AMA Manual of Style - Stacy L. Christiansen, Cheryl Iverson 2020

Correct and Preferred Usage of Common Words and Phrases
Correct and Preferred Usage

Style, not least, adds beauty to the world. To a literate reader, a crisp sentence, an arresting metaphor, a witty aside, an elegant turn of phrase are among life’s greatest pleasures. . . . [T]his thoroughly impractical virtue of good writing is where the practical effort of mastering good writing must begin.

Steven Pinker¹

11.1 Correct and Preferred Usage of Common Words and Phrases.

Following simple rules for correct and preferred usage of common words and phrases is important in scientific communication because it increases clarity, provides consistency, and helps avoid miscommunication.

Note: All terms (and pairs of terms) are in alphabetical (not preferential) order.

ability, capability, capacity—These near-synonyms have slightly different meanings. Ability means an actual (as opposed to potential) skill, either mental or physical; it may be native or acquired. Capability is a unique fitness for a defined end; the word is sometimes used in place of ability, but its use in place of capacity is rarely correct. Capacity is the potential to exercise or develop a skill, usually mental; it is native as opposed to acquired.

The ability to select candidates who will thrive and successfully complete a residency is especially critical for general surgery programs.

The capacity of the patient to make medical decisions should be evaluated within the context of specific medical conditions.

In this study of the association between walking and future risk of dementia, findings are based on a sample of physically capable elderly men.

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 19.0, Study Design and Statistics). Avoid the use of normal and abnormal to describe persons’ health status. Results of cultures and tests for specific reactions or microorganisms may be negative or positive. Other tests display a pattern of activity rather than a single feature, and in these 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 tomograms.

See 11.10, Laboratory Values.

abort, terminate—Abort means to stop a process prematurely. In pregnancy, abortion means the premature expulsion—spontaneous or induced—from the uterus of the products of conception. A pregnancy, not a fetus or a woman, may be aborted. The synonym terminate—to bring to an ending or a halt—may also be used.

about, approximately, around—Although each of these words is used to refer to a value that is estimated and therefore imprecise, whether it is acceptable to use them interchangeably depends in part on context and the level of accuracy being implied. When referring to an inexact value in casual conversation, around, about, and approximately are all acceptable. When referring to an inexact value in medical or other technical writing, about may very occasionally be used if one carefully assesses the context; approximately is nearly always the best choice. Also, an estimated may be better.

accident, injury—According to the National Center for Injury Prevention and Control of the US Centers for Disease Control and Prevention,² 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).²

Accident (and accidental) is considered by the public health community to be imprecise and should therefore be avoided. The injury-causing event can be described as noted above or with other terms, such as motorcycle crash, shooting, drowning, collision, poisoning, suffocation, fall from stairs, burning, paintball injury.

Note: Do not change accident if it is integral to the terminology being used, for example, an established injury classification system or as established terminology within a specific discipline (eg, Fatality Analysis Reporting System of the US National Highway Traffic Safety Administration, the World Health Organization’s International Classification of Diseases, cerebrovascular accident).

acute, chronic—These terms should be used to describe 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.

Exception: Acute abdomen is a specific serious intra-abdominal condition—for example, appendicitis—with pain, tenderness, and muscular rigidity and for which emergency surgery may be indicated.

A note on short- and long-term patient care: According to Kane and Kane,³ “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 or adjust to fit a particular circumstance or requirement. To adopt means to take by choice into a relationship.

Despite health being vulnerable to the vagaries of climate, humans have adjusted their behavioral patterns and technologies to adapt to a diverse range of climates.

Purchasers, plans, practitioners, and organizations that certify or license clinicians or accredit training programs should adopt systems for measuring, monitoring, and improving quality for psychosocial interventions.

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 (in terms of, 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.⁴ Noncompliance has a negative connotation that may indicate 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.⁵

Continued interaction with patients may provide an opportunity to identify barriers to medication adherence as well as a chance to suggest potential strategies to overcome them (eg, use of a pill box or cueing the taking of medications with a routine activity, such as toothbrushing).

Possible exception: A patient with a mental illness may be required to comply with court-ordered therapy.

adverse effect, adverse event, adverse reaction, side effect—Side effect is the secondary consequence of implementing an agent (usually a drug). The term is often used incorrectly when adverse effect, adverse event, or adverse reaction is intended. Because a side effect can be either beneficial or harmful, a specific term should be used.

A recent study examined the incidence of serious and fatal adverse drug reactions in hospitalized patients.

The beneficial side effects of aspirin include preventing myocardial infarctions and reducing the severity and damage from thrombotic strokes.

affect, effect—Affect, as a verb, means to have an influence on. Effect, 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].

Ingesting massive doses of ascorbic acid may effect his recovery [produce the recovery].

