{"id":41428,"date":"2018-02-16T17:36:01","date_gmt":"2018-02-16T16:36:01","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=41428"},"modified":"2018-02-16T19:32:39","modified_gmt":"2018-02-16T18:32:39","slug":"jeffrey-aronson-when-i-use-a-word-medical-catachresis-confusibility","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/02\/16\/jeffrey-aronson-when-i-use-a-word-medical-catachresis-confusibility\/","title":{"rendered":"Jeffrey Aronson: When I Use a Word . . . Medical catachresis\u2014confusibility"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-32935\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson-223x300.jpg\" alt=\"jeffrey_aronson\" width=\"117\" height=\"144\" \/><\/a>Catachresis (Greek \u03ba\u03b1\u03c4\u03ac\u03c7\u03c1\u03b7\u03c3\u03b9\u03c2, from \u03c7\u03c1\u1fc6\u03c3\u03b8\u03b1\u03b9 to use, \u03ba\u03b1\u03c4\u03ac giving a sense of perversion) is the mistaken use of one term for another. When not due to sheer ignorance, it can arise through confusibility or ambiguity. Confusibility occurs when two or more terms can easily be mistaken for each other. Ambiguity is the capacity of a single term to be understood in two or more ways. Here I shall deal with the former.<\/p>\n<p>Of the many sources of terminological confusibility, the following are the most common:<\/p>\n<ul>\n<li>homonyms, of which there are two types:\n<ul>\n<li>homophones, words with different meanings and different spellings but the same sound (e.g. \u201creed\u201d &amp; \u201cread\u201d, \u201cred\u201d &amp; \u201cread\u201d);<\/li>\n<li>homographs, words with different meanings but the same spelling and the same sound (e.g. \u201cpink\u201d, for which the <i>Oxford English Dictionary<\/i> (<i>OED<\/i>) has 14 different entries, nine nouns, one adjective, and four verbs);<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>heteronyms, words with the same spelling but different sounds and meanings; these are of three types:\n<ul>\n<li>a difference in vowel sound (e.g. bass, a fish, and bass, a musical instrument; tear, to rip, tear, a drop of fluid from the eye);<\/li>\n<li>a difference in consonantal sound (e.g. close, near, and close, to shut; number, one, two, etc, and number, less sensitive);<\/li>\n<li>a difference in accent (e.g. desert, to leave, and desert, an arid region);<\/li>\n<\/ul>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">words with shared elements that can be applied in different ways to the same phenomenon; \u201cserious\u201d and \u201csevere\u201d, terms used to describe adverse drug reactions, are not the same but may be confused; for example, the acronym SCARS is <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29026345\"><span style=\"font-weight: 400\">usually interpreted<\/span><\/a><span style=\"font-weight: 400\"> as meaning \u201csevere cutaneous adverse reactions\u201d, but is <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16741783\"><span style=\"font-weight: 400\">occasionally interpreted<\/span><\/a><span style=\"font-weight: 400\"> as \u201cserious cutaneous adverse reactions\u201d; but adverse reactions, a headache for example, can be severe but not serious;<\/span><\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">words with semantic proximity; for example, the word \u201cseverity\u201d is often used to denote the intensity of a reaction, ignoring the fact that a reaction may be of mild, moderate, or severe intensity; \u201cmild severity\u201d and \u201cmoderate severity\u201d are oxymoronic and one would not talk of \u201csevere severity\u201d, although <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25895006\"><span style=\"font-weight: 400\">some do;<\/span><\/a>&nbsp;<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">mistaken interchangeability <\/span><span style=\"font-weight: 400\">(\u201cuse\u201d and \u201cusage\u201d mean different things, as do \u201cdose\u201d and \u201cdosage\u201d)<\/span><span style=\"font-weight: 400\">;<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">failure to qualify or define a word precisely (see below);<\/span><\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">failure to distinguish the meanings of words that can be both <\/span><a href=\"https:\/\/blogs.bmj.com\/bmj\/2017\/09\/29\/jeffrey-aronson-when-i-use-a-word-language-that-counts\"><span style=\"font-weight: 400\">count nouns and non-count nouns.<\/span><\/a><\/li>\n<\/ul>\n<p>As an example of the last of these, take the word \u201cprescription\u201d. A prescription error can be an error made in the act of prescription (non-count noun) or in writing the prescription (count noun). In order to distinguish these two interpretations of the phrase, I have <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19594526\"><span style=\"font-weight: 400\">suggested<\/span><\/a><span style=\"font-weight: 400\"> using the term \u201cprescribing fault\u201d for the former, restricting \u201cprescription error\u201d to the latter.