Sunday, March 25, 2007

Fog index - Medical Jargon: Measure It, End It, Create It

Jargon -- SPECIALIST LANGUAGE that is used by a particular group, profession, or culture, especially when the words and phrases used are not understood or used by other people.

Encarta World English Dictionary, St. Martin’s Press, 1999

Herein lies two “how-tos.”

1) How to measure and end medical jargon when speaking or writing for patients. I call this process “jargonoughting.”

2) How to create medical jargon to impress your fellow physicians. I call this process “jargonauting.”

I do this because I believe one fundamental innovation that will change health care will be translating medical jargon into language patients can understand. This will facilitate patient education, overcome patient illiteracy, make medicine more effective, and reduce misunderstandings between doctors and patients.

Michelle Sobel leads a creative team at Emmi Solutions. This Chicago company produces interactive online visual programs narrated in plain words to inform patients what to expect from surgical and chronic disease episodes. Michelle has mastered the art of converting medical jargon into plain language. The language in the Emmi programs are phrased and written at the sixth grade level.

But how, you may ask, can I, as a doctor, be sure I’m writing at the sixth grade level? I don’t know Michelle’s secret. But as for me, I measure my jargon by using the Fog Index. Yes, the Fog Index? In 1968 Robert Gunning, a consultant who advised publications how to write in language people understood, devised this numeric index.

To find the Fog Index of a piece of prose:

1) Calculate the average number of words in your sentences (or complete thoughts linked by punctuation marks);

2) Count the number of three syllable words per 100 words (don’t count proper words, combinations of short words (e.g manpower) or verb forms made into three syllables by adding –ed, -es, or –ing.)

3) Add 1 and 2 and multiply by 0.4 to get the Fog Index.

Let’s say the Fog Index is 6. Six reflects the grade level it takes to read with ease a given passage.

Jargonought, and Fog Index

To give you a feel for the Fog Index, let’s count it for a well-known biblical passage.

I returned and saw under the sun, that the race is not to the swift, nor the battle to the strong, neither yet bread to the wise. nor yet riches to men of understanding, nor yet favor to men of skill, but time and chance happen to them all.

Fog Index

1. 7-8-6-7-6-7-8=49/7=7.0
2. 1=1.0
3. Fog Index= 7.0+1.0 x 0.4= 3.2

Now let’s take a GI group’s paper instructing a patient how to prepare for an intestinal endoscopy exam.

These are instructions for your endoscopy preparation for tomorrow in the operative suite at our endoscopy facility. You are now scheduled to have an examination of your lower and upper intestine with the use of a lighted flexible tubular instrument called a endoscopy scope. You will be administered medication prior to your examination that will enable your physicians to perform the test with as little discomfort to you as possible. Please be aware of the medication's sedative properties. Because of these sedative effects, you must make arrangements for someone to accompany you home or to your apartment or condominium after the procedure.

1. 17-27-26- 8-24= 102/5= 20.4
2, 102X 29/91=28.4
3. Fog Index = 20.4 + 28.4 X 0.4 =19.5

Using the Jargonought technique, this passage's Fog Index could be reduced.

You are scheduled to have an exam of your colon and upper bowel., We will use a lighted tube called an endoscope to do this. You will be given a drug to put you at ease. This drug will sedate you. So we ask you bring someone to drive you home.

1. 13+12+5+10 = 10.0
2. 1= 1.0
3. Fog Index= 10.0 + 1.0 X 0,4 = 4.4

Jargonaut, Or Mixing Wind and Fog

Where do physicians learn to use jargon? They learn it in medical school. Jargon is a contagious disease. Doctors catch it early on in academic medical centers where the “public or perish “ phenomenon flourishes. Then jargon spreads, becomes endemic, then epidemic as doctors seek to impress one another. Unfortunately jargon is hard to stamp out, and doctors may lapse into using it when talking to patients.

To show how to practice jargonaut, and to become a jargonaut, I wrote this piece for the Journal of the American Medical Association.

Space-Occupying Gambits for Medical Writers

As a rule, disease as it stalks through the land cannot keep pace with the incurable vice of scribbling about it.

John Mayo, de Rachitide, 1668

Space-occupying prose diffuses through medical writing like a fog. Yet space-consuming efforts of some of us continue to be rejected. The message of this essay is that obscurity, when properly inflated, can lead to publication. Your goal is clear – to produce the greatest number of papers from the minimal amount of data using the maximal number of words.