Affect, as a noun, refers to immediate expressions of emotion (in contrast to mood, which refers to sustained emotional states). Effect, as a noun, means result. Affect is often used as part of psychiatric diagnostic terminology.

The patient’s general lack of affect was considered an effect of recent trauma.

Note: In reports of research, use of the word effect should be limited to studies with designs that permit assessment of causal findings (eg, randomized trials, controlled laboratory experiments) and should not be used in reports of observational studies (eg, cohort, cross-sectional, case-control, case series, and meta-analysis) unless related to a statistical measurement such as effect size. See also association, relationship and 19.0, Study Design and Statistics.

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 11.7, Age and Sex Referents).

The patient, aged 75 years, had symptoms of mild cognitive impairment.

Alternative: The 75-year-old patient had symptoms of mild cognitive impairment.

The US Preventive Services Task Force recommends chlamydia and gonorrhea screening for all sexually active women younger than 25 years (including teenaged girls), even if they are not engaging in high-risk sexual behaviors.

Note: In some expressions regarding age, it is redundant to add of age after the number of months or years because it is implied in the adjectives younger and older.

Influenza vaccination is not recommended for infants younger than 6 months.

See 11.2.1, 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.

Symptoms of gastroesophageal reflux disease can be aggravated by certain foods, such as chocolate, citrus fruits, spicy and tomato-based foods, caffeine, and alcohol, or by eating just before going to bed.

Wool, chemicals, soaps, and other substances can irritate the skin and cause itching.

alternate, alternative—Alternate is an adjective, adverb, or verb and alternative is usually a noun. Alternate means “occurring in turn” and alternative means “another possibility.”

Medications that interfere with testing should be stopped only if safe alternatives can be substituted.

The drugs should be taken on alternate days.

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 in the adverbial construction, meaning “however” or “nevertheless,” is correct.

Although the analysis was performed correctly, the terms of the investigation were too narrow to be interesting.

Squamous cell skin cancer, though common, remains largely unreported and unstudied.

ambiguous, equivocal—The 2 words are close in meaning but distinct in usage. Ambiguous means able to be understood in more than one way, having more than one possible meaning, or not expressed or clearly understood. Equivocal is defined as having 2 or more possible interpretations or not easily explained or understood.

The student was faulted for her ambiguous answer to a crucial question.

Further assessment for the presence of human papillomavirus can clarify an equivocal result from Papanicolaou testing.

among, between—Among usually pertains to general collective relations and always in a group of more than 2. Between pertains to the relation or association of 1 item and 1 other item. For instance, a treaty may be made between 4 countries because 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 the two of us, we are certain to find the common factor among the patients 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—Apt connotes a volition or habitual tendency and should not be used in regard to an inanimate object. Apt also means suited to a purpose. Liable connotes the possibility of risk or disadvantage. Likely merely implies probability and thus is more inclusive than apt.

A child is apt to cry when frustrated.

Patients receiving immunosuppressant drugs are liable to acquire fungal infections.

The computer system is likely to crash if it is overloaded.

article, manuscript, paper—An unpublished study, report, or essay—that is, the document itself—may be referred to as a manuscript or paper. When published, it is an article.

The authors thank Frank J. Kobler, PhD, for statistical review of the manuscript.

Nancy MacClean, ELS(D), 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.

Similarly, since should be avoided when it could be construed to mean “from the time of” or “from the time that.”

association, relationship—Association occurs between 2 or more variables in which the independent variable does not necessarily cause the other dependent variable(s). Relationship implies cause and effect, and in reports of research, the term should only be used for studies with designs that can demonstrate causality (eg, randomized clinical trials and controlled laboratory experiments) (see 19.5, Glossary of Statistical Terms).

To our knowledge, this is the first cohort study to analyze the association between a patient’s expected prognosis and do-not-resuscitate decision-making.

There was an inverse relationship between cholesterol levels and coronary artery disease in the intervention group in this randomized clinical trial.

assure, ensure, insure—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 the families of workers the provision of adequate funds for a proper burial.

The journal editors can assure readers that research was conducted ethically by mandating that every relevant paper include a statement that an institutional review board reviewed the study protocol.

because of, caused by, due to, owing to—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 the meaning of a sentence.

One mechanism is the increase in macular inflammation due to retinal amyloid-β deposition.

Meaning: One mechanism is the increase in macular inflammation caused by retinal amyloid-β deposition

Caused by could be substituted for due to, and the meaning would be retained. That is could be inserted before due to without changing the meaning of the sentence.

Percentages have been rounded owing to missing data.

Meaning: Percentages have been rounded because of missing data.

Because of could be substituted for owing to, and the meaning would be retained. However, if that are is inserted before owing to, the meaning of the sentence 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”).

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.

Observations are made of the biopsy specimen, not on the biopsy itself.

