It affects young people in a productive phase of life, is a cause of work absenteeism and...

Irritable Bowel Syndrome: Patient-Provider Interaction and Patient Education

“…Only about 50% of patients with IBS are provided with a definitive diagnosis after seeing a physician [ 36 ]. The uncertainty about the diagnosis, including the uncertain diagnostic language used to describe the condition to the patients, may contribute to patients’ disregard of their diagnoses and may result in increased disease-associated anxiety or more unnecessary testing and surgeries [ 37 , 38 ].…”

The Brain-Gut Team

“…These infection-like packages may include symptoms induced inadvertently, contradictory changes in eating habits and psychological inputs. Thus, the brain-gut axis may operate pathophysiologically not only within the patient but also through contact with other individuals, patients or not, and even health providers and the media [24]. This concept of "contagious" functional illness is to be taken into account, particularly in the current over informed and over connected society.…”

Mechanism-Oriented Therapy of Irritable Bowel Syndrome

“…Furthermore, concerns have been expressed about the difficulties that would be encountered in the future to disentangle the current terminology should new methods be developed to establish the diagnosis beyond exclusive symptom criteria. Furthermore, as pointed out by Quigley and Shanahan [ 5 ], an exclusively symptom-based definition of a medical condition such as IBS and other functional syndromes may unintentionally create an illusion of understanding and equate complaints with “disease”. Such risk is already noticeable in clinical practice as physicians often include cases of unexplained abdominal pain into the IBS diagnosis without specifically checking whether all these patients really meet published Rome criteria [ 6 ].…”