{"id":44447,"date":"2019-04-12T11:41:55","date_gmt":"2019-04-12T10:41:55","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=44447"},"modified":"2019-04-26T16:50:31","modified_gmt":"2019-04-26T15:50:31","slug":"jeffrey-aronson-when-i-use-a-word-clinical","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/04\/12\/jeffrey-aronson-when-i-use-a-word-clinical\/","title":{"rendered":"Jeffrey Aronson: When I use a word . . . Clinical"},"content":{"rendered":"

\"jeffrey_aronson\"<\/a>Last week<\/span><\/a> I discussed the idea of a minimal clinically important difference, <\/span>introduced<\/span><\/a> in the 1980s. It was <\/span>later<\/span><\/a> suggested that the term \u201cclinically\u201d should be omitted, implying as it did the doctor\u2019s sphere rather than the patient\u2019s personal experience. Was that justified?<\/span><\/p>\n

The IndoEuropean root KLEI meant to lean or slant. In Latin clinare, to lean, gave us decline, incline, and recline. A clinometer is used to measure slopes. An aclinic line on the surface of the earth is one marking places where a magnetic needle does not dip. If you are matroclinous you resemble your mother more than your father and if patroclinous vice versa.<\/span><\/p>\n

Clivus in Latin meant a slope, from which we derive acclivity, an up slope, declivity, a down slope, and proclivity, an inclination towards something.<\/span><\/p>\n

The Greek word for the clitoris, <\/span>\u03ba\u03bb\u03b5\u03b9\u03c4\u03bf\u03c1\u03af\u03c2, may have originally meant a lit<\/span>tle slope. But it is more probably connected<\/span> with a different root, KLEU, which gave the Greek verb \u03ba\u03bb\u03b5\u03af\u03b5\u03b9\u03bd, to close or confine, and the noun \u03ba\u03bb\u03b5\u03af\u03c2, a key. The latter was originally \u03ba\u03bb\u1fb1\u03dd\u1fd1\u03c2, the extra letter in the middle being the obsolete letter, or episemon, digamma, a semi-vowel pronounced like a <\/span>w<\/span><\/i>. The Latin equivalent of \u03ba\u03bb\u03b5\u03af\u03c2 is clavis. Two musical instruments, the ophicleide, from \u03ba\u03bb\u03b5\u03af\u03c2 and its resemblance to a serpent (<\/span>\u1f44<\/span>\u03d5<\/span>\u03b9\u03c2),<\/span> and the clavichord, from clavis, both have keys.<\/span><\/p>\n

The Latin word cliens originally designated one who was under the protection or patronage of another, i.e. one who leant on him, hence a retainer or follower, a votary of a god, a vassal state, and later one who used the services of a legal adviser, a client. <\/span><\/p>\n

Add an <\/span>m<\/span><\/i> to KLEI and you get the Greek word <\/span>\u03ba\u03bb\u03af\u03bc\u03b1<\/span>, Latin clima, an inclination or slope of the ground at a particular latitude or in a particular region. It therefore came to mean, as Liddell & Scott\u2019s <\/span>Greek-English Lexicon<\/span><\/i> puts it, one of seven latitudinal strips in the \u03bf\u1f30\u03ba\u03bf\u03c5\u03bc\u1f73\u03bd\u03b7 (the known world) on which the longest day ranged from 13 to 16 hours in half-hour intervals, a system credited to Ptolemy in his book <\/span>Geographia<\/span><\/i>. Each of those zones, associated with a particular latitude, therefore came to be known as a climate. Each was associated with one of the seven known planets, celestial objects that could be seen with the naked eye, and each climate was named after the location through which it passed (Table 1 and Figure 1). And since the weather conditions varied with latitude, \u201cclimate\u201d came to be used to refer to the weather in the seven zones.<\/span><\/p>\n

Table 1.<\/b> Ptolemy\u2019s seven climates<\/span><\/p>\n

\"\"<\/p>\n

\"\"<\/p>\n

Figure 1.<\/strong> The Ptolemaic geocentric system; the peripheral legend, \u201ccoelum empireum, habitaculum dei et omnium electorum\u201d, means \u201cfiery heaven, dwelling of God and all those chosen [to live there]\u201d <\/span><\/p>\n

Now further extend the root with an <\/span>x<\/span><\/i> and you get the Greek word \u03ba\u03bb\u1fd6\u03bc\u03b1\u03be, a sloping ladder or a staircase, giving us climax;<\/span> \u03ba\u03bb\u03b9\u03bc\u03b1\u03ba\u03c4\u03ae\u03c1 was a rung on a ladder and hence any turning point in one\u2019s life, eventually applied specifically to the menopause, the climacteric<\/span>.<\/span><\/i><\/p>\n

In Teutonic languages the K in KLEI was replaced by an h: hleinen and similar variants gave the English word lean; hl\u1fd1\u0111, to cover or, as it were, lean something over the top of a container gave the English word lid; and hlaidrj\u00e2 gave the English word ladder.<\/span><\/p>\n

Add an <\/span>n<\/span><\/i> to KLEI and you get the Greek word \u03ba\u03bb\u03af\u03bd\u03b7, a bed, something on which you lie. In Roman times a triclinium was a couch that ran round three sides of a table.<\/span><\/p>\n

The English noun clinic originally (17<\/span>th<\/span> century) meant one who is confined to bed by sickness or infirmity. It then came to mean one who defers baptism until on his deathbed. When Voltaire was dying he was exhorted to renounce the devil; this was no time, he said, to be making new enemies. Then \u201cclinic\u201d became an adjective, meaning bed-ridden or relating to the sick-bed, replaced in the 18<\/span>th<\/span> century by the adjective \u201cclinical\u201d, which particularly referred to instruction at the bedside. The earliest instance cited in the <\/span>OED<\/span><\/i> is from 1780: \u201cDr John Parsons was unanimously elected Clinical Professor to the Radcliffe Infirmary at Oxford.\u201d Parsons had been elected in 1772. It was not until the early 20th century that \u201cclinical\u201d came to mean detached and dispassionate, like a medical report or examination; diagnostic or therapeutic, like medical investigation or treatment; and treating any subject matter as if it were a case of disease.<\/span><\/p>\n

So \u201cclinical\u201d implies the bedside, and dropping\u201d clinically\u201d from minimal clinically important difference, stressing the patient\u2019s experience rather than the doctor\u2019s, was strictly speaking justified. However, doing so might lead you to forget that the difference so described was in any way medical.<\/span><\/p>\n

Jeffrey Aronson<\/strong>\u00a0is a clinical pharmacologist, working in the Centre for Evidence Based Medicine in Oxford’s Nuffield Department of Primary Care Health Sciences. He is also president emeritus of the British Pharmacological Society.<\/em><\/p>\n

Competing interests:<\/strong>\u00a0None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"

Last week I discussed the idea of a minimal clinically important difference, introduced in the 1980s. It was later suggested that the term \u201cclinically\u201d should be omitted, implying as it […]<\/p>\n

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