The utility of standard biopsy in addition to targeted biopsy for prostate cancer was found to be limited.

Millions of breast biopsies are performed annually.

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, for example, single-blind review, where the reviewer can see the author’s name and affiliation on the paper but the reviewer’s identity is concealed, or double-blind review, where both reviewer and author identities are concealed. The equivalent term masking (or masked review or assessment) is preferred by some investigators and journals, particularly those in ophthalmology (see 5.7.1, Confidentiality During Editorial Evaluation and Peer Review and After Publication, and 19.5, Glossary of Statistical Terms).

breastfeed, nurse—When referring to human lactation, use breastfeeding (breastfeed, breastfed). 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 transplant, 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 an adjective).

can, may, will—Bernstein,⁶ in his classic The Careful Writer, perhaps said it best: “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.” When summing up findings, will is used to express futurity or inevitability; may suggests the possibility to do something.

Use of the most common antibiotics in early life may increase the risk of autoimmunity in children at increased genetic risk.

Use of the most common antibiotics in early life will increase the risk of autoimmunity in children at increased genetic risk.

Improved air quality can promote molecular longevity from birth onward.

Improved air quality will promote molecular longevity from birth onward.

case, client, consumer, participant, patient, subject—In biological 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. 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 19.0, 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,

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].

Many patients in the United States have type 2 diabetes [only persons under medical care].

A case is evaluated, documented, and reported. A patient is examined, undergoes testing, and is treated. A research participant is recruited, selected, sometimes exposed to experimental conditions, and observed. See also diagnose, evaluate, examine, identify and follow, follow up, 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; morbidity, morbidity rate; mortality, mortality rate—Fatality is the occurrence of death and case-fatality rate is the probability of death among people diagnosed as having a disease. The rate is calculated as the number of deaths during a specific period divided by the number of persons with the disease at the beginning of the period.⁷ Morbidity is a diseased state, and morbidity rate is the frequency with which a disease appears in a population. Mortality is the number of deaths in a given time or place, and mortality rate is the death rate described by the following equation: [(Number of Deaths During Period) × (Period of Observation)]/(Number of Individuals Observed)⁷ (see 19.5, Glossary of Statistical Terms).

catatonic, hysterical, manic, psychotic, schizophrenic—Do not use these terms when referring to patients. It is dehumanizing to refer to a patient as “a schizophrenic.” Use “a patient with schizophrenia” (see 11.12.6, Terms for Persons With Diseases, Disorders, or Disabilities).

cerebrovascular accident, stroke, stroke syndrome—Cerebrovascular accident (abbreviated CVA) is an older but acceptable generic term synonymous with stroke and stroke syndrome. However, when using any of these terms, an author should also specify, if possible, the subtype(s) under discussion (eg, ischemic stroke, hemorrhagic stroke, and/or transient ischemic attack).

cesarean delivery, cesarean section—According to the American College of Obstetricians and Gynecologists Publications Department, the preferred terms are cesarean delivery or cesarean birth. Most etymologists believe that cesarean and section originated from the Latin verbs that both mean “to cut”; therefore, cesarean section is redundant.⁸ Do not capitalize cesarean.

chief complaint, chief concern—Chief complaint has been traditionally used by physicians when taking a patient’s medical history. However, chief concern may be a better description because complaint may be construed as pejorative and confrontational. Also, patients report symptoms and concerns. Avoid “patient complaint.”

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).

Primary liquid dysphasia is a classic symptom suggestive of achalasia.

Darkening of the iris pigmentation and eyelash hypertrichosis are classic findings associated with the use of a prostaglandin analogue agent.

The figure represents the aesthetic of the age: clear, beautiful, simple, and clean design, with a background of twirling leaves reminiscent of classical themes.

However, some disciplines (eg, genetics, immunology) use classical for specific terms:

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 14.8.3, Nomenclature, 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 distinguished from those specializing in laboratory science, research, policy, or theory, for example. When referring to a particular type of clinician or practitioner, it is preferable to use the more descriptive term (eg, physician, nurse, dentist, optometrist, podiatrist). The plural forms clinicians and practitioners may be appropriate to refer to a group of such professionals from different fields. Avoid use of the nonspecific term provider. 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).

Patients in both active treatment groups had greater improvements from baseline in psychosocial functioning compared with patients receiving only routine medical care.

Few medical discoveries can compare to the discovery of penicillin.

compose, comprise—Comprise means to be composed of or to include; it takes the active voice, whereas compose takes the passive voice. The whole is composed of its parts and comprises its parts.

The chemotherapeutic regimen is composed of several toxic ingredients.

The chemotherapeutic regimen comprises several toxic ingredients.

Clue to usage: Never use of with comprise.

