usage

A Dirty Look at the AMA Manual of Style

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Remember how much fun you had reading The Elements of Style? How about the times you yukked it up over the ambiguity examples in Warriner’s English Grammar and Composition? Here is a classic to jog your memory:

As soon as the students had left the classrooms, the custodians cleaned them.

That’s entertainment!

You can revisit those days of abandon in the quest for clear writing, even if no one seems to chuckle when they consult the AMA Manual of Style. Maybe this owes to its being a behemoth. If you wish to consult the manual with a smile instead of grim determination, the opportunities are there.

Every so often, a nonassociation style guide becomes a bestseller. Such a chartbuster assumes that usage matters, and that correct usage rules and examples entertain and inform. Authors have climbed the list with pragmatism (thanks, Susan Thurman), charm (hi, Mary Norris), innuendo (I’m talking to you, Lynne Truss), or light-heartedness (howdy, Bill Bryson).

Some even go dirty, quick and dirty, as in Mignon Fogarty’s amazing Grammar Girl. I understand this. A down and dirty read (a basic, practical review and not a backstreet editing assignation) is often called for when deadlines loom.

But pragmatic or dirty, these bestsellers put their readers in good hands. That they entertain and inform offers a springboard for a quick dive into the ways that the style manual, in addition to assuring you that you’re in good hands, can entertain as it informs. Here is a representative down and dirty look at a portion of the manual.

If you hand out Halloween candy, you have seen the proverbial “fun size,” a bite that only leaves you wanting more unless it is a Butterfinger. My idea of fun size would be a candy bar as big as my arm. However, any amount of candy is fun (except a Butterfinger), so in that spirit, small can be fun size. By my original standard, the 1010-page Manual of Style is already fun size, but chapter 11 offers the overlooked qualities of being thought-provoking and entertaining. (So do chapters 7-10, 12, and 13, but that is another post.)

The online manual can take you right to 11 without the papercuts, but the idea is to look at its alignment with the tone of popular usage books. From a certain vantage, this chapter could stand as a compact usage book alongside other usage books that sell well. A fun size AMA style guide!

The “Correct and Preferred Usage” chapter starts with 2 fun quotations, one with empathy for proofreaders and another that mentions a porcupine. The entries begin with word choice examples aplenty (similar to Bryson’s look at troublesome words), with italicized labels and directives that establish a hierarchy (Incorrect, Correct, Also Correct, Avoid, Preferred, Also, and the apotheosis of middle ground, Acceptable).

Sometimes a truth plainly spoken is in itself amusing, and that truth can orient you toward correcting descriptive language. The entry “abnormal, normal, negative, positive” indicates “Examinations and laboratory tests and studies are not in themselves abnormal, normal, negative, or positive.” If you have gone around allowing authors to describe tests as negative, it can be bracing to see such clear direction.

The entry for Jargon offers a similar plain-spokenness. “….[D]rugs are usually neither systemic nor local but are given for systemic or local effect.” Parallelism can sharpen a keen awareness of specificity.

Because redundant words are always funny according to natural law, section 11.2, with its eye-opening list of redundancies, expendable words, and incomparable phrases, can supply abundant levity. You will also encounter a well-known quotation from Yogi Berra.

The legal profession once advocated plain language (ha ha!). Everyone talks about jargon, but the AMA Manual of Style does something about it. Granted, you can violate the manual’s jargon directives and still be allowed to walk around freely, vote, and drive a car, but if you see what Morris Fishbein wrote on page 408, you will never want to use jargon again. Even by accident or in an emergency.

Chapter 11 contains scores of other usage grace notes. Shakespeare’s Polonius says, “brevity is the soul of wit,” and you can verify that by looking up “describe, report” for an example. Even one of the longer entries (“because of, caused by, due to, owing to”) ends with a lovely Clue to usage (a one-off category) that brings it all home in 3 lines.