Windfoggery Weave

Windfoggery is the bedrock of all obscurity. Wind and fog don’t coexist in nature. But they can be woven together on the printed page. Give the reader a low-fact diet with high-jargon content. Sprinkle with polysyllabic words. Scramble the syntax. If you doubt a predecessor’s methods, don’t say: “Jones’ methods are questionable.” Deepen the fog, and raise the wind velocity by saying: “The quantitative variables assayed by Jones were analyzed and scrutinized and appeared, according to our interpretations, to demonstrate significant fluctuations, which seems to vacillate diurnally.” Note the murky merging of wind and fog.

The Retrospective Ramble

In the retrospective ramble, pay homage to the past by exhaustively reviewing your subject, The flood of references will inundate the editor and drown the reader. Refer to inaccessible, outdated, or foreign journals. This adroit maneuver discourages and diverts critics. Their futile search through back alleys of print will wear down objectivity. It will blur perspective. Complete your conquest over comprehension by quoting everything ((or nearly everything) that has been said about your subject. Whether the material is relevant isn’t important. It’s the number of references that count. It’s wise not to be discretely excessive. The discerning editor will quickly reject such a clumsy effort as this.

“I 26,31,14 believe that21,88 this technique25,85,99 of using excessive references 922 to previous papers is abused 71,02, 502 by most authors, 28,192,617 particularly myself1,22,3581,269 in my exhaustive reviews of articles, 67-84 all of which have been rejected by numerous journals.0

The Humble Hedge

The humble hedge is a gambit whereby you qualify your meaning into nothingness while appearing to be objective. Always convey doubts about your statements. Arrange a retreat from clarity with hedge verbs like indicate, suggest, appear, may, and might. Withdraw with these nouns: speculation, conjecture, theory, and hypothesis. Hedges can be classified as first, second, and third order or as single, double, and triple barreled. A fourth-order or quadribarrelled hedge is clumsy and should be avoided. A fifth-order hedge, such as “Speculation about etiological factors might possibly suggest that previous investigators may have been wrong some of the time.” is excessive and poor form. The sentence could be reduced to a third-order hedge with only slight loss of ambiguity.

The Passive Ploy

In the passive ploy, place yourself in the background. Stress vague pronouns, fuzzy facts, and lofty concepts. To do this, write in the passive voice. You can add words, befog your meaning, and become a detached sage. It was discovered by the author is nearly 4 ½ times longer than I found and is more humble. It was reported by this investigator in a recent publication requires eight times more space than I noted and is more sedate. But, how, you may ask, can I be sure I am writing in the passive voice? You could consult books of grammar, but most doctors are too busy for that sort of thing. So I have gathered together some practical suggestions.

• Commence you sentences with impersonal remarks –It is though, it is believed, it is felt.• Strip your sentences of verbs which picture or imply action .
• Glue your thoughts together with have, seem, or some form of to be – is, are, was, were.• Delete the personal pronouns – I or we.
• Strew your sentences with whichs, bys, or ofs.

The passive voice allows you to avoid straight statements. The true scientist is never direct or blunt. Use the passive voice often. It is the most space-occupying weapon at your command.

The Word Wedge

Word wedging is art of forcing big words into sentences where they don’t belong. The careful wedger picks his tools. He prefers abstract terms with scientific overtones – armamentarium, congeners, continuum , dynamic, esoteric, kinetics, methodology, modality, oncogensis, parameter, sophisticated. If the wedger is clever, he will drop bureaucratic buzz bombs by intermixing any of the following words in these three columns in any combination.

1 2 3
total management care
regional supportive coordinator
universal health analyses
primary integrated centers
comprehensive ambulatory services
national resource priorities
quality pilot planning
interdependent involvement needs
preventive paramedical studies
systematized effective utilization
feasible digital implementations
delivery scientific objectives
unmet outreach systems
community multidisciplinary maintenance
centralized medical parameters
longterm multiphasic feedback

The following example of wedging if from an article in a well-known medical journal,

Substances which are immunologically foreign are composed of autohochthonous materials. These are not diagnostic, but with progressive increase as seen by serial samples, in association with other suspicious parameters, electrophorectic pattern may become significant as a predictor.

Observe the passive mingling of windfoggery, hedging , and wedging – all combining to produce hieroglyphic obfuscuity.