A good alternative for comprise is to use “consist of” or “include.”

condition, disease, disorder—Although these terms are frequently used interchangeably, differences between them exist and can assist in using them in more specific senses. Condition is perhaps the least specific, often denoting states of health considered normal or healthy but nevertheless posing implications for health care (eg, pregnancy). The term might also be used to indicate grades of health (eg, a patient might be described as in stable, serious, or critical condition). Condition indicates a state of health, whether well or ill. A condition conferring illness might further be classified as a disease or disorder; however, condition might be used in place of disease or disorder when a non—disease-specific term is indicated.

Disease is often used in a general sense when referring to conditions that affect a physical system (eg, cardiovascular disease) or a part of the body (eg, diseases of the eye). The term also may be used in specific senses; for example, a writer might refer in general terms to neurologic disease or cognitive impairment or in more specific terms to Alzheimer disease or dementia with Lewy bodies.

Disorder, in contrast, denotes a condition characterized by functional impairment without structural change. Although certain disorders or categories of disorders might be accompanied by specific signs and symptoms, their presence is not required for a condition to be termed a disorder.

continual, continuous—Continual means to recur at regular and frequent intervals. Continuous means to go on without pause or interruption.

The patient with emphysema coughed continually.

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 compound administered to enhance portions of the anatomy on an image).

criterion standard, gold standard—Criterion standard is a test considered to be the diagnostic standard for a particular disease or condition, used as a basis of comparison for other (usually noninvasive) tests. A commonly used synonym, gold standard, is considered jargon by some in the methodological literature but not in the medical literature⁹ (see 19.5, Glossary of Statistical Terms).

diabetes—The types of diabetes currently recognized by the American Diabetes Association are as follows:

Prediabetes refers to blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes. The term prediabetes is sometimes referred to as impaired glucose tolerance or impaired fasting glucose, depending on what test was used when it was detected.¹⁰

“Mellitus” need not be specified when referring to diabetes, even at first mention; the term mellitus has etymologic significance (and there are other, rarer, types of diabetes, such as insipidus), but mellitus need not be added.

For other specific types of diabetes, consult Diabetes Care.¹¹

diagnose, evaluate, examine, identify—Diagnose, evaluate, and identify apply to conditions, syndromes, and diseases. Patients are examined. Patients may be evaluated for the possibility of a condition (eg, The patient was evaluated for possible cardiac disease). Although diagnose was formerly avoided when referring to a patient, it is now acceptable to say a patient “was diagnosed.” See also case, client, consumer, participant, patient, subject and management, treatment.

The patient was diagnosed as having schizophrenia.

The patient was diagnosed with schizophrenia.

die from, die of—Persons die of, not from, specific diseases or disorders.

The patient died of complications of disseminated intravascular coagulation.

dilate, dilation, dilatation—According to the American College of Obstetricians and Gynecologists, dilate is a verb meaning to expand or open. Dilation means the act of dilating. Dilatation means the condition of being stretched or expanded.⁸

The patient’s cervix dilated during a period of 12 hours.

The patient was treated with 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).

discomfit, discomfort, disconcert—These words are commonly confused, perhaps because they begin with the same 5 letters and sound similar.

Discomfit, although occasionally still used in the sense of “to frustrate or thwart,” is currently most often used to indicate mental, rather than physical, states, specifically in the sense of one’s being perplexed or embarrassed (ie, disconcerted). Discomfort is most often used to indicate one’s feeling physically or emotionally uncomfortable, resulting from the efforts of others, from personal excess, or from a condition or disease state. Disconcert, indicating perplexity or disturbed composure, is still occasionally used as a verb but currently is used much more frequently as an adjective.

The medical student felt discomfited by her palpable grief at the loss of a patient.

The excitement produced by the first meal since bariatric surgery may be followed by a feeling of abdominal discomfort.

I found the discussion to be premature and very disconcerting.

discreet, discrete—Discreet is defined as careful and circumspect in one’s speech or actions, especially to avoid causing offense or to gain an advantage (ie, intentionally unobtrusive). Discrete means individually separate and distinct.

Working with sensitive patient information, physicians and other medical staff must be discreet.

Although the lesions are usually discrete, they can appear grouped and only rarely do they coalesce.

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 and free from selfish motives; to be uninterested is to be unconcerned, indifferent, inattentive, or unbiased. 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, such as a person with an MD, MBBS, or a DO or equivalent degree. See also clinician, practitioner and provider, and 11.5, Jargon.

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.

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 clinical 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; a measure of the extent to which an intervention fulfills its objectives.

Few safe, effective weight-management drugs are currently available.

The researchers investigated the safety and efficacy of liraglutide vs placebo for weight management in adults with overweight or obesity and type 2 diabetes.