One-off labels nod toward the gray areas of usage, which are usually skillfully handled in style guides. The manual may be a behemoth, and another one-off category, Possible exception, under “adherence, compliance,” may help explain why. This example shows its accommodation of nuance. Nuance can take space.

Across its chapters, the manual draws from literature (Alexander Pope, Samuel Johnson, Mark Twain, Toni Morrison) for contextual quotations. Medical editing embraces the humanities in its quest for clarity.

For a good time, read chapter 11 of the AMA Manual of Style.  It shares some of the endearing qualities of the bestselling usage guides (except, I think, innuendo). Review the material when you aren’t searching for an answer. It’s not just for reference anymore.—Timothy Gray

 

Quoth the Raven

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The word impact as a verb comes up pretty often in the course of my work. I am not a fan (and neither is the AMA Manual of Style). I prefer to use affect instead, and when it comes to nouns I like effect better than impact, but I always had to stop and think about it and be sure that I was correctly using these words. I just could not remember. Then, a few weeks ago, I was poking around the internet and came across this useful mnemonic device, RAVEN.

“Remember: Affect is a Verb and Effect is a Noun.”

It’s not a new thing, but I hadn’t heard it before. It stuck in my mind because crows and ravens, those smart, handsome birds, are very interesting to me. Since then, I’ve noticed that the phrase popped into my head right away when I was confronted with the effect/affect question.

Happy Halloween!—Karen Boyd

 

 

People-First Language

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In the new Netflix series Atypical, a father attends a support group meeting for parents of children with autism. As he begins to describe how well his son has been doing lately as an “autistic person,” he is gently interrupted by the support group leader.  She stresses the importance of him using “people-first” language, that his son is not an autistic person, but rather a person with autism. When she intercedes again to remind him that his son can’t get “better” from autism, he stares at her blankly while his wife (who is more well-versed in the appropriate vocabulary) interjects with an explanation of their son’s recent progress using replacement behaviors.

The scene is played to parodic effect—the support group leader comes across as a pretentious pedant who pays more sensitivity to correct language use than to an exasperated father who is struggling to connect with his son. The insistence on using people-first language is seen as a distraction from what is really being communicated, and I couldn’t help but be reminded of similar reactions from authors over this same issue. How many times as a manuscript editor have I rolled my eyes when I’ve seen the phrase “the patient was diagnosed with” and known I’d have to significantly restructure the sentence? How many authors have been annoyed with the sea of red strikethroughs they encounter because their article is filled with “autistic patients” or “diabetics ” or “the disabled”?

But yet, whenever I explain to authors that AMA style is strict about not defining patients by their illnesses or survivors by their experiences, they get it. “Oh yeah,” they say, “that makes sense.” They understand that it’s important for patients to have autonomy and a sense of personhood, that it’s important to recognize that behind the data are human beings who trying to live their lives while facing all sorts of experiences, of which illness may only be one.

There has been considerable pushback from politicians, corporate leaders, and even comedians against what is seen as a culture of “political correctness,” with people bemoaning that there is a social imperative to use what they see as arbitrary substitutions for words that are considered insensitive or offensive. But what good word nerds know (and manuscript editors take that title with pride) is that words and the way we choose to use them are symbolic and communicate more than their definitions.  And that is why AMA style is committed to using its reputation as an industry standard to set a tone of inclusion and sensitivity for medical discourse, a tone that states that these values are not only accepted but required.—Amanda Ehrhardt

Weeds and Words

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Here at AMA Manual of Style headquarters, there is snow on the ground and all the weeds are mostly dead. However, that doesn’t mean we don’t “get into the weeds” on a near-daily basis, particularly during style manual committee meetings. Here’s a post from The Word Detective that explores, but does not solve, the mysteries of that phrase’s origin. —Brenda Gregoline, ELS

Reluctant, reticent

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These 2 terms are not interchangeable, although reticent is occasionally seen in informal usage as an imprecise synonym for reluctant.

