Roundtable: Medical abbreviations and linguistic regulation

Today we present an email roundtable among some of our contributors. This is the first of hopefully more than one such roundtables where we collaborative scratch our heads at a bit of unusual data. The discussion doesn’t have to end with what’s inside the post. Please share your thoughts! And let us know if you’re interested in being a part of a future roundtable.

Information on today’s data (presented by Mark):
The Joint Commission on Accreditation of Healthcare Organizations “Do Not Use” list for abbreviations, acronyms, and symbols.

Direct link to the .doc file we looked at
A similar, incomplete document posted on the Joint Commission’s website
-If you are nervous on clicking a link to a .doc file, you can google “JCAHO do not use list”

This document is available widely online, but dates to around 2003 or 2004. I learned on Wikipedia that many hospitals and pharmacies and such are members of the JCAHO, though it’s not a monopoly. My interest in this was prompted when I saw the table pinned to the bulletin board in my doctor’s office a few weeks ago.

Mark Lewis (doctoral student in educational linguistics):
I’m most interested in the directives that require writers to stop using Latin and Greek abbreviations or symbols, and to use English instead. The social meaning of orthography has been noted by lots of scholars, and I don’t think this document contradicts any of that literature, but it is a bit of a weird edge case in that the social meaning of Greek letters or Latin words in scientific contexts has a history quite unlike more living, broadbased sorts of varieties. It’s rare that we see linguistic prescriptivism that is pretty strongly in the interest of a non-social end. The guidelines warn that if medical writers don’t use English, patients might die. They’re probably right! A “thousand-fold dosing overdose” sounds pretty bad! Mainly what I’m getting from this document is that the history and context of linguistic regulation or prescription matters immensely. Totally, even. I guess I already knew that. But I’m so used to saying and hearing that prescriptivism is bad, regulation is probably bad, etc. I was struck here by the fact that for this example, I didn’t really mind, for what I realized were very specific historical and contextual reasons. Namely, that I don’t really care that JCAHO is chipping away at the place of the Latin language in medical institutions.

Okay, so how about you other illustrious thinkers? What does this document suggest to you about institutional language, orthographic regulation, or any other interesting thing?

Haley De Korne (doctoral student in educational linguistics):
This perfectly echoes a news article I was just looking at, about verbal hygiene (i.e., banned words) in a UK school (short article, plus entertaining public poll at the bottom).

I think this is the kind of prescriptivism that makes most of us cringe a bit. Interestingly they state that this is part of ‘building vocabulary’, when it is appears to be a purely subtractive, not additive approach to language use.

The kind of ‘verbal hygiene’ in the JCAHO piece, on the other hand, strikes me as actually partly descriptive, rather than prescriptive– in that the goal is to describe the message content accurately, and only possibly ambiguous expressions– expressions which fail to describe what they intend to– are critiqued. There is no critique of the style through which they are conveyed per se, nor the content itself. It seems to me that there is no aesthetic/ moral/ ideological preference, other than for disambiguation.

Coleman Donaldson (doctoral student in educational linguistics):
At first glance, I’m struck by two subordinate purpose clauses (is that the right name for that syntactic constituent? I’m thinking it’s subordinate clause that probably got a fancy name like a ‘deverbal infinitival noun phrase’).

“To reduce the numbers of errors related to the incorrect use of terminology…”

“To improve the effectiveness of communications among caregivers…”

These subordinate clauses are followed by matrix clauses that prescribe specific usages of the linguistic code. As Haley and Mark point out these prescriptive statements strike us as weird. We’re linguists (hope that doesn’t offend anyone here) and therefore naturally bristle at any suggestion that any linguistic code is not self-sufficient for communicative purposes. We need to stop the masses from discriminating against people just for having their systematic grammar that doesn’t perfectly match Standard American English! But wait, these people are speaking…Latin?! And wait, they’re not even speaking it. They’re just writing it in abbreviated conventionalized form as a stand-in for typical English clauses. And as Mark and the JCAHO authors point out, these conventions or metalanguage are not transparent to American-English-speaking Joe Schmoe who therefore will possibly die a violent death while in cough-medicine-overdose induced madness. Ok, surely we can and should give the others a pass on the prescriptivism — this is a matter of life and death!

Very well.