Cost-effectiveness analysis is the comparison of strategies to determine which provides the most clinical value for the cost.¹² Comparative effectiveness research is the conduct and synthesis of systematic research comparing different interventions and strategies to prevent, diagnose, treat, and monitor health conditions. The purpose of this research is to inform patients, health care professionals, and decision makers about which interventions are most effective for which patients under specific circumstances¹³ (see 19.5, Glossary of Statistical Terms).

eg, ie—eg comes from the Latin exempli gratia: “for example” and ie comes from id est: “that is.” Both should be followed by a comma.

In this study, the general module of messages included information generally provided by secondary prevention programs, eg, on chest pain action plans, guidelines and risk factor targets, and medications and adherence.

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.

elicit, illicit, solicit—These words have distinctly different denotations, yet they are often confused or misused. In medical and scientific contexts, it is especially important to preserve the distinctions between them.

Illicit, denoting simply not permitted or unlawful (and sometimes used colloquially to indicate naughty, unseemly, or immoral), has limited use in medical writing. For example, written materials might convey the risks associated with the use of illicit drugs, discuss illicit relationships between researchers and industry, or report on the illicit trade in human body parts. Beyond such instances, the word is not often used in medical literature.

Elicit, however, means to call forth or draw out (as information or a response) or to draw forth or bring out (something latent or potential). The word occurs frequently in medical contexts. It might be used in both senses regarding a patient-physician encounter. For example, a physician evaluating a patient’s pain will ask questions to elicit information about the characteristics of the pain (eg, location, nature, duration, exacerbating factors, severity). Having thus elicited information about a patient’s pain, the physician then tries to elicit the real concern. In materials that cover the basic sciences and their clinical applications, elicit is perhaps most frequently used in the second sense. A writer might report that a new vaccine elicits a given immune response, describe pathological mechanisms that elicit organ damage, or present a theory of how a treatment might elicit changes in gene expression.

Illicit and elicit are easily distinguished from each other; illicit is always an adjective, whereas elicit—in current usage—is always a verb. It also can help to remember that illicit denotes illegal.

Solicit is most frequently used in medical contexts in the sense of to approach with a request or a plea. It is often used interchangeably with elicit. However, such use obscures an important distinction. The Oxford Dictionary of American Usage and Style states, “To solicit a response is to request it. To elicit a response is to get it.”¹⁴ Thus, the physician solicits information regarding the patient’s pain and then performs a physical examination to elicit and evaluate actual pain. In medical contexts, the distinction has obvious implications for reports of survey studies and possibly for discussion of power calculations in reports of clinical trials.

endemic, epidemic, hyperendemic, pandemic—Endemic conditions or diseases are prevalent in a particular place or among a particular group. 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 occurs abruptly throughout a wide geographic area, even worldwide, and is (usually) temporary.

Cowpox is an orthopoxvirus infection endemic in European wild rodents but with a wide host range, including human beings.

The Ebola epidemic sparked a much-needed course correction that favored strong health infrastructure.

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 50 million and 100 million people died in the 1918-1919 influenza 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 more commonly used 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. The term is best avoided in scientific reports.

Etc is not followed by a period except when it is at the end of a sentence.

Gelatin is made from animal ligaments, tendons, bones, etc, that have been boiled in water. Gelatin is often used in confectionery, ice cream, and other dairy products.

fasted, fasting—These terms are derivative forms (adjective and participle) of the noun and verb fast that are often used in the scientific literature.

fellow, intern, internist, resident—Fellows have completed their residency and can elect to complete further training in a specialty. Interns have graduated medical school and are in the first year of post—medical school training. Interns can only practice medicine within their training program. Internists are physicians specializing in internal medicine. Residents have completed their intern year and are still in training.

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.

fewer, less—Fewer and less are not interchangeable. Use fewer for number (individual persons or things that are countable) and less for volume, mass, and percentage/proportion (indicating degree or value).

Fewer interventions may not always mean less care.

The report suggests that fewer women are receiving screening mammograms.

Note: We spent less than $1000 (not: We spent fewer than $1000).

There was less than 30% difference in outcomes.

The outcome of interest occurred in less than 30% of the patients.

They reported fewer data (not: They reported less data).

follow, follow up, 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).

Patients with retained intracranial fragments have been followed up, and the sequelae of such fragments were analyzed. To date, 9 patients have been lost to follow-up.

foreign-born—This term may be considered derogatory and should not be used. It is preferable to say that a person was born outside the country of interest. For example, use non—US born or non—Canadian born.

The best approach to testing among non—US-born residents is uncertain.