<\/span><\/p>\n<p><span style=\"font-weight: 400\">A dramatic example of an adverse reaction resulting from a failure to qualify a word precisely was <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/4113520\"><span style=\"font-weight: 400\">reported<\/span><\/a><span style=\"font-weight: 400\"> in 1972. A 34 year-old man with a history of duodenal ulceration developed epigastric pain and vomiting. A \u201cmilk drip\u201d was ordered, the intention being that the milk should be dripped slowly into the stomach via a nasogastric tube. However, the patient was instead given 100 ml of pasteurized cow\u2019s milk by intravenous infusion. An immediate hypersensitivity reaction, with disseminated intravascular coagulation and evidence of fat embolism, was successfully treated. \u201cDrip\u201d is defined in the<\/span><i><span style=\"font-weight: 400\"> OED<\/span><\/i><span style=\"font-weight: 400\"> as \u201cthe continuous slow introduction of fluid into the body (especially intravenously) involving its passage drop by drop through a chamber\u201d. The inclusion of the word \u201cespecially\u201d in the definition emphasises the source of the problem in this case. The error arose because \u201cdrip\u201d was not qualified precisely.<\/span><\/p>\n<p><span style=\"font-weight: 400\">A modern catachresis confuses the adjective \u201cgood\u201d with the adverb \u201cwell\u201d. \u201cHow are you?\u201d \u201cI\u2019m good\u201d. As a colleague of mine will reply, \u201cThat\u2019s for me to judge\u201d.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-41429 aligncenter\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/02\/aronson_confuse.png\" alt=\"\" width=\"709\" height=\"615\" \/><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-41430 aligncenter\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/02\/aronson_confuse2.png\" alt=\"\" width=\"736\" height=\"382\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/02\/aronson_confuse2.png 736w, https:\/\/blogs.bmj.com\/bmj\/files\/2018\/02\/aronson_confuse2-300x156.png 300w\" sizes=\"auto, (max-width: 736px) 100vw, 736px\" \/><\/p>\n<p><span style=\"font-weight: 400\">The top panel shows an extract from the definition of \u201cdrip\u201d in the <em>OED<\/em> (&#8220;drip, n.&#8221; OED Online, Oxford University Press, January 2018, www.oed.com\/view\/Entry\/57768. Accessed 16 February 2018); note that the earliest citation the dictionary gives is from 1933, describing the use of a nasogastric drip of milk, the first occasion on which that therapy was described; however, the bottom panel shows an antedating from 1924, referring to an intravenous drip.<\/span><\/p>\n<p><em><strong>Jeffrey Aronson<\/strong>\u00a0is a clinical pharmacologist, working in the Centre for Evidence Based Medicine in Oxford&#8217;s Nuffield Department of Primary Care Health Sciences. He is also president emeritus of the British Pharmacological Society.<\/em><\/p>\n<p><strong>Competing interests:<\/strong>\u00a0None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Catachresis (Greek \u03ba\u03b1\u03c4\u03ac\u03c7\u03c1\u03b7\u03c3\u03b9\u03c2, from \u03c7\u03c1\u1fc6\u03c3\u03b8\u03b1\u03b9 to use, \u03ba\u03b1\u03c4\u03ac giving a sense of perversion) is the mistaken use of one term for another. When not due to sheer ignorance, it can [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/02\/16\/jeffrey-aronson-when-i-use-a-word-medical-catachresis-confusibility\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38359,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5762],"tags":[],"class_list":["post-41428","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-jeff-aronsons-words"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Jeffrey Aronson: When I Use a Word . . . 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Medical catachresis\u2014confusibility - The BMJ","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/bmj\/2018\/02\/16\/jeffrey-aronson-when-i-use-a-word-medical-catachresis-confusibility\/","og_locale":"en_US","og_type":"article","og_title":"Jeffrey Aronson: When I Use a Word . . . Medical catachresis\u2014confusibility - The BMJ","og_description":"Catachresis (Greek \u03ba\u03b1\u03c4\u03ac\u03c7\u03c1\u03b7\u03c3\u03b9\u03c2, from \u03c7\u03c1\u1fc6\u03c3\u03b8\u03b1\u03b9 to use, \u03ba\u03b1\u03c4\u03ac giving a sense of perversion) is the mistaken use of one term for another. When not due to sheer ignorance, it can [...]More...","og_url":"https:\/\/blogs.bmj.com\/bmj\/2018\/02\/16\/jeffrey-aronson-when-i-use-a-word-medical-catachresis-confusibility\/","og_site_name":"The BMJ","article_publisher":"https:\/\/www.facebook.com\/bmjdotcom\/","article_published_time":"2018-02-16T16:36:01+00:00","article_modified_time":"2018-02-16T18:32:39+00:00","og_image":[{"width":540,"height":350,"url":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/Jeffrey-Aronson.jpg","type":"image\/jpeg"}],"author":"BMJ","twitter_card":"summary_large_image","twitter_creator":"@bmj_latest","twitter_site":"@bmj_latest","twitter_misc":{"Written by":"BMJ","Est. reading time":"4 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/bmj\/2018\/02\/16\/jeffrey-aronson-when-i-use-a-word-medical-catachresis-confusibility\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2018\/02\/16\/jeffrey-aronson-when-i-use-a-word-medical-catachresis-confusibility\/"},"author":{"name":"BMJ","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe"},"headline":"Jeffrey Aronson: When I Use a Word . . . 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