Reluctant refers to someone who feels or shows doubt about doing something, not willing or eager, or feeling or showing aversion.  Synonyms are disinclined, dubious, hesitant, loath.

Dr Smythe was reluctant to share his preliminary, non–peer-reviewed research with the news media.

Reticent refers to someone who does not reveal his or her thoughts or feelings readily and is restrained in expression, presentation, or appearance.  Synonyms are reserved, withdrawn, introverted, inhibited, diffident, shy, uncommunicative.

 Professor Harrington has been described by colleagues and friends as “shy and reticent” but is also well known for his poise and calm demeanor during a medical emergency.

—Roxanne K. Young, ELS

 

Intention, Intent

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These words are used interchangeably in many contexts, and such usage is often perfectly acceptable. In some contexts, however, they do have slightly different meanings.1

Although both words connote an attitude of resolve toward a contemplated action, intention is the weaker term, often suggesting “little more than what one has in mind to do or to bring about”2 and sometimes also further signaling that the action was not or will not be acted on. If, for example, a speaker begins a sentence by saying “I had every intention of….” the listener knows very well the gist of what’s coming next, regardless of the words that actually follow.

Intent, on the other hand, is all business, suggesting a concentration of will and the active application of reason in making a contemplated action come to pass1: “They were rushing upon the old peasant with no very merciful intent.”3Intent often further signals that a contemplated action actually has been or will be carried out—which perhaps leads to its use in sentences such as “He who wounds with intent to kill…. shall be tried as if he had succeeded.”3 Perhaps for these reasons, intent is now most often encountered in legal communication,1,3 and its connotations in such contexts are well understood. Imagine, for example, that NBC’s Law & Order: Criminal Intent had instead been titled Law & Order: Criminal Intentions. Loses something, does it not?

Another difference between the words is that intention is a countable noun, whereas intent is an uncountable noun.4 So, whereas a person might have a veritable laundry list of intentions related to a contemplated action (one might, for example, speak of one’s intentions for the coming weekend), one typically has only a single state of mind—an intent—related to that action. In short, intention often suggests mere ambition to achieve something, whereas intent often suggests the application of reason to actually achieve it. A clue to the distinction is that the words usually take different prepositions: intention takes to (think “to-do list”) or of, whereas intent takes on or upon.5

Intent and intention can sometimes apply in the same instance. A person might, for example, have every intention of never gambling again, even while heading to the track intent on making a killing.

In medical contexts, the words appear in the constructions “intent-to-treat analysis” and “intention-to-treat analysis”— ie, analyses “based on the treatment group to which [study participants] were randomized, rather than on which treatment they actually received and whether they completed the study.”6 Although both constructions are used, in light of the negative connotations of intent, “intention-to-treat” might be preferable.

The bottom line:

● Intention and intent are often used interchangeably, and in many cases such usage is acceptable.

● However, although intention and intent both connote an attitude of resolve toward a contemplated action, intention is the weaker term, often suggesting mere ambition. Intent, on the other hand, suggests deliberate planning or the active application of the will to make an action come to pass.

● Although in medical contexts “intent-to-treat analysis” and “intention-to-treat analysis” are used interchangeably, given the negative connotations associated with intent, “intention-to-treat” might be preferable.—Phil Sefton, ELS

 

 

1. Ask the Editor: “Intent” and “Intention.” Merriam-Webster Learner’s Dictionary website. http://www.learnersdictionary.com/blog.php?action=ViewBlogArticle&ba_id=78. Accessed September 10, 2013.

2. Intention, intent. Merriam-Webster’s Dictionary of Synonyms. Springfield, MA; Merriam-Webster Inc; 1984:458.

3. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:861.

4. Intention or intent? Glossophilia website. http://www.glossophilia.org/?p=416. Accessed September 10, 2013.

5. Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:240.