The “That” Thrust

Put this gambit into play by thrusting the word “that” into the start of your sentences. With “that,” you can introduce your sentences, qualify your thoughts, blunt your meaning, express wonderment, and consume thought. Let me show what I mean with these examples – It is fascinating to note that, in spite of the fact that, It is often the case that, But it may be possible that, There can be little doubt that, It is interesting to observe that. Not the running start. Each example consists of six word obstacles the reader must traverse before he reaches the beginning of the sentence. Think of “that” as a suitcase word. Whenever you use it, you carry along verbal baggage, and “that,” after all, is your mission – your main game.

The Verb Void

Save this gambit for your first revision (a second revision is rarely necessary in jargon-filled space –occupying writing). Read over your paper. Look for verbs that can be changed into nouns, Void your sentences of vulnerable verbs. Then rearrange the entire sentence. Study these three examples to see how they gambit works.

Before Revision – Then we decided to explore the other possibility (8 words).

After Revision – Then the decision was arrived at that an exploration of the other possibility was advisable (16 words, 100% increase.

Before Revision – We investigated what causes cells to mutate (7 words).

After Revision –We then made an investigation of what the causes were for the mutation of the cells (16 words, 130% increase).

Before Revision – Surgeons enlarge the cavity by incising laterally.

After Revision –The best means for enlargement of the cavity by surgeons is by means of a lateral incision (18 words, 160% increase)

As a beginning gamesman, you’re no doubt impressed most by the increase in the number of words. With experience, you will realize another virtue of the verb void – it breeds other gambits. In the last example above, the passive play came into play. Finally, the act of trading active lean verbs into edematous, sedentary nouns is always good gamesmanship.

The Double Dawdle

The double dawdle permits the gamesman to double his world volume while keeping his facts constant. This gambit has two variations -- the supersuperlative dawdle and the redundant dawdle. Execute the supersuperlative dawdle by adding the words very, markedly ,tremendously, much, quite to your adjectives. If you’re describing a big uterus, you can call it a very enlarged uterus, a quite enlarged uterus, a markedly enlarged uterus, a tremendously enlarged uterus, or a much enlarged uterus. Beware of the triple or multiple dawdle. A “very much markedly enlarged uterus of tremendous size” wouldn’t likely slip through the editor’s net. Only you and the reader will appreciate the profundity of your distinction. Perform the redundant dawdle by joining such words as equal halves, hazardous risks, linear lines, and tumor masses. You appear to be reinforcing your meaning, but you are really just duplicating words.

The Paragraph Parry

When you have a large space to fill, word gambits are good, but paragraph parries are better. Open your paragraph by sallying forth with a decisive sentence. The reader, caught off guard, will plunge into the paragraph. Immediately parry with a series of indecisive sentences. What you give away in your opening, take back in the discussion. Begin with courage. End with prudence. What more could be asked from a dignified scientist. Here is an example of a paragraph parry.

I define cerebral palsy as any paralysis, weakness, or incoordination, or dysfunction resulting from brain damage. Jones, however, regards cerebral palsy as and condition characterized by paralysis, weakness, incoordination , or other derangements of motor function due to pathology of motor control centers of the cerebral cortex. On the other hand, Smith’s definition is more comprehensive, “Cerebral palsy is a condition occurring from birth trauma and resulting form interference with the motor system and leading to neuromotor dysfunction, psychological aberration, atypical convulsions, and behavior disturbance of organic origin,” It is obvious that the brain is a complex organ subject to varying degrees of damage which are manifest in unusual disturbances interpreted in various fashions by different, independent observers.

The writer’s opening sortie is a crisp definition. He then counters with two meandering redefinitions and completes the gambit by admitting hopeless confusion.

Finishing Finesse

Employ the finishing finesse in the backwaters of the discussion and in the stagnant summary. Only the able gamesman should handle this gambit, for he must manipulate ideas that were never expressed. The finishing finesses may be defined as the use of large words in loose phrases to achieve a wandering endings, e.g.

The pathogenesis of the diverse forces operative in electrolyte disturbances were studied, and it was concluded that the variability of the methodology did not permit delineation of the therapeutic modalities.

Observe that the writer ends by hovering above the concrete by talking in abstractions, and the readers ends where he started – fogbound.

I know what you’re thinking – what’s the Fog Index of this essay he just tried to fog by me.

The answer is:

1) 2456/262 = 9.3
2) 346X100/2256= 14.1
3) Fog Index = 8.7 + 14,0 X 0.4 = 9.4

1 comment:

Anonymous said...

He's consistently on point and absorbing to jewelrys replica watches and accept to whether he's giving a columnist appointment or actualization on a accepted allocution appearance like he did endure night on the "Late Show" with Dave Letterman. President Obama is the man.