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Most of us have heard the axiom, "be careful what you wish for." However, it often takes seeing your words in print to prove the truth of the phrase, "be careful what you say."

I learned the importance of that phrase when I was still a novice medical writer at the Houston Chronicle. In the pre-AIDS era, the scary sexually transmitted disease was genital herpes, and I wrote about it enough to have some familiarity with the topic. A frequent phrase that I used was that the disease could not be cured.

I thought my words were understandable enough until I got a telephone call one day. "My doctor says I have that herpes you talk about and I want to know how much longer I have to live," said the man at the other end of the line.

"Longer to live?" I asked. "What do you mean?"

"You always say it is incurable," he said.

I had, but I had never said it was terminal. I explained the difference and then asked him if he had told his wife yet. When he said he had not, I told him he would live at least as long as it took to have that discussion.

It was then that I realized that it was more important that the people for whom I was writing understood the words I used than that I understood them. It was the connotation rather than the exact definition that was important in communication.

It is not only the connotation of words that matters. It is also attitude. In many ways, the language of physicians conveys an attitude of paternalism and, at times, disappointment.

Why else would they write that patients fail treatment? Surely, it is the treatment that failed to cure or alleviate the disease of the patient.

Or why would they say that they "visualized" the (name your organ here)? Surely, it takes more than a mental imagining to determine the state of a vital organ?

Would it hurt say that they "used" an instrument rather than "utilized" it?

In truth, most physicians do not use this kind of language when they talk to patients, but they often use it in written communications. It is rife in consent forms and descriptions of studies or trials of new drugs or devices.

It is easy to laugh at people's mistakes or erroneous assumptions. The jargon of medicine is often arcane. A resident, for example, no longer lives in the hospital, but is instead pursuing a certification of specialization in a particular kind of medicine. When a person "sleeps on the floor" in a hospital, it means that he or she remains in the hospital and sleeps in an empty bed to remain close to the action. It does not mean that physician curled up on the linoleum with a blanket next to the patient's bed.

A common "old saw" in medical circles is the tale of the woman who became pregnant because she used her birth control pill as a vaginal suppository rather than an oral medication. However, in the grand scheme of things, who made the mistake and did not realize that she had no idea what the term oral meant in relation to birth control pills? And who paid the price?

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