Physician, explain thyself: science English vs lay English

Doctors and scientists may be brilliant in their fields but some may not be great at communicating their knowledge to the rest of us. This is obviously important when doctors are explaining things to their patients, as it is when research scientists are seeking to engage the public with their work. To succeed, the experts need to tailor their language to a lay audience.

There’s a lot of good advice you can get on how to tell engaging stories about science, and on how to apply principles of clarity and coherence to scientific prose. But, like Vincent Vega in Pulp Fiction, what strikes me most is the little differences between lay English and the English of biomedical science.

I’m going to talk you through a few of the things that I notice again and again as a copyeditor. Biomedical science is my patch, but some of these points will apply to any expert who wants to address an audience of outsiders.

Jargon

Specialist terms are great among specialists, but they can make an outsider’s brain shut down. Everyone knows this, but specialists often underestimate how niche their own jargon is. If you and all your colleagues use a word every day for years, it becomes familiar and obvious. But that doesn’t mean knowledge of it has spread more widely.

For example:

  • A study in the American Journal of Emergency Medicine found that 79% of adult patients in a US hospital emergency department didn’t know that “hemorrhage” was bleeding; 38% didn’t know that “sutures” were stitches; 78% didn’t know that a “fractured” bone is a broken bone (sorry to say, nor did I!).
  • In the UK, the Wellcome Trust Monitor survey of the public found that 48% of adults felt they had a good understanding of the term “DNA” and another 37% some understanding. But only 12% felt they had a good understanding of “human genome” and 14% some understanding; 19% had heard of it but didn’t understand it and 52% had never heard of it.

Steven Pinker writes insightfully about this “curse of knowledge” and how to overcome it. The best trick is to show your writing to an outsider and see what puzzles them. Failing that, you should try to distance yourself from your writing when you review it, and err on the side of caution.

Unless part of your aim is to educate people about specialist terms, avoid them where you can by substituting general descriptions (“parts of a cell with specialised functions” instead of “organelles”) or common names, if they exist (“white blood cell” instead of “leukocyte”). Where you need to use them, introduce them with short, straightforward definitions – and then use them consistently.

The more terms you introduce, the more the reader will struggle – even if you explain each one clearly, newly learned words are harder to keep in mind than old, familiar ones.

I do not think it means what you think it means

Jargon can bewilder people, but they do at least know it when they see it. Potentially more confusing is when everyday words, used in well-known ways by most of us, are used in subtly or completely different ways by scientists (whether across the board or just in certain fields).

For example, in the context of communicating climate science, a paper in Physics Today lists several such words, including:

  • Scientists use “theory” to mean an explanatory framework, but the public use it to mean a hunch or speculation.
  • Scientists use “uncertainty” to mean the range of an estimate, but the public use it to mean ignorance.
  • Scientists use “positive trend” to mean an increase and “positive feedback” to mean a vicious circle, but the public use “positive” to mean good.

In the same vein, a report by the Royal College of General Practitioners cautions that while doctors use “chronic” to mean persistent, patients may think it means severe.

And a few that I’ve come across recently:

  • Scientists may use “determine” to mean influence, but it’s commonly understood to imply more complete control.
  • Scientists use “significant” to mean they’re confident an observation isn’t just chance, but it’s commonly understood to mean important or telling.
  • Scientists may use “fraction” to mean a part, but it commonly has a connotation of being a small part.
  • Scientists and doctors may use “insult” to mean biological damage or injury, but, as the common phrase suggests, insult and injury are widely understood to be different.
  • Doctors often use “trauma” to mean physical damage, but it’s commonly used psychologically.
  • Scientists use “factor” in several specific ways, but to most people it’s vaguer, normally meaning an aspect of a situation that contributes to something happening.
  • Biologists often use “fate” to describe the result of a cell’s development. I like the poetry of this, but for most of us, the word has strong connotations of inevitability and death.
  • Biologists use “analogous” to mean having the same function but a different evolutionary origin; ordinarily, it just means similar to.
  • Scientists may use “predict” to mean give information about or indicate, without the predicted thing necessarily being in the future – the word’s normal meaning. This might make sense from the perspective of a scientist who has yet to examine the predicted thing, but that can confuse lay readers.

