“Neurologic” or “Neurological”? Settling Semantics
We dive into two professional societies’ recommendations for common word choice discrepancies in medical documentation.
Professional Society: American Academy of Neurology
Year: 2008
The American Academy of Neurology (AAN) is the world's largest professional association of neurologists and neuroscience professionals, leading efforts in medical education, scientific research, and advocacy for both neurologists and their patients. In an effort to ensure presenters for its 2008 AAN Annual Meeting produced materials with standardized language, the AAN published the American Academy of Neurology Writing Styles and Standards Guide. The guide offers insight into how physicians write and settles common style debates, such as:
apostrophes: Apostrophes should not be used to create the plural form of an all-capital abbreviation, number, or year.
Example: EEGs, MRIs, “patient in his 30s,” “the early 00s”
capitalizing titles: Capitalize prepositions ≥5 letters, lowercase prepositions with fewer.
Example: After, in
education vs. educational: Use "education" when referring to a specific program (the what) and "educational" when referring to its qualities (the how).
Example: "Dr. Garcia creates helpful education programs. Her lectures are educational."
health care vs. healthcare: Always use health care.
neurologic vs. neurological: "Neurologic" is always preferred over its longer counterpart.
Example: "neurologic examination," "neurologic disease"
Note: -ical is sometimes necessary to distinguish from the -ic form of words. For example, biologics are a distinct class of medication and cannot be referred to as “biologicals”; similar, the classical pathway for complement activation cannot be referred to as the “classic pathway.”
Professional Society: American Medical Association
Year: 2020
Our discovery of the AAN's writing style guide led us, in turn, to the AMA's Manual of Style. The AMA's guide is extensive, so we will focus on highlights from its “Correct and Preferred Usage” section. This section shares a similar mission to the AAN's guide: reducing phrase heterogeneity and improving clarity.
capitalizing titles: Capitalize prepositions ≥5 letters, lowercase prepositions with fewer.
Example: Capitalize “After” but lowercase “the”.
chief complaint vs. chief concern: Both are technically correct, but “chief concern” is preferred as it does not carry the potential stigma that “complaint” might if a patient were to read their chart.
die from vs. die of: Always use “die of” when referring to death due to disease or complications.
Example: “died of complications post-transplant”
dose vs. dosage: Dose refers to the quantity administered at one time whereas dosage refers to the overall regimen—a series of units given over time.
Example: “She received a dose of 40mg twice a day, meaning her dosage was 80mg/d.”
systemic vs. local: It is nearly always better to avoid writing “systemic” or “local” when referring to a drug. While the intent is to describe a drug’s effect, these terms are nonspecific and often inaccurate. For instance, topical steroids have systemic effects which are not clinically insignificant. Instead, its better to simply write the route of administration (e.g., topical, nasal, ocular).
Exception: Local anesthetics are a drug class so must be referred to in this manner. Not to be confused with the techniques for delivering anesthesia which are general, local, and regional.
Exception: Chemotherapy and hormonal treatments may be referred to as systemic therapies.
ultrasonography vs. ultrasound: Not interchangeable! Use ultrasonography when referring to the imaging procedure. Ultrasound is correct when referring to the actual sound waves that penetrate the body during ultrasonography.
Example: “Samuel Hamilton underwent RUQ ultrasonography to evaluate for causes of his pain and nausea.”
vision vs. visual acuity Vision refers to a patient’s reported ability to see. Visual acuity is assessed by clinicians via physical examination. It is possible to have normal visual acuity despite impaired vision, such as if peripheral fields are impaired by a condition.
Example: “As the vitreous hemorrhage cleared, vision improved and visual acuity returned to 20/20.”
Interestingly, the AAN and AMA recommend structuring e.g./eg and i.e./ie respectively. This is similar to discrepancies observed in punctuation use depending on the media source, such as news organizations’ preference for em dashes with spaces on either side (eg, word — word) whereas other forms of literature do not (word—word).
Interestingly, the AAN and AMA recommend different styling for common abbreviations. For example, the AAN recommends more liberal use of punctuation (e.g., i.e.), while the AMA omits them when they can (eg, ie). This is similar to style discrepancies observed outside medicine, such as journalists’ preference for spaced em dashes (e.g., word — word) compared to book publishings’ use of unspaced em dashes (word—word).
While these recommendations might seem superfluous, clear and concise writing is important to medical documentation. A patient’s note is likely the only line of communication that exists between medical providers and future readers of the patient’s record. Perhaps unfairly, a clinician’s wording may reflect on their overall knowledge as a clinician, so using correct terminology can only benefit others' perception of the writer. As an extreme example, lawyers prey on wording errors. A minor mistake can turn a simple case review into a costly legal nightmare with every ambiguity weaponized. (Note: Ready for Rounds is not legal advice and does not substitute for the expertise of experienced legal professionals.) Finally, precise terminology is crucial for proper coding and billing, directly impacting the financial health of the practice or hospital. In short, attention paid to language in medical documentation is important for practicing in a professional and financially prudent manner.
To Read More: American Academy of Neurology. American Academy of Neurology Writing Styles and Standards Guide, 2nd Edition. (2008). https://www.aan.com/globals/axon/assets/3078.pdf
Network, Editors, The Jama. AMA Manual of Style : A Guide for Authors and Editors, Oxford University Press, Incorporated, 2020. ProQuest Ebook Central, https://ebookcentral.proquest.com/lib/unmhsl/detail.action?docID=6130874.