6. Iverson C, Christiansen S, Flanagin A, et al. AMA Manual of Style: A Guide for Authors and Editors. 10th ed. New York, NY: Oxford University Press; 2007:873.

Significant and Significance

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If there is any doubt about whether significant/significance refers to statistical significance, clinical significance, or simply something “important” or “noteworthy,” choose another word or include a modifier that removes any ambiguity for the reader.

The AMA Manual of Style (§20.9, Glossary of Statistical Terms, pp 893-894 in print) includes definitions for statistical significance (the testing of the null hypothesis of no difference between groups; a significant result rejects the null hypothesis) and clinical significance (involves a judgment as to whether the risk factor or intervention studied would affect a patient’s outcome enough to make a difference for the patient; may be used interchangeably with clinical importance). Significant and significance also are used in more general contexts to describe worthiness or importance.

Often the context in which the word appears will make the meaning clear:

▪ Statistical Significance:

• Exposure to the health care system was a significant protective factor for exclusive throat carriage of Staphylococcus aureus (odds ratio, 0.67; P = .001).

• Most associations remained statistically significant at the adjusted significance level (P < .125).

▪ Clinical Significance:

• Low creatinine values in patients with connective tissue diseases were found to be clinically significant.

• The combination of erythromycin and carbamazepine represents a clinically significant drug interaction and should be avoided when possible.

▪ Worthy/Important:

• His appointment as chair of the department was a significant victory for those who appreciated his skill in teaching.

• A journal’s 100th anniversary is significant and should be celebrated.

Sometimes, however, the context does not clarify the meaning and ambiguity results.

▪ The one truly significant adverse effect that has caused carbon dioxide resurfacing to lose favor is hypopigmentation, which can be unpredictable and resistant to treatment.

To avoid the possibility of ambiguity, some have recommended confining the word to only one of its meanings. However, why cheat a word of one of its legitimate meanings when there are ways to retain its richness and yet not confuse the reader?—Cheryl Iverson, MA

Option, Alternative, Alternate

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Alternate means “one after the other,” whereas alternative means “one instead of the other”1—and option and alternative are essentially the same thing. Easy peasy, no?

Well, no. At least not quite.

Although few writers would incorrectly use alternative in place of alternate in the sense of “one after the other,” there are subtle differences between these words—and between option and alternative, as well—when they are used in other senses. The potential for confusion is readily apparent when one considers, for example, that option has been defined as “something that may be chosen”2(p871); alternative as “one of two or more things, courses, or propositions to be chosen”2(p37); and alternate as “one that substitutes for or alternates with another”.2(p37) And that’s considering only the use of these words as nouns. As an adjective, alternative has been defined as “offering or expressing a choice” and alternate as “constituting an alternative.”2(p37)

So—is there a way through this thicket?

Option and choice are usually considered interchangeable, but an alternative is an option or choice that stands “instead of the other.”1 Thus, a person faced with numerous options (choices) will always have one more option than alternatives.3 (Some authorities have proposed that alternative should be used only when no more than 2 choices are available. However, few writers observe this distinction.3,4) For example, a diner presented with a dessert menu that lists 4 desserts will—assuming a 1-dessert limit—have 4 options (ie, choices) but only 3 alternatives. Furthermore, it is usually assumed that one of the options will be the original or preferred one, to which the others are alternatives. For example, on that dessert menu, the red velvet cake, tiramisu, and crème brûlée might be alternatives to that triple fudge ganache lava brownie that one has been ogling, in the event that the server comes back with the sad news that the brownie has apparently been everyone else’s first choice as well.

