Word Routes

Exploring the pathways of our lexicon

Medical Misapprehensions

On the Web you can find some well-traveled lists of medical malapropisms, supposedly collected from patients who misunderstand names of diseases and medications. So for instance, Alzheimer's disease becomes old-timer's disease, sickle-cell anemia becomes sick as hell anemia, spinal meningitis becomes smilin' mighty Jesus, and phenobarbital becomes peanut butter balls. These lists are good for a laugh, but it turns out misunderstandings of medical terminology can sometimes have dangerous or even deadly consequences.

A Washington Post article reports that names of drugs and other medications can be extremely confusing, even to experienced health care professionals. One example is of a nurse prescribing a patient the drug fentanyl, a narcotic used for pain management. The hospital pharmacist misheard this as sufentanil, a derivative of fentanyl that is actually about 10 times more potent. The patient, who was going into surgery for an endoscopy, ended up requiring CPR.

One major problem is that a tremendous number of new drugs are proliferating, often with similar sounding names, like Celexa (an antidepressant) and Celebrex (an anti-inflammatory). An organization called U.S. Pharmacopeia (USP) is supposed to be on the lookout for easily confused drug names, but it's challenging to keep up with so much new nomenclature. More examples from the Post:

Losec, for heartburn, was confused so often with Lasix, a diuretic, that the name was changed to Prilosec. But now that gets confused with Prozac, according to a USP report.

And the Alzheimer's drug Reminyl was changed to Razadyne after mix-ups involving Amaryl, which lowers blood sugar. The mix-ups reportedly resulted in two deaths...

The report issued earlier this year by USP on the relationship between drug names and medication errors reviewed more than 26,000 records. It found almost 1,500 different drugs implicated in medication errors as a result of names that looked or sounded alike. The drugs in question added up to 3,170 pairs, double the number of pairs found in a 2004 report. According to the document, 1.4 percent of the errors resulted in patient harm, including seven that may have played a part in patient death.

It's not just "sound-alikes" that can cause problems. Some drug names are pretty unwieldy on their own, like the Alzheimer's drugs tarenflurbil and bapineuzumab. Even seasoned doctors can trip over those.

And then there's the matter of differing regional pronunciations. One expert points out that there are distinct American and British pronunciations of the word barbiturate, though both are considered acceptable. In the U.S., the word is very often pronounced as if it were spelled barbituate (without the second r), and in fact that's a very common misspelling. (Of course, British speakers may drop the first r when pronouncing the word, but that's because they speak mostly "non-rhotic" or "r-less" dialects.) Though the two pronunciations of barbiturate might not be terribly perplexing, it's easy to see how similar cases could lead to crucial failures to communicate between speakers with different regional accents.

Fortunately, the medical world isn't descending into Babel-like confusion. In the U.S., initiatives are underway to ensure "good naming practices" for new drugs, and pronunciation guides have been drafted and distributed with an eye towards consistent usage. Best of luck to our hard-working health-care providers in overcoming these new linguistic hurdles.


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Ben Zimmer is executive editor of Vocabulary.com and the Visual Thesaurus. He is language columnist for The Wall Street Journal and former language columnist for The Boston Globe and The New York Times Magazine. He has worked as editor for American dictionaries at Oxford University Press and as a consultant to the Oxford English Dictionary. In addition to his regular "Word Routes" column here, he contributes to the group weblog Language Log. He is also the chair of the New Words Committee of the American Dialect Society. Click here to read more articles by Ben Zimmer.

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Comments from our users:

Thursday August 7th 2008, 6:25 PM
Comment by: Paula P.
My brother-in-law, a Baptist preacher, visited a lady in the hospital who was very secretive about her condition. He finally caught up with her husband and asked what the lady's problem was. Seems she had surgery for "fireballs of the eucalyptus" (fibroids of the uterus).
Friday August 8th 2008, 9:29 AM
Comment by: Theodore D.
Demerol= damn it all
Ted DuPuy, MD

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