Tuesday, June 19, 2012

Are You and Your Expert Speaking the Same Language?

Medical terminology has been specifically designed to allow medical professionals to describe the human body, its parts, possible defects and associated conditions or procedures in a very exact way that is instantly clear to the listener or reader. In this system, words are built based on root words, prefixes and suffixes. The various elements of the word are usually derived from Greek or Latin and can be combined in multiple ways to produce almost endless options. Prefixes are added to the beginning of the root word to designate size, location, number or time involved. Suffixes are added to the end of the root word to specify a condition, type of disease or procedure. For example, let’s look at the word hemilaminectomy. “Hemi” the prefix meaning half, “lamina” the root word meaning the flat posterior aspect of the vertebral arch, and “ectomy” the suffix meaning to cut out. So combined together “hemilaminectomy” means the surgical removal of half of the lamina of any spinal vertebra.

Sounds simple right? Wrong. As with any system, it is only simple if everyone follows the rules. Regretfully, it has been my experience that many experts are influenced by the era they attended medical school, where they went to school, where they currently practice and arbitrary personal preferences when it comes to how strictly or loosely they utilize medical terminology. For the purposes of this article I will use examples related to intervertebral disc injuries and spinal surgery to show how medical terminology can be corrupted.

First we’ll look at the categorization of intervertebral disc injuries. “Officially” a disc injury that results in an expansion of the disc material beyond the normal border while the nucleus material remains contained within the annulus should be referred to as a bulge or possibly a protrusion. A disc injury that involves a tear of the annulus allowing the nucleus to protrude beyond the border of the disc should be referred to as a herniation, rupture or extrusion. It is a clear-cut differentiation, but it doesn’t always work that way. I recently reviewed a case with a patient who had undergone three MRI scans within months of a motor vehicle accident. When viewing the films, it was clear that there was no change in the amount of disc protrusion from study to study, but a different radiologist had reviewed each of the MRIs. One report referred to the injury as a bulge, another called it a protrusion and the third listed it as a herniation. I have seen similar discrepancies from expert to expert in reference to the same exact MRI study.

Similar departures from standard medical terminology can be seen in reference to surgical terms. The example we used above was hemilaminectomy that refers to a complete removal of half of the lamina. Similar terms include laminectomy, the complete removal of both sides of the lamina, and laminotomy, the removal of a small portion or the creation of a window in the lamina. These three terms have very specific definitions but I have seen in countless operative reports a surgeon refer to all three by the catchall term of laminectomy. You have to read the details within the body of the narrative report to determine what was actually done.

These are just a few examples. The point I’m trying to make is that you should not assume that your expert is always following the rules of correct standard medical terminology. When meeting with or corresponding with you expert, you need to go deeper and insist on detailed descriptions of his opinions and definitions of any terms that he uses. Also, be suspicious of terms you encounter in the medical records. If a client has a disc bulge before the accident and then has a herniation afterward, don’t immediately assume that there has been a worsening of the condition. It may just be a difference in the terminology used by each of the radiologists. Only a direct side-by-side comparison of the films can reveal if there is any change in condition.

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