Dearly Departed Languages
Why Greek and Latin Medical Terminology Is Better Off Dead
Blepharophimosis, ptosis, and epicanthus inversus syndrome, type 1 (BPES I). Sounds intimidating, right?
Blepharo- is from the ancient Greek word for eyelid; -phim- is Greek for muzzling, ptosis from piptein, “to fall”, and the shared -osis suffix for condition. Epi- is Greek for above, and -canthus is for the corner of the eye. Inversus is the Latin form of its similar-looking English meaning — inverted; type 1 affects males; and syndrome is a “running together” of symptoms that affect someone at the same time.
As a classicist, I would love to celebrate this contemporary outfit of classical civilization: after the papacy’s abandonment of Latin, medicine looks like the final frontier for ancient language. But as a patient, I have trouble reconciling it with the fact that, for twenty-one years, those nine different ancient roots precluded my understanding of my own illness. I hate that.
For any positive health outcome to occur, I, the patient, must be involved in my own care. If I don’t understand my condition, or the importance of my medication, or the treatments I can choose from, how could anyone expect me to get better?
It’s my conviction that the language of medicine must change. To make medical terminology more accessible, the field of medicine must reconcile its contrasts: it is forward-facing, yet rooted in tradition; patient-centered, yet varnished in tough-to-crack parlance; public-serving, yet enshrouded in terminology that might as well be magic spells. It’s time we ditched the ancient roots and let language evolve.
What are Latin and Greek doing in medical terminology in the first place?
Blame two Greek doctors: Hippocrates (of “Hippocratic Oath” fame), considered the father of medicine, and Galen, the doctor to Roman emperor Marcus Aurelius himself. As the heavy lifters in the ancient medical tradition, Hippocrates, Galen, and their Greek language — the building blocks of medical terminology — were on the lips (and on the reading lists) of generations upon generations of medical students for more than a thousand years. Greek and the language of medicine seemed one and the same.
Fourteen centuries later came Andreas Vesalius, a Renaissance physician who laid the groundwork for the study of anatomy. He supplied the other piece of the puzzle: when he finally penned his seminal work The Fabric of the Human Body in the 1500s, Latin was Europe’s language of scholarship, the lingua franca with which Renaissance philosophers, artists, and writers could communicate. In line with this tradition, Vesalius opted to name all the muscles, ligaments, veins, arteries, organs, and bones in Latin.
After the Renaissance, nostalgia for the ancient world wouldn’t be cured for a long time. From that point, if classical education wasn’t the goal of your academic career, it was required for further academic pursuits, including medicine. That’s why English medical terminology wasn’t changed, save for the words’ Anglicized forms — small tweaks to imbue the language with English spellings, endings, and combining forms.
The Classics discipline enjoyed its position of privilege until the 1960s, when the United Kingdom sloughed off its Latin-proficiency requirements for admission to medical and law schools. That act didn’t come out of the blue — after Pope John Paul XXIII declared Tridentine Mass (pre-Vatican II Mass celebrated in ecclesiastical Latin) nonstandard in 1962, classical education experienced a precipitous fall in popularity, as more and more institutions lost sight of its importance. The effacement of Latin and Greek from standard educational plans had begun.
But as the world around it cast off its ancient roots, the field of medicine did not.
The common denominator between Hippocrates, Galen, and Vesalius is that they were teachers. All three of them wrote didactic texts — Medicine for Dummies, basically — so that patients and future physicians alike could understand the reasoning behind their practices, methods, and manners of speaking.
You can see their natural propensity for teaching in the ways they talked to their patients. This is from Hippocrates:
It is particularly necessary, in my opinion, for one who discusses this art to discuss things familiar to ordinary folk. For the subject of inquiry and discussion is simply and solely the sufferings of these same ordinary folk when they are sick or in pain … if you miss being understood by laymen, and fail to put your hearers in this condition, you will miss reality. Therefore for this reason also medicine has no need of any postulate.
Hippocrates and his fellow physicians were battling for people’s trust. In its infancy, medicine seemed no more plausible than magic. Hippocrates had to call for descriptive, patient-centered, clear language so that he and his students wouldn’t confuse people or lose their trust.
After all, the Hippocratic School was advocating for empiricism: medicine that was evidence-based, supported by research, and observable by others. That’s why all these fabricated Greek compounds in medicine — I’m talking even about the ones we have now, like microcephaly, anosognosia, and ptosis — would have been descriptive and easily understandable to Greek people (“tiny-head-ness,” “no-knowledge-of-disease,” and “drooping-condition,” respectively). That clarity the patients of ancient Greece would have enjoyed is lost on almost every patient today.