But things get a bit fuzzy when it comes to the choice between alternative and alternate. As suggested above, these words have acquired meanings that are quite close. When a distinction is made, it would seem to hinge on whether a degree of compulsion is in play, with alternative preferred when such compulsion is not present. For example, a person selected to serve as an alternate juror has little choice in the matter; similarly, whereas a person planning a trip might well map out several alternative routes, the same person faced with an unexpected road closure is forced to take an alternate route.5 And, although option and choice can be used interchangeably, alternative has a bit more nuance than choice, suggesting “adequacy for some purpose.”4 Alternative also can suggest a “compulsion to choose”4—although in this case the compulsion is to choose between alternatives (eg, “The alternatives are liberty and death,”4) rather than, as is the case with alternate, a compulsion or duty to serve in place of another (eg, alternate juror, alternate batter).

In practice, although some authorities still advocate maintaining the traditional distinctions between alternative and alternate, actual usage is changing rapidly, and alternative is now often used when a noun is called for and alternate when an adjective is called for.6 However, a big nota bene for medical writers: alternative is used as an adjective in medical contexts when referring to nonallopathic medicine, treatments, or therapies, such as acupuncture, homeopathy, etc. So, the adjective alternate is certainly preferred when referring, for example, to different allopathic treatment choices available to a patient (eg, “the consulting physician recommended surgery but also proposed 3 alternate approaches”).

The bottom line:

● Looking for a word that indicates “one after the other”?1 Use alternate (eg, “Alternate smiles and frowns, both insincere.”7)

● An alternative is by definition an alternative to something else—usually a preferred choice or original plan of action—so one will always have 1 more option than alternatives.

● Although some authorities still maintain the traditional distinctions between alternative and alternate, usage is changing rapidly, and alternative is now often used when a noun is called for and alternate when an adjective is called for—but in medical contexts, the adjective alternative is often used in reference to nonallopathic medicine, treatments, or therapies.—Phil Sefton, ELS

1. Alternate/Alternative. In: O’Conner PT. Woe Is I: The Grammarphobe’s Guide to Better English in Plain English. 3rd ed. New York, NY: Riverhead Books; 2009:88.

2. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003.

3. Fogarty M. Quick and Dirty Tips: “Alternate” Versus “Alternative.” Grammar Girl website. http://grammar.quickanddirtytips.com/alternate-versus-alternative.aspx. Accessed January 16, 2013.

4. Alternate; alternative. In: Garner BA. The Oxford Dictionary of American Usage and Style. New York, NY: Oxford University Press; 2000:18.

5. Alternate vs. alternative. Grammarist website. http://www.grammarist.com/usage/alternate-alternative/. Accessed March 27, 2013.

6. Alternate, alternative. English Forums website. http://www.englishforums.com/English/AlternateVsAlternative?bzxvg/post.htm. Accessed January 16, 2013.

7. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:41.

Aegis

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“Recognizing that the genetic contribution to health disparities is likely to be relatively limited is not the only reason to question the wisdom of promoting genetic research under the aegis of health disparities.”1

“In several examples published under the aegis of the [Agency for Healthcare Research and Quality], the benefit side rests on the data from randomized controlled trials….”2

“[T]his definition and associated regulations have become de facto rules for US academic and other research institutions and are applied to any work done by their employees or under their aegis regardless of the source of funding.”3

While somewhat infrequently encountered in medical writing, aegis is occasionally used in content related to health policy, institutional oversight, or the conduct of research. It also is occasionally used to refer to a journal’s vouching for the validity of data or other findings published in its pages; when such validity is called into question, a journal may issue a full retraction or simply “withdraw aegis,” ie, issue a statement to the effect that the journal is no longer responsible for the data.4

In its original sense, aegis (Greek aigis [goatskin]) referred to the shield or protective cloak worn by Zeus or Athena in the myths of ancient Greece.5 In the centuries since, the word has by association come to be used idiomatically to indicate defense (“Feeling is the aegis of enthusiasts and fools.”6) or guidance or influence (“They made their valuable individual contributions, but under the Ellington aegis they found themselves constantly enriched musically.”6). Similarly, the word is perhaps most often used in the construction “under the aegis of” to express patronage or sponsorship (“under the aegis of the museum”) and, especially, protection (“a child whose welfare is now under the aegis of the courts”).5

All of which is perfectly comforting. However, the classical roots of the word are far less benign. Whereas aegis-like shields appear in Egyptian, Nubian, and Norse mythology and art,7,8 the most elaborate account of the origins and attributes of the aegis comes, as suggested above, from the narratives of ancient Greek mythology and literature, in which it is consistently depicted as an object possessing fearsome supernatural power.

