Medical nomenclature is needlessly complex

Try your hand at a question from one of our anatomy exams.

What nerve supplies the obturator internus muscle (a muscle in the pelvis)?

The correct answer is the “nerve to obturator internus.” It’s like answering who is buried in Grant’s Tomb.

As a time-strapped medical student, it feels like a godsend when a medical term is named in an obvious way. Even a lay person can intuit the meaning of medical terms like “urinary tract infection,” “vocal cord paralysis,” and “foot drop.” Unfortunately, the meanings of medical terms are rarely so obvious.

Sometimes I can decipher the meaning of a medical term by looking at its Latin or Greek roots. Nephrectomy, the surgical removal of a kidney, is a combination of nephro