Speaking of perspective…

Points of view

Scientists writing about their research in journals rightly take a scientist’s perspective. And science writers who want to tell a story about a scientist’s work can sensibly do the same, although in a different way.

But when the focus is on the subject matter of the science rather than the process of doing it, and when the audience is general, some verbal habits can carry over from journals in little ways – turns of phrase that make prose a bit harder for a lay reader to get into.

For instance, people with a medical condition might be called “patients” or even “cases”.

Being a patient is a limited role rather than an identity. For doctors, who see us in their professional capacity, we definitely are their patients. And we accept that. But after we go home or back to work, that role recedes. To be a patient is typically to be receiving treatment; just having a condition doesn’t quite cut it.

And “cases” is reasonable from an epidemiological point of view, but maybe not if those cases are your readers.

Then there are a few words that shift the perspective from the subject matter to the observations of the people working on it. Writing about “a child showing symptoms of flu” puts the reader in the shoes of the doctor to whom these symptoms were shown. Likewise “presenting” and “displaying”. If you’re writing about what the doctor saw and did, that’s fine. If not, try just “a child with symptoms of flu”.

In with the in crowd

Prepositions are slippery little suckers. These are the words that show relationships between things: on, in, near, under, about, before, during, of, from, to, by…

There are only a couple of hundred prepositions in English, which means they each tend to accumulate a lot of uses. The OED lists 63 definitions of “on”, not counting the archaic or obsolete ones. Which uses go with which prepositions is often arbitrary, and people speaking a second language can easily slip up (French “sur” doesn’t neatly match those 63 English “on”s).

I’ve noticed that in biomedical English, some of the preposition use is different from that in lay English. The biggest difference is with “in”.

I come across descriptions of treatments working in (not for) patients, studies in (not of or on) mosquitoes, drugs used in (not on or for or against) hypertension, bacteria that are deadly in (not to) mice…

Why is this? I think it may be perspective again. If you’re a scientist examining something (a patient, a mosquito, hypertension, a mouse), it may be natural to think of that thing as a container – figuratively or literally – of observable phenomena. So things happen in it. Maybe.

But to laypeople, this sort of language is unusual. It’s a small but distinct sign that a piece of writing isn’t meant for us. And if it is meant for us, that sign is a mistake.

In a similar vein, there are some differences in how articles are used.

Doctors and medical scientists often write things like “prospects for recovery after stroke” while most lay people would say “prospects for recovery after a stroke”. Likewise, compare “damage to visual cortex” and “damage to the visual cortex” (assuming that “visual cortex” isn’t too jargony).

So…

I hope some of this might be helpful. If you have any thoughts on things I could add or change, please let me know in the comments.

Update: I want to stress that while I’ve focused on science and medicine, the problems of insiders talking to outsiders can pop up anywhere. The social sciences, humanities and arts have their own ways of using language. So do people in pretty much any line of work: rocket scientists and brain surgeons, managers and politicians, plumbers and hairdressers.

Has a mechanic ever told you what was wrong with your car while you nodded along dumbly and reached for your wallet?

For any organisation you might you work in, you and your colleagues will know more about it, and probably talk about it differently, than people who don’t (or new starters).

Even socially, if you tell someone an anecdote about a person or situation they don’t know, you may need to fill in some of the background for them to understand it properly.

And I suppose even language bloggers might use too much editing or linguistics jargon from time to time. Sorry about that…

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Comments

  • David Colquhoun  On November 27, 2014 at 9:48 am

    “Scientists use “significant” to mean they’re confident an observation isn’t just chance”
    Hmm, not scientists who know what they are talking about: http://rsos.royalsocietypublishing.org/content/1/3/140216

  • Steve Vernon  On November 27, 2014 at 10:45 am

    Reblogged this on YOURS IN STORYTELLING… and commented:
    A lot of times I’ll hear a doctor speaking and I will wonder to myself just what the heck that fellow is saying. And I have watched a LOT of House episodes.

    My wife went back to college and is now working in a hospital and I hear an awful lot of medical jargon getting tossed around.

    So I get a lot of what this blogger is talking about.

    SO – how many of you writer-types out there have characters in medical professions?