We estimated the cost-effectiveness of testing and treatment for latent tuberculosis infection in residents born outside Canada.

gender, sex—Sex is defined as the classification of living things as male or female and is a “biological component, defined via the genetic complement of chromosomes, including cellular and molecular differences.”¹⁵

Gender comprises “social, environmental, cultural, and behavioral factors and choices that influence a person’s self-identity and health.”⁹ The term gender “includes gender identity (how individuals and groups perceive and present themselves), gender norms (unspoken rules in the family, workplace, institutional, or global culture that influence individual attitudes and behaviors), and gender relations (the relations between individuals of different gender identities).”¹⁵

The terms should not be used interchangeably. In reports of research, if demographic information about human participants is included, the term used should be indicated and defined and the method used to assess sex or gender should be described (eg, self-report, investigator observed, metadata in a database). In many instances, authors of articles in biomedical publications use the term gender when they intend the word sex. As noted by Clayton and Tannenbaum, “[W]hen sex is based on self-report, it will be incorrect in a very small percentage of individuals because some individuals will not be 46XX or 46XY. However, in most research studies, it is not possible to conduct detailed genetic evaluation to determine the genetic make-up of all participants.”¹⁵

A sex ratio of 1.06:1, the ratio of male to female births, has declined in the past decades.

Many studies indicate that women are less likely than men to undergo cardiac procedures after an acute myocardial infarction, raising concerns of sexual bias in clinical care. However, no data exist about the relationship among 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-based factors (psychosocial), or both has not been determined.

The survey of bias in the workplace asked women and men to self-report their gender.

Transgender means of, relating to, or being a person whose gender identity differs from the sex the person had or was identified as having at birth. Cisgender means of, relating to, or being a person whose gender identity corresponds with the sex the person had or was identified as having at birth.

Avoid using any trans term as a noun; the adjectival form is preferred (not transman or transwoman but transgender man and transgender woman).

Surgeons are seeing an increase in consultations for surgical therapy to help transgender and gender-nonconforming individuals.

The study examined the health status of gender minorities in the United States compared with cisgender peers.

See 11.7, Age and Sex Referents, the GLAAD Media Reference Guide-Transgender Issues website,¹⁶ and the Gender Equity Resource Center website.¹⁷

global, international—Global relates to or involves the entire world; an equivalent term is worldwide (a global system of communication, global climate change, global health security).

Spread of infection with Zika virus among pregnant women has become a global public health concern.

International affects 2 or more nations (international trade, international movement, international consortium).

Researchers conducted an international survey, with respondents selected from Australia, China, France, the United Kingdom, and the United States.

But: global amnesia, global aphasia, global ischemia, global cognitive function, global pain relief, Global Assessment of Functioning Scale

health care—Express this term as 2 words. It is not necessary to hyphenate health care in its adjectival form (see 8.3, Punctuation, Hyphens and Dashes).

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).

This historical novel has had a historic impact.

This article considers the historical effect of Medicare and Medicaid on mental health services and discusses this history as a basis for appraising the legislation now before the US Congress.

Note: The aspirant “h” in both historic and historical is not silent (see 7.3.2, Indefinite Articles, and 11.11, Articles).

-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

immunize, inoculate, vaccinate—Immunize means to induce or provide immunity by giving a vaccine, toxoids, or preformed antibodies. 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 of an HBsAg-positive woman against hepatitis B, the patient should be inoculated with both hepatitis B immunoglobulin 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.

The World Health Organization is partnering with the United Nations Children’s Fund to conduct a massive vaccination campaign in 7 countries to inoculate more than 20 million children against polio and other diseases.

impaired, intoxicated—These related terms are used in the United States to define impairment in driving performance attributable to the use of alcohol or drugs. For instance, in some jurisdictions, a blood or breath alcohol (ethanol) concentration of 0.08 g/dL is considered 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, restricting our ability to infer the causal directions underlying the observed associations.

Note: Inference is the process of passing from observations to generalizations, usually with calculated degrees of uncertainty.

In the presence of missing data, mixed models can provide valid inferences under an assumption that data are missing at random.

See 19.5, Glossary of Statistical Terms (inference).

incidence, prevalence—Incidence refers to the number of new cases of disease among persons at risk that occur over time,⁷ as contrasted with prevalence, which is the total number of persons with the disease at any given time.

See 19.5, 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. If uncertain, query the author.

in order to—In order can often be removed from the phrase in order to without changing its meaning (see 11.2.1, Redundant Words). However, in some cases such a deletion may be awkward or change the meaning.

Our students must have the learning opportunities that they need in order to acquire true understanding. [If “in order to” 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.”]

irregardless, regardless—Irregardless—most likely a blend of irrespective and regardless—is incorrect regardless of usage.

life expectancy, life span—Life expectancy is the average period that a person may expect to live. Life span is the length of time a person lives.

limited-income, low-income, resource-limited, resource-poor, transitional—These adjectives are used to describe a nation, region, or group in which most of the population lives on far less money—with far fewer basic public services—than the population in wealthy countries. For the purposes of financing, debt relief, technical assistance and advisory services, and special initiatives, the World Bank also categorizes countries as heavily indebted poor countries, middle-income countries, low-income countries under stress, and small states. There is no universal, agreed-on criterion for describing a country in terms of its economic or human “development” and which countries fit these different categories, although there are different reference points, such as a nation’s gross domestic product per capita or the limited nation’s Human Development Index (HDI) compared with that of other nations.

