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

What Your Doctor Is Saying What Your Doctor Is Saying

The Mystery of the 'Opathies'

February 27, 2013

By Robert H. Shmerling M.D.

Beth Israel Deaconess Medical Center

Last reviewed February 27, 2013

Catch your doctor talking to another doctor and you are likely to hear conversation like this: "…she does have type 2 diabetes but no history of nephropathy, retinopathy or neuropathy …." It is the sort of talk that gives the medical profession a reputation for speaking its own language.

Contrary to what you may have heard or assumed, most of what your doctor is saying is in English — they are just terms used rarely in other settings. Many of these words have a common ending (suffix) that is particularly useful when describing a medical condition.

What Are "Opathies"?

When added to the end of a word, the suffix "-opathy" simply means "disease." The conversational snippet above was about the following conditions:

  • Nephropathy — kidney disease
  • Retinopathy — disease of the retina, the area at the back of the eye that receives visual information and transmits it to the brain
  • Neuropathy — nerve disease

These three conditions are sometimes called the "triopathies" because they so commonly occur in concert as complications of diabetes.

Other common examples include:

  • Encephalopathy — disease of brain function
  • Coagulopathy — disorders of blood coagulation (clotting)
  • Cardiomyopathy — disease of heart muscle

The suffix "opathy" is a general term that covers a wide range of specific diseases; for example, nephritis indicates inflammation of the kidney and is one form of nephropathy.

"Well, Why Didn't You Say So?"

Often patients ask why doctors use terminology that is confusing to the layperson rather than "just using English" to say the same thing. Just yesterday, I received a copy of a letter sent from an ulcer specialist to a patient informing her that she had "intestinal metaplasia" — it's likely she did not know what this meant, and worse, she may have assumed it was something awful. (In fact, it means that cells of one type have been replaced by another type; it is a reason to maintain close follow-up and repeat evaluation, but it is not itself a dangerous condition.)

Asking why technical language is used is certainly a fair question, and one that is often raised in other disciplines, such as the legal profession. After all, there are ways to express the same thing without using these terms. The answers probably depend on the specific term and situation but include the following:

    • Shortcuts — Everyone, including health care professionals, likes shortcuts. Although it probably seems like a minimal reduction in the time required to write, type or say these terms rather than using less technical language, one word often works well in place of several.
    • Standardization — When health care professionals in different fields of medicine or in different locations use the same terminology with the same intent, it promotes a measure of understanding that may be missing if more descriptive (and more variable) terminology was used.
    • Precision — Sometimes, the "opathy" word is the single best choice to say exactly what is intended; lack of precision sometimes leads to miscommunication. For example, "cardiomyopathy" means heart-muscle disease, but just using the term "heart disease" could mean valve problems, a heart attack or an irregular rhythm. The appropriate term in the appropriate setting can reduce confusion between physicians (even as it may increase confusion for the patient).
    • Intended imprecision — It may be that there are times your health care professional would prefer to be vague, for example, when the situation is unclear. Using a medical term may allow him or her to "stall" until more definitive results are available or the problem is otherwise sorted out.
    • Inertia — Some terms have been used for so long, they are difficult to change or eliminate, even if they are not good ones. In fact, some terms not only confuse laypersons, but also confuse doctors, yet they persist. "Rheumatism" is a good example; it is still used by many health care professionals and patients, even though it may refer to rheumatic fever, rheumatoid arthritis or other aches and pains.
    • Exclusivity — Perhaps it's just human nature, but many professions have terms that only members of the profession use to leave out "nonmembers," sort of like a secret handshake. Among the many reasons for using technical language in medicine, this is the least compelling.

The Bottom Line

If you are not sure what a term means, especially as it relates to your health, ask for an explanation — your health care professional may assume you understand it if you don't speak up! As odd as it may seem, many doctors do not realize they are using terminology that a nonmedical person will not understand because day in and day out, that's how they talk. And recognize that as far as the terminology goes, there is no mystery — just alternative ways of saying things.

From the health care professionals' side, improving communication with patients has become a higher priority in recent years; this is particularly evident in the ways medical education has changed. And effective communication usually means using the patient's language, not "medicalese."

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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