In The Beginning Was the Word. A few observations on medical terminology
As a child you may have enjoyed Jerome K. Jerome’s novel “Three Men in a Boat”. If so, you probably remember J, the narrator, who after reading a patent medicine advertisement, discovered to his amazement, that he was a subject of all the diseases except housemaid’s knee. Since that time nothing has changed much, except more opportunities for self-checking are available via Internet and numerous apps. But the results are still confusing. Suddenly you realize that multiple diseases are hunting you.
Are people confused because of the lack of the basic medical knowledge hidden beneath a sophisticated terminology? Partially so. Another part is the obscurity of medical terminology itself. Ideally, a scientific, in particular, a medical term is a denomination that has a precise and fixed meaning, at least for a certain period of time. In “hard” sciences such as, e.g., physics, chemistry or even mathematics, terms are mostly of operational character i.e. they are based on measurable facts verified in multiple experiments. Think about such seemingly abstract notions as mass, weight, gravity, motion, etc. that all have a precise and specific meaning.
Contrary to that, medical terminology was traditionally based on the set of observations vaguely described by a patient and subjectively interpreted by a physician. With the development of modern medical technologies such as ECG (electrocardiogram), EEG (electroencephalogram), PET/CT (Positron Emission Tomography – Computer Tomography, etc. and with the advance of sensor-based devices able to register concrete biological and clinical expressions of the human organism, medicine drifted closer to science, but its terminology has largely remained the same, dwelling on old principles of opinions and intuition.
Unlike in natural sciences, the sheer number of available synonyms in medicine describing deviations from the state of health and labeled as diseases, ailments, pathologies, disorders, dysfunctions, disabilities, anomalies and so forth already implies diagnostic uncertainty and the possibility for misconceptions. To a great extent, medical terminology reflects not the cause, but the overt symptoms of the disease.
Take, for example, such a widely used diagnosis as “angina pectoris”. Sounds scientific and impressive, but a mere translation from Latin would be “a strangling feeling in the chest”. The American Heart Association defines angina pectoris as “the medical term for chest pain or discomfort due to coronary heart disease”. If angina is a coronary diagnosis in itself, how can it be defined through other coronary heart disease? The description of the so-called disease is described through an ensemble of external equally confusing conditions: pain in your arms, neck, jaw, shoulder or back accompanying chest pain, nausea, fatigue, shortness of breath, sweating, dizziness. One can easily confuse such warning signs with a mere tiredness, exhaustion caused by stress or lack of sleep. Women with high level of tolerance are especially failing to recognize the approaching heart attack. One in four women in the UK dies through heart disease according to the British Cardiac Patient Association being unable to identify the upcoming risk of cardio failure.
The situation is even worse in the area of psychology. For example, the whole bunch of notions related to autism is defined by Centers of Disease Control and Prevention (CDC) through rather subjective notions such as “disabilities that can cause significant social, communication and behavioral challenges”. The definition implies that there are certain stable social or behavior norms, deviations from which are branded as diseases. Often patients declared as autistic are treated with serious medications such as selective serotonin reuptake inhibitors (SSRIs) including citalopram, fluoxetine and sertraline. According to Autism Spectrum Disorders Health Center ”it is widely believed (!) that elevation of these chemicals is associated with improvement in mood in depressed people”. Thus the modern psychology is relying on its widely spread beliefs prescribing treatments that may cause quite unpleasant side effects such as nausea, restlessness, insomnia, headache, weight gain or loss, sexual disorders, etc. Autism, attention deficit disorder (ADD) and bipolar syndrome (formerly known as manic-depressive disorder) are common psychological disorders that are misdiagnosed because of their loosely described expressions.
The victims of ambiguity are, of course, patients. After going through numerous symptom checkers they, similar to J, suddenly realize that they are under attack of the array of diseases. For example, the abdominal pain could be a symptom of a harmless indigestion with constipation as well as the sign of endometriosis, acute poisoning, ulcer or appendicitis.
No wonder that patients are not satisfied with the numerous symptom checkers available online or as mobile applications. Thus Harvard Medical School research has tested 23 online “symptom checkers” run by brand names such as the Mayo Clinic, the American Academy of Pediatrics and WebMD, as well as lesser-knowns such as Symptomate. The study reflected the deep dissatisfaction of consumers. It reveals that as a whole all programs were astonishingly inaccurate. Symptom checkers provided the correct diagnosis in only 34 percent of cases, and within the first three diagnoses 51 percent of the time. One can hardly blame the software. It just reflects the traditional ambiguity of medical terminology based on non-measurable external manifestations of the disease.
Let us start with the basic – the pain. It is one of the most important indicators of the anomaly and one of the most challenging parameters for doctors to measure. Most of us were probably asked by a doctor to measure our pain from 1 to 8 (or 10 which is even more difficult). Beside the fact that people have different barriers of pain tolerance, it is not easy for an individual to spot the difference between, e.g., 6 or 7 pain levels.
But this can change. The new sensor-based technologies can provide more clarity on our body screams. Thus an Israeli biomed startup Medasence has developed a technology that mathematically measures pain in order to give doctors the best assessments. The pain monitor is a sensor-woven sleeve worn on a patient’s finger, which takes blood pressure, pulse, sweat, temperature and movement readings, using statistical tools to give an objective pain reading – noninvasively i.e. without disturbing a patient. Most important, it is measuring your own individual pain, not the statistical one.
Another vague symptom often discussed with your physician is fatigue. Fatigue could be a sign of severe disorders, but also a transitory mild violation, e.g., a consequence of the life style, workload or other routine activities. What is the difference between a normal fatigue level and the one we perceive as exhaustion? The Australian company EdanSafe has developed a Smart Cap, a fatigue monitoring system which can measure your electroencephalography or EEG by capturing your brain waves and detecting Alpha (8 Hz to 13 Hz), Beta (>13 Hz to 30 Hz), Gamma (from 30 Hz to >100Hz), Delta (up to 4 Hz), Theta (4 Hz to 8 Hz), and Mu (8Hz to 13Hz) each of them reflecting the specific type of the brain activity.
One day smart sensors and nanochips may be getting into the most sacred area of our body – the brain, thus breaching the strongest bastions of medical ambiguity – the psychology. Researches from MIT are experimenting with flexible electronic device which can be delivered into the brain via injection. By deciphering the patterns of electronic signals produced by neurons those brain nanochips may shed light on the brain’s dysfunctions, such as schizophrenia or Parkinson’s disease, gradually transforming psychology from a philosophical speculations into an objective science.
Will medical terminology adjust to new objective methods in healthcare in order to be more precise and understandable for patients and consumers? After all, medical terminology is also a living language. As we move to the patient-centric care, it is important that patients and physicians should clearly understand each other. As said: in the beginning was the Word.