Choice of an appropriate term will depend on context, and writers should choose respectful terms that reflect a specific country’s economic and social situations.

Use of the terms first world/third world and developed/developing are not recommended as descriptors when comparing countries or regions. The term third world is pejorative and archaic. The term developing may seem like an acceptable alternative, but it too can be considered pejorative and insensitive to the many complexities of metrics used to measure economic, political, resource, and social factors. Best practice is to avoid such general terms and use specific terms that reflect what is being compared, such as low-income or high-income for an article comparing countries based on measures such as gross national product per capita.

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.

Relatives of patients with carcinoma of unknown primary (CUP) are at increased risk of CUP and several other malignant neoplasms, including lung, pancreatic, and colon cancer.

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 HIV infection” 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 or mitral regurgitation). Management may also be used to refer to the monitoring or periodic evaluations of the patient.

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.

An increasing body of evidence presents the possibility of developing drugs to mitigate cognitive decline.

This review considered evidence related to mitigation of risk in the use of opioids for chronic pain.

multivariable, multivariate; univariable, univariate—Multivariable means many variables and refers to any statistical test that deals with 1 dependent variable and at least 2 independent variables. It may include nominal or continuous variables, but ordinal data must be converted to a nominal scale for analysis. Multivariate analysis is similar to multivariable analysis except that there is more than 1 dependent variable. The term multivariate is frequently incorrectly used in the scientific literature when multivariable analysis is meant. Univariable analysis refers to statistical tests involving only 1 dependent variable and no independent variables or may also apply to an analysis in which there are no independent variables. For univariate, the suffix “-ate” means to act on. Because no variable is acted on in a univariable analysis, univariable is a more appropriate term than univariate when there is only a single variable involved.

See 19.0, Study Design and Statistics.

nauseous, nauseated—These terms are often used interchangeably to mean feeling unwell, but they have distinctly different meanings. Nauseous refers to causing an illness or disgust, and nauseated refers to feeling ill or disgust.

The nauseous smell sickened several people in its vicinity.

The patient was nauseated after taking aspirin.

-ology—This suffix, derived from the Greek logos, meaning “word,” “idea,” or “thought,” denotes science of or study of. Many terms with this suffix, like morphology, histology, etiology, and symptomatology, are general and abstract nouns and should not be used to describe individual and particular items. Pathology is an exception and can be used.

on, upon—In scientific articles, upon often simply means on, which is the preferred term.

operate, operate on—Surgeons operate on a patient or perform an operation on a patient. Similarly, patients are not operated but are operated on.

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 performed on a living body to repair damage or a defect or restore health; it is the surgical procedure.

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 treatment rooms.¹⁸

ophthalmologist, optician, optometrist—Ophthalmologists are specialists in medical and surgical eye disease. Opticians are technical practitioners who design, fit, and dispense corrective lenses. Optometrists are health care professionals who provide primary vision care that ranges from sight testing and correction to the diagnosis, treatment, and management of vision changes.

over, under—Correct usage of these words depends on context.

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 11.2.1, Redundant Words).

percent, percentage, percentage point, percentile—See 18.7.2, Numbers and Percentages, Forms of Numbers, Percentages.

persons, people—Both terms are acceptable.

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.

preventative, preventive—As adjectives, preventive and its derivative preventative are equal in meaning. The shorter preventive is preferred.

principal, principle—These words sound the same but have very different meanings. Principal can be a noun or an adjective and has several definitions, including a loan amount that requires repayment, someone who has an important role, or something that is primary or pivotal. Principle is always a noun and only refers to a law or rule.

The patient was hospitalized with a principal diagnosis of chest pain.

The principal investigator observed the first 2 interventions.

The physician studied the principles of ethics of the American Medical Association.

prostitute, sex worker—Epidemiologic studies use the term sex worker (or commercial sex worker) to describe these persons of any gender, 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 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.

To protect the public health and safety during recovery operations after a hurricane, the Centers for Disease Control and Prevention has created guidelines of interest to health care providers (trauma surgeons, nurses, and psychologists), relief workers, and shelter operators.