But just like the language of medicine’s stubborn use of ancient roots, the emphasis of the ideal relationship between patient and physician has not changed. The ability to communicate — or teach — is the major factor in building trust between doctors and patients. In the Primary Care Assessment Survey, an evaluation of how physicians’ behaviors affect how much a patient trusts them, clear communication was ranked higher than demonstration of knowledge: according to patients, how their doctors talk is more important than how much they know. Communication is so embedded in the medical practice that first-year students in the first month of school meet actors who pretend to be patients so that students can practice talking to them. That’s how important communication is.
Galen emphasized a similar sentiment:
We, for our part, are convinced that the chief merit of language is clearness, and we know that nothing detracts so much from this as do unfamiliar terms.
The message is simple: accessible words for accessible communication. These ancient authors, venerated in the medical field as founding fathers, are being ignored. It’s time we started to listen.
Terminology hurts patients, but it also presents several barriers to would-be physicians. I’ll put it this way: if Dr. Frankenstein were an etymologist, the language of medicine would be his monster. And for medical students, that monster is a tough labor to face, especially in their first two years.
Starting out, students have thousands upon thousands of new words thrown at them — it’s like learning a new language. A weak and slow pulse (a sign of aortic valve stenosis) is parvus et tardus. A painful “strangling” sensation in the chest due to problems with blood flow to the heart is angina pectoris. Shallow breathing during sleep — not quite apnea — is hypopnea.
If you study Latin or Greek, you know that the roots of those terms give a lot away about their meanings: these phrases may sound and look complicated, but they are, in the end, just Latin and Greek translations. To study medicine is not only to study all the names of diseases, treatments, and the parts of the body; it’s to study decontextualized etymology — alpha and omega — origins and modern-day equivalents. But if we know there’s a more accessible, simpler way to say something, to have to learn its etymology — the original Latin, the Greek roots — creates out of nothing an unnecessary burden for students (and patients) to decipher.
A physician mentor told a friend of mine in his second year of medical school, “A medical student will forget more than people usually learn in their lifetime.” That mentor was trying to be funny, but not many doctors will contest that the medical path is a never-ending cycle of cramming and forgetting. One doctor told me that as much as 95% of what students learn in medical school won’t be used in their actual practice. That’s hardly motivational, to say the least.
But while medical students do a lot of forgetting after they take their exams, it’s hard to move past the memory of those first few years. The journey to becoming a physician is difficult, stressful, and draining. And it has led to high prevalence of mental illness among medical students. Concerns about students’ mental health have started to enter national conversations about how much work and stress we put these doctors-in-training under. In this meta-analysis that looked at data collected from several studies, more than a quarter of medical students showed signs or were diagnosed with depression. But only 15.7% of them (shown positive for depression) sought treatment.
While changing vocabulary isn’t a cure-all for medicine’s problematic culture surrounding mental illness, it can lift weight off students’ shoulders. Accessible language is something that can be institutionalized, and it will help students remember, learn, and understand material rather than forget what they’ve learned, waste their time, and waste their energy.
Tradition is difficult to overcome, but necessary to defeat. Here’s hope: in Canada, a new initiative to make medication instructions, labels, and packaging more patient-accessible went into effect this past summer (June 13th, 2017, to be exact). It’s called the Plain Language Labeling (PLL) Regulations, and it requires health product information to be provided “in an easy-to-read format.”
Why are these regulations important? In Canada, 1 in 9 visits to the emergency room are connected to drug adverse events, and 68% of those are preventable if patients understood all the symptoms, limitations, and risks of their medications. The PLL regulations are a simple fix. I’m sure they will save lives.
If you haven’t looked it up yet, BPES is a condition people are born with. I have BPES I. The condition made my eyelids droop, to a point where it felt like I could only see half the world. But it was correctable by surgery, and the problems were mostly cosmetic, although it could have affected my vision if left untreated.
From my earliest memories as a kid, I had a whole slew of procedures that eventually led to a healthier pair of eyes. I’m fine — thanks for asking — and I’m healthy, and I don’t like to believe there’s much cause for concern.
But that comfort in knowing what my syndrome entails or what the surgeries were for or why I had to keep going to check-ups didn’t come in a day. And more importantly, neither did the acceptance of it. I didn’t like to think my eyes were different, but now after much research, soul-searching, and conversations with my parents, I know how and why my eyes are different, and I love them all the same (and Catullus, you should too).
If you think I’m asking for a different name for BPES, you’ve missed the point. It took me this long to understand what my condition was about — how long does it take others? How much uncertainty do people feel when they pay for bank-breaking treatments, take medication, or go into surgery? Why do medical practitioners need a language to talk amongst themselves when the patient — the expert in the room, the one who knows their body best — is left in the dark?
If Death has come for Latin, so be it. But let medical terminology be next.
Tino Delamerced is a Filipino American from Cincinnati, OH. He studies Latin at Brown University.