In one such narrative, the goat deity Amaltheia suckles the infant Zeus, who then—in the curiously detached manner so frequently encountered in mythological accounts—breaks off her horns and flays her hide. From one of her horns Zeus fashions the cornucopia, or horn of plenty; from her hide, he fashions the shield or cloak that would come to be called the aegis, which he then wears, on the counsel of an oracle, into battle against the marauding Titans.9 However, in the hands of Zeus, king of the gods, the aegis is more than a protective device; when in his wrath he shakes the aegis from his perch atop Mount Olympus, thunder crashes, bolts of lightning slash the sky, and fierce storms devastate the land.10 Moreover, in the Iliad, Homer describes the device as the “tempestuous terrible aegis, shaggy [and] conspicuous… given to Zeus to the terror of mortals.”11

But the aegis is associated with deities other than Zeus. In the Iliad, for example, Zeus lends the aegis to Apollo, who wields it to push his enemies back to their ships12; in other accounts, Zeus lends the aegis to his daughter, Athena, goddess of war,12 or presents it to Athena after his conquest of the Titans.9 In the most colorful account, Zeus swallows his wife, Metis, whole—after which Athena is born from Zeus’ head, emerging fully formed and bearing the aegis and other weapons of war.13 Regardless of how Athena comes to possess the aegis, however, in her hands it becomes more formidable still. For example, in the Iliad Homer reverently describes the aegis as no mere goatskin but rather as “ageless and immortal,” worn by “bright-eyed Athene” and adorned with tassels of the purest gold12; moreover, elsewhere in the Iliad he describes the aegis as a dramatic golden cloak fashioned by Hephaistos, god of fire and metalwork,14 to resemble a scaly skin like that of a snake, linked and fringed with writhing serpents, and bearing in its center the severed head of the Gorgon Medusa, eyes rolling and scalp also bristling with serpents.11

Charming as this may be, given the provenance of the word and the fell associations that come with it, how did aegis, apart from its military associations, come to be used to express defense or protection? Perhaps more puzzling, how did it come to be used to express benevolent guidance, influence, or patronage? A possible clue is that whereas early accounts often depict Athena as cultivated, civilized, urbane, and wise, the economy of ancient Greece was bolstered by military pursuits, and in short order Athena came to be depicted as the goddess of war—although, importantly, her military might was tempered by the cultivation and divine wisdom earlier attributed to her.15 Thus, Athena is sometimes viewed as having 2 sides. The first is characterized as wrathful, tempestuous, and destructive; however, the other is characterized as divinely beneficent and endowed with the inclination and ability to grant the gifts of aid, wisdom, and protection to favored mortals.16 The power of both sides is wielded through the supernatural power of the aegis—hence Homer’s description of the device in the Iliad and its depiction in visual art as inky black or brilliant gold.11,12,16

Interestingly, however, while Athena extends divine beneficence and protection—backed by the wrathfulness also attributed to her—she does not authorize those mortals fortunate enough to come under her favor to act on her behalf. Thus, whereas in current usage aegis is correctly used to express defense, protection, guidance, influence, patronage, or sponsorship, its use to indicate “under the jurisdiction of” is considered incorrect.17 —Phil Sefton, ELS

1. Sankar P, Cho MK, Condit CM, et al. Genetic research and health disparities. JAMA. 2004;291(24):2985-2989.

2. Vandenbroucke JP, Psaty BM. Benefits and risks of drug treatments: how to combine the best evidence on benefits with the best data about adverse effects. JAMA. 2008;300(2):2417-2419.

3. Iverson C, Christiansen S, Flanagin A, et al. AMA Manual of Style: A Guide for Authors and Editors. 10th ed. New York, NY: Oxford University Press; 2007:157.

4. Hammerschmidt DE, Franklin M. The limits and power of peer review. Minn Med.

http://www.minnesotamedicine.com/PastIssues/PastIssues2006/June2006/CommentaryHammerschmidtJune2006/tabid/2527/Default.aspx. June 2006. Accessed February 13, 2013.

5. Aegis. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003:19.

6. Aegis. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:22.

7. Aegis: in Egyptian and Nubian mythology. Museum of Learning Web site.

http://www.museumstuff.com/learn/topics/aegis::sub::In_Egyptian_And_Nubian_Mythology. Accessed February 15, 2011. 8. Aegis: in Norse mythology. Museum of Learning Web site. http://www.museumstuff.com/learn/topics/aegis::sub::In_Norse_Mythology. Accessed February 15, 2011.

9. Amaltheia. Theoi Project Web site. http://www.theoi.com/Ther/AixAmaltheia.html. Accessed February 13, 2013.

10. Zeus. Theoi Project website. http://www.theoi.com/Olympios/Zeus.html. Accessed February 13, 2013.

11. Hephaistos Works 2. Theoi Greek Mythology Web site. http://www.theoi.com/Olympios/HephaistosWorks2.html. Accessed February 13, 2013.

12. Teleporter: aegis mound. Entropia Planets Web site. http://www.entropiaplanets.com/wiki/Teleporter:Aegis_Mound. Accessed February 13, 2013.

13. Athena. Theoi Project Web site. http://www.theoi.com/Olympios/Athena.html. Accessed February 13, 2013.

14. Hephaistos. Theoi Project Web site. http://www.theoi.com/Olympios/Hephaistos.html. Accessed February 13, 2013.

15. Athena. Encyclopedia Britannica Online. http://www.britannica.com/EBchecked/topic/40681/Athena?anchor+ref85160. Accessed February 13, 2013.

16. Deacy S, Villing A. What was the colour of Athena’s aegis? J Hellenic Stud. 2009;129:111-129. http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=6779888. Accessed February 13, 2013.

17. Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:29.

Emergency, Emergent, Urgent

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As I was editing a manuscript on patients undergoing surgery for brain tumors, I came across the sentence, “Patients who required emergency care were admitted to the hospital and classified as needing emergent or urgent surgery.” As I reread the sentence, the terms emergency, emergent, and urgent started to swim before my eyes, each backstroking to take the place of the other. Soon I was reading, “Patients who required urgent care were admitted to the hospital and classified as needing emergency or emergent surgery.” And then, “Patients who required emergent care were admitted to the hospital and classified as needing emergency or urgent surgery.” What was going on? Was my late-night habit of perusing stylebooks and usage guides before bedtime starting to produce side effects (oops, I mean adverse effects)? Was I no longer able to delineate the difference between commonly used medical terms? I had to take action.

Diligent medical copy editor that I am, I turned to my bookshelf, which is chock full of dictionaries and grammar, usage, and editing books. Now I would be able to solve this conundrum. I would take this problem step by step, or rather word by word, and find the resolution. Here’s what I found:

Emergency

Stedman’s Medical Dictionary1 defines emergency as “an unexpected development or happening; a sudden need for action.”

Dorland’s Illustrated Medical Dictionary2 defines emergency as “an unlooked for or sudden occurrence, often dangerous, such as an accident or an urgent or pressing need.”

Merriam-Webster’s Collegiate Dictionary3 defines emergency as “an unforeseen combination of circumstances or the resulting state that calls for immediate action.”

Consensus! There’s nothing a copy editor likes better.

Resolution: An emergency is basically an unexpected event that requires immediate action.