The phrase nonphysician provider should be avoided because it is similarly imprecise and can refer to numerous health professionals licensed to provide a health care service. It is better to specify the type of professional (eg, nurse, pharmacist, dentist) 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 physician and other health care professionals may be acceptable as long as the phrase is defined at first mention. This also applies to other professions (eg, avoid use of nonnurses, nonpharmacists, nondentists).

psychiatrist, psychologist—Psychiatrists are trained physicians who can prescribe medications and focus on medication management as a course of treatment. Psychologists cannot write prescriptions and focus on psychotherapy and treating patients with behavioral intervention.

race, ethnicity—These terms are not equivalent (see 11.12.3, Race/Ethnicity, for a discussion of usage).

regime, regimen—A regime is a form of government, a social system, or a period of rule (eg, a military regime). A regimen is a systematic schedule (involving, for example, diet, exercise, way of living, physical therapy, or medication) designed to improve or maintain the health of a patient.

Resistant hypertension is the failure to reach goal blood pressure while adhering to full doses of an appropriate 3-drug regimen that includes a diuretic.

A retrospective study compared mild-, moderate-, and high-intensity exercise regimens in patients with detectable hepatic fat.

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.

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.

Low back pain, other muscular disorders, and neck pain rank first, third, and fourth, respectively, among the 30 leading diseases that contribute to years lived with disability in the United States.

safe injection site, safer injection sites, supervised injection facility or site—Use supervised injection facility or site.

section, slice—Use section to refer to a radiologic image; use slice to refer to a slice of tissue (eg, for histologic examination).

But: frozen-section biopsy

See also cesarean delivery, cesarean section.

side effect—See adverse effect, adverse event, adverse reaction, side effect.

signs, symptoms—Signs can be seen and read by other people. Symptoms can only be described by the person feeling them.

substance abuse, substance use—Never use the term substance abuse. Many consider it to be pejorative, but it is a clarity and accuracy issue as well. If what is meant is “use” (“The patient used heroin”), then “use” is sufficient. There is no difference between heroin “use” and heroin “abuse,” so “abuse” adds no information. If what is meant is “The patient had depression and substance use disorder” (eg, both are medical illnesses), then saying “The patient had substance abuse” would be unclear and inaccurate (unless specifically referring to meeting the DSM-IV substance abuse definition). Use “substance use disorder” to mean uncontrolled use of a substance with recurrent consequences. Use “substance use” to mean the action of taking a substance without any conclusions about whether it has harmed the person or whether they have control over its use (“The patient used marijuana last night”). See 11.12.6, Terms for Persons With Diseases, Disorders, or Disabilities.

suffer from, suffer with— See 11.12.6, Terms for Persons With Diseases, Disorders, or Disabilities, for a discussion of usage.

suggestive of, suspicious of—To be suggestive of is to give a suggestion or to evoke. To be suspicious of is to distrust.

supine, prone—These terms are antonyms. Supine means lying on the back or with the face up. Prone means lying on the front of the body facing downward.

The patient was placed in supine position for thoracic surgery.

The patient was placed in a prone position for the spinal surgery.

survivor, victim, victimization—In scientific publications, avoid the use of the word victim when describing persons who experienced physical, domestic, sexual, or psychological violence, bullying, or a natural disaster. Similarly, avoid labeling (and thus equating) people with a disability or disease as victims (eg, AIDS victim, stroke victim; see 11.12.6, Terms for Persons With Diseases, Disorders, or Disabilities). The term victimization should likewise be avoided; instead, a term or phrase that describes the specific exposure should be used (eg, exposure to violence, experienced trauma, bullying, being bullied).

Victim may imply a state of helplessness.¹⁹ 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 experience or trauma. In such cases, survivor may be more appropriate (eg, rape survivor, tsunami survivor, survivor of torture).

Survivors of sexual assault often choose not to speak publicly about their experiences.

Refugees who reported experiencing violence had higher rates of anxiety than those who did not report such experience.

Children who were bullied and participated in the group counseling sessions reported lower scores for symptoms of depression compared with those who did not participate in the group counseling.

If a person who experienced such trauma has died, referring to them as a victim may be appropriate (victim of a landmine explosion or gunshot wound). Victim may also be used in the vernacular (victim of his own success).

titrate, titration—In therapeutics, titrate and titration refer to dosing schedules that start with a small dose and gradually are increased to the recommended or therapeutic dose. Patients are not titrated.

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.

But: toxic shock syndrome, toxic neuropathy, toxic epidermal necrolysis, toxic megacolon

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 use the noun transplant in this context. Transplantation is traditionally the noun used to describe the overall field. Never use the plural transplantations.

For the adjectival form, use transplant, as well as pretransplant and posttransplant (not pretransplantation and posttransplantation).

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.

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.

We used correlation and hierarchical linear regression analyses.

Vitamin C helps the body use the iron present in the diet.

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 terms.

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 compose vs comprise was discussed earlier.

The style manual determines what the correct usage should be.

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 the verb employ be routinely changed to use. Use employ to mean hire.

vision, visual acuity—Vision is a general term that describes 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 patient describing symptoms of his or her visual sensation would be describing the overall visual performance of the eye(s) and would use the term vision: “My vision is improved [or worse].”

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).