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Harvard Commentaries
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Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


What Your Doctor Is Saying What Your Doctor Is Saying
 

Tech Speak


October 10, 2013

By Robert H. Shmerling M.D.

Beth Israel Deaconess Medical Center

 

When your doctor is speaking with you about your health, you'll probably be paying close attention. He or she will try to make sure that the information is clear. But despite this, physicians or other health care professionals may use terms that are not particularly technical, but are used in a way that non-medical persons don't understand. In fact, frequently, a doctor will not even realize it is happening; I know I use language this way more than I care to admit.

Why Learning Latin Won't Help

The terms a doctor uses in conversation may seem to be from another language. I was convinced that the "other language" was mostly Latin so I took Latin courses before medical school thinking it would help — it didn't. Perhaps that's because many of the most common terms doctors use are simply "regular" words used in a different way than what is usual for most people. And while technical terms are more readily noticed and "translated," the less technical terms may be even harder to spot and avoid.

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Terms Your Doctor May Use: A Top 10 List

I listened to my colleagues (and to myself) for a week, and here are 10 of the most common expressions I heard:

  1. Lesion
    Example: "After chemotherapy, the lesion on chest X-ray disappeared."
    This term may apply to almost any finding out of the ordinary; it may be a rash, a lump, an abnormality on an X-ray or on the part of the brain affected by a stroke. Importantly, its meaning can range from something that is medically insignificant to a dangerous finding. Many physicians will use this word when the exact nature of the problem is not yet known, or when they are trying to avoid a specific term (such as "cancer") until more definitive information is available.
  2. Status-post
    Example: "Ms. Jones is status-post hip replacement."
    Often used before a condition or a procedure, this term indicates something the person has had in the past. The word "post" means "after," as in "postoperative."
  3. Compensated/Decompensated
    Example: "As long as he took his medications, his heart failure was well compensated, but when his prescription ran out, he decompensated."
    "Compensated" describes the ability to counter whatever the condition or problem is; the person (or the diseased part of the body) is able to keep up or keep going despite the condition, maintaining a balance that may be fragile but is adequate for the moment. "Decompensated" is just the opposite, indicating that the balance has been tipped and things are getting worse.
  4. Infiltrate
    Example: "The chest X-ray showed an infiltrate in the left lower lung field and the skin biopsy revealed an inflammatory infiltrate."
    An infiltrate is something that has invaded or shown up where it does not belong. It's often used as another term for pneumonia when used to describe a chest X-ray; it may refer to inflammation when used to describe white cells gathering in one area of tissue when viewed under the microscope.
  5. Pathologic
    Example: "During the physical examination, no pathologic lymph nodes could be detected."
    This term is reserved for describing a condition or situation in which there is clearly something wrong or diseased. This term is especially helpful to distinguish a finding that might be normal (such as soft, small lymph nodes felt by the examiner during a routine examination) from a concerning finding in the same organ (such as enlarged or hard lymph nodes).
  6. Negative
    Example: "Even though the child had a fever and sore throat, the throat culture was negative."
    This term may be misleading, since "negative" may suggest something bad. In fact, it's usually just the opposite — it means that an abnormal result is not present. Related terms include "stable" (meaning not changing or not getting worse, generally viewed as a good thing), "within normal limits" (meaning a result has fallen within an acceptable or normal range) and "unremarkable" (meaning normal, or not remarkably unusual).
  7. Nonfocal
    Example: "The neurologic examination of the upper and lower extremities was nonfocal."
    Usually referring to the nervous system, this term indicates that both sides of the body perform equally well and that no specific abnormalities are present. However, an examination may be nonfocal even in the face of significant disease, such as when all the muscles are weak or a person is unconscious. In those cases, the term indicates that the underlying problem is unlikely to be in one single, small area of the nervous system, but is instead a more diffuse or widespread disorder.
  8. Atypical
    Example: "He went to the emergency room for atypical chest pain, but a chest X-ray showed evidence of an atypical pneumonia."
    Rather than meaning "unusual" in the way many non-medical persons would think of the word, this has a more specific meaning to health-care providers. It generally precedes "chest pain" to indicate that its features do not suggest that the pain represents angina or a heart attack. Similarly, an "atypical pneumonia" has a particular appearance on chest X-ray (not confined to one section of the lung) and causes relatively less sputum and fever than do other types of pneumonia. Certain infectious agents (such as mycoplasma) cause this type of pneumonia more than others.
  9. Indication/Contraindication
    Example: "The indication for his appendectomy was appendicitis, but his allergy to penicillin was a contraindication to the usual antibiotics."
    Often used in the context of a medication or an operation, these terms refer to the reason or underlying condition for which an intervention is performed (or avoided). Every prescription medication has one or more indications approved by the U.S. Food and Drug Administration that identifies those conditions for which it has been most thoroughly evaluated (though doctors often prescribed for additional, or “off-label,” conditions.) When the medication should be avoided, however, it is said to be "contraindicated." Similarly, surgeons will offer surgery for certain reasons, or indications — situations for which surgery is most likely to be necessary and helpful — but tend to avoid operating when those indications are not present.
  10. Nonspecific
    Example: "The results of the CT Scan were nonspecific, and so additional tests were planned."
    This term means that there is not a single interpretation for a symptom, a finding on examination or a test result; that is, many explanations are possible. A cough, for example, is nonspecific because there are many causes of cough.

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The Bottom Line

Unfortunately, this list could have included many more terms — every specialty seems to have its own language, and different doctors tend to favor particular terms or phrases. It may seem impossible or even frustrating — you are familiar with the word, yet the sense of the conversation may still be uncertain. Realize that it is like any other unfamiliar territory: Understanding more about the language of medicine can be a powerful way to make the information more meaningful and less overwhelming.

Talking with your doctor is an important way to stay informed about your health, but ask for an explanation if there are words or phrases you don't understand. Be aware that even though a term may sound familiar or nontechnical, it may be used in a way that is unfamiliar — it's important to ask for a clarification in those situations also. The more you learn about what your doctor is saying, the less mysterious and the more useful the conversation will be.

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Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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