Emergent

Dorland’s defines emergent first as “pertaining to an emergency” and second as “coming into being through consecutive stages of development, as in emergent evolution.”

Stedman’s omits the definition stemming from the term emergency and defines emergent first as “arising suddenly and unexpectedly, calling for quick judgment and prompt action” and second as “coming out; leaving a cavity or other part.”

Merriam-Webster’s defines emergent as “arising unexpectedly” or “calling for prompt action.”

This one’s a little trickier. Dorland’s relates the term emergent to emergency and Stedman’s and Webster’s simply define emergent as the adjectival form of the noun emergency. So, is there a difference between these 2 words or are they synonymous? It was time to reach deeper into my bookshelf.

I first turned to the classic text A Dictionary of Modern English Usage by H. W. Fowler.4 I knew Fowler wouldn’t let me down. Fowler’s entry on emergence and emergency reads as follows, “The two are now completely differentiated, -ce meaning emerging or coming into notice, and -cy meaning a juncture that has arisen, especially one that calls for prompt measures.”

After some additional research, I found this entry in Common Errors in English Usage by Paul Brians5: “The error of considering ‘emergent’ to be the adjectival form of ‘emergency’ is common only in medical writing, but it is becoming widespread. ‘Emergent’ properly means ‘emerging’ and normally refers to events that are just beginning—barely noticeable rather than catastrophic. ‘Emergency’ is an adjective as well as a noun, so rather than writing ‘emergent care,’ use the homely ‘emergency care.’”

Eureka! Emergent means beginning to arise and emergency means arising unexpectedly.

Resolution: Use emergent to mean emerging (as in Dorland’s section definition of “coming into being through consecutive stages of development, as in emergent evolution”) and emergency to mean an unexpected event that calls for immediate attention.

But then what about urgent?

Urgent

Neither Dorland’s nor Stedman’s defines the term urgent.

Merriam-Webster’s Collegiate Dictionary defines urgent as “calling for immediate action.”

So, can urgent and emergency be used interchangeably? The Children’s Hospital of Wisconsin website provides a list of surgery types. It groups urgent or emergency surgery and defines it as surgery “done in response to an urgent medical need, such as the correction of a life-threatening congenital heart malformation or the repair of injured internal organs after an automobile accident.”6 However, the website Trivology.com states, “There is major difference between elective, urgent, emergency surgery. In urgent surgery we can wait until the patient’s health is unwavering but it has to be performed in 1-2 days. But emergency surgery needs to be performed without any impediment otherwise there will be colossal risk to patient’s life.”7

Therefore, in medical editing, be careful of changing emergency to urgent because emergency means immediate attention is required and urgent indicates quick but not immediate action is required. There is no such thing as emergent surgery unless you mean surgery that is just beginning.

Resolution: Although emergent and urgent both indicate calls for swift action, urgent is more, well, urgent.

Well, there you have it. I guess that original sentence I was editing makes sense after all. “Patients who required emergency surgery [immediate surgery because of the unforeseen nature of the incident] were admitted to the hospital and classified as needing emergent [with a few hours] or urgent [within 24 hours] care.”— Laura King, MA, ELS (January 2013)

1. Stedman’s Medical Dictionary. 26th ed. Baltimore, MD: Williams & Wilkins; 1995.

2. Dorland’s Illustrated Medical Dictionary. 32nd ed. Philadelphia, PA: Elsevier Saunders; 2012.

3. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003.

4. Fowler HW. A Dictionary of Modern English Usage. 2nd ed. Oxford, England: Oxford University Press; 1965.

5. Brians P. Common Errors in English Usage. 2nd ed. Sherwood, OR: Williams James & Co; 2008.

6. The Children’s Hospital of Wisconsin website. Types of Surgery. http://www.chw.org/display/PPF/DocID/22082/router.asp. Accessed January 10, 2013.

7. Trivology.com. http://www.trivology.com/articles/209/what-is-elective-surgery.html. Accessed January 10, 2013.