  • Tyrrell Cottage  On November 27, 2014 at 11:03 am

    This is a great blog post, Tom – thanks.

    Doctors’ use of the word ‘acute’ is another one that gets me. Like ‘chronic’, it sounds serious, but in a slightly vague way – not what you want from a diagnosis…!

  • Ilovepigenetics  On November 27, 2014 at 1:16 pm

    this is a much-needed article. From my PhD on, my mentors have made me aware of how what I wrote and what words I used affected individuals and people we were writing about in these documents.

    One thing we seriously need to consider is gene names. For example, I am the founder of a non-profit thet advocates for a rare condition that results in primary infertility. Women are born with an underdeveloped reproductive tract that usually is incapable of sustaining a pregnancy, although our ovaries normally are fine. This condition, called MRKH (named after the four physicians who first described it) falls under a larger umbrella of differences in sex development where the gonads may not match the outward genitalia. These conditions are usually quite traumatic for the family and the affected individual.

    Drosophila researchers love to think up quirky gene names. One of these is called Ken and barbie. Mutations in Ken and barbie cause a lack of external genitalia in males. The official human nomenclature uses the gene name that describes the pathway, thankfully. However, there are papers in the human literature that use this pejorative gene name. It is not fun to tell parents or an affected individual that they or their child has a mutation in these quirky gene names. We all need to pause a bit and really think about the words we use.

    Another example is disorder. This is a neutral term in the medical community, but affected individuals feel that the medical community is calling them disordered. This is not about us educating the affected population. This is about the biomedical research enterprise becoming sensitive to the population we are serving.

    • muddybootsandfingernails  On December 1, 2014 at 9:45 am

      That’s a really good point about the use of ‘funny’ gene names and communication to families with genetic conditions. I’d never considered it.

  • surgeryattiffanys  On November 27, 2014 at 8:24 pm

    Great post, we (doctors) often forget that our daily language doesn’t exist in everyday life. When I talk to patients, I do try very hard to keep it simple and clear without jargons. However, when I blog, I am not so pedantic about it. I have both medical and non medical readers on my blog and I try very hard to accommodate both. However, I do find that the momentum, feel and authenticity of the stories can often be lost if it is ‘dumbed down’ too much, especially when one has to insert an extra sentence here and there just to explain one or two words in the previous sentence. If the jargon doesn’t contribute that much to the overall meaning of my post, I usually just let it ride.

  • Chris Freeman  On November 27, 2014 at 11:03 pm

    Significant and important posting. How can trainee (and old hand) doctors appreciate how important the words they use to their patients are?

  • Doctor Cinnamon  On November 30, 2014 at 2:56 pm

    So true! Thanks for this precious reminder and guide lines. I very much resonate with all this from the perspective of a physicist (http://arxiv.org/abs/1210.0082).
    I’ll do my best to avoid these traps into the “curse of knowledge”.

  • muddybootsandfingernails  On December 1, 2014 at 9:52 am

    Lovely round-up of some of the worst offenders. I’m a science writer in my day-job, but I think even I’ve fallen into the ‘in’ trap (e.g. ’causes X in mice’).

    Another example is ‘morbidity’, often used by clinicians to mean an illness you live with, but conversely with a ‘deathy’ meaning to everyone else.

  • Lev  On December 4, 2014 at 11:32 am

    I rather think the real problem with newspaper articles about science is that they are written by people that totally misunderstand what they are writing about.

  • Conrado Fontanilla  On December 7, 2014 at 2:42 am

    I can do science (wrote my own undergraduate thesis, edit thesis -masteral and dissertation) and write about science. That is, translate a technical article into layman language. The language (English) is the first barrier when writing for an audience to whom English is the second language. Given that the audience is proficient enough in English, I have to consider what Ludwig Wittgeinstein said about “language game.” A certain field has its own language game. In tennis, “love” means zero. At least that is how I understand it. In medicine, “heart disease” means narrowing of arteries that supply blood to heart muscles. To understand a certain field of knowledge one has to master its language game. A medical journalist must master the language game of medicine and the language game of the layman or his/her audience.

  • دانلود فیلم  On December 26, 2014 at 3:25 pm

    very good

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