What this suggests is that we’re in agreement with the purpose offered to explicate the prescriptive matrix clause. We’ve accepted that “reducing errors related to the incorrect use of terminology” and that “improv[ing] communications” are legitimate goals at times when it comes to language. In this sense, I am interested in the way that these subordinate purpose clauses could be potentially be re-appropriated or adapted for other causes. Take a look at the two which I provide below albeit with some changed blank constituents for madlibbing:

“To reduce the numbers of errors related to the incorrect use of terminology, [Noun Phrase] recently issued a list of abbreviations, acronyms and symbols that should no longer be used.”

“To improve the effectiveness of communications among [Noun Phrase], [Noun Phrase] [Verb Phrase] that [Noun Phrase] should no longer be used.”

I love imagining the first example invoked in the case of other seemingly incorrect terminologies. In fact, linguists and experts attempt to do this all of the time by claiming that using this or that label is not a helpful distinction to make or misleading because of the ambiguous and/or problematic connotations that the folk usage entails. I’m thinking of a case like dialect which I have essentially abandoned myself in favor of variety. While I never formulate or declare my prescriptive attitude regarding the two terms, I implicitly formulate this in my own usage and responses to others’ usage of the term dialect.

The second one takes us perhaps a bit further. What is “effective communication”? Some would argue that it innocently denotes acts of successful reference or leading one’s interlocutor to a real or imagined entity in the world. But if we take seriously the idea that referring is also entails typifying or characterizing people, behaviors and entities in certain ways, then we might argue that “effective communication” could also be construed as more than successful reference. As we know, ways of talking about things & people is an object of contention in the social world. Some for instance believe that we inaccurately and unjustly categorize certain people in particular kinds of ways. On this account, “effective communication” could be a rallying call for more socially just usages of terms in acts of referring or typification. While the term dialect may be used thousand of times a day to successful lead one’s interlocutor to a particular grammatical code (say “Wolof” for instance), it may also be ineffective in someone’s eyes because it inaccurately or unjustly suggests that something like Wolof or Cantonese or Black English is subordinate to some other ways of speaking.

Mark Lewis:
So far it seems like the three of us so far are all highlighting different ways in which this example of linguistic regulation, and others we come up with, takes on its particular meaning only by considering numerous aspects of the context it works in. Even working from the somewhat stable perspective of linguists who don’t approve of people being mean about language, we’re seeing the need for nuance in an assessment of just how nasty a certain act of prescriptivism is. I’m seeing from this discussion that there’s good evidence for thinking linguistic regulation and evaluation is way more complex than most linguists or even sociolinguists take it to be.

Other quick hits:
–I agree with Haley and Coleman that the “effective communication” standard invoked is very tricky. Maybe it applies less ambiguously here, but other examples we could think of or find would be much fishier.
–I think a notion of time is very important here, and we probably all doubt that this JCAHO regulation would have been successful, or even thought of, in a past era when the role of Latin in scientific contexts was taken more seriously.
–Coleman tweeted this story about a case in Malaysia concerning the word “Allah” that are relevant here.

Haley De Korne:
I like how Coleman pointed out the rhetorical formula of prescriptivism– but I maintain my view that this is not an example of the kind of linguistic hygiene/ meanness that we might be concerned with, and maybe shouldn’t be called prescriptive at all. I think it takes more than linguistic form to amount to prescriptivism. Characteristics of prescriptivism should also include some kind of power-over relationship, or punishment for non-compliance– I think that’s absent here. Also prescribing a form that privileges those who do the prescribing– here the prescribed form privileges the less powerful participants in the speech act.

Mark Lewis:
That’s an interesting idea, Haley. I wonder how you’re making your conclusions about the power in this situation. It’s tough for me to decide the best way to describe it, but there is at least some power going on. Maybe it’s just power we seem to approve of? JCAHO is saying that anybody who is under their organizational umbrella MUST follow these guidelines. Presumably there organizational consequences for noncompliance and insistent use of Latin. We are all seeing the value in this regulation, given that we are convinced there are serious health risks associated with forbidden abbreviations. But I think you’re right to say that nobody is really getting harmed here… there’s certainly not rampant discrimination against Latin speakers in the world today.

So it’s either a particular kind of prescriptivism WITHOUT symbolic violence, or it’s NOT prescriptivism because there is no symbolic violence.

This is definitely making me more carefully think through the relationship between prescriptivism and symbolic violence. However we decide on the terminology, I think it’s interesting and important to consider “edge cases” of a thing like prescriptivism so that we learn more about what makes it tick.

That’s all! Please join us in the comments, and let us know if you want to be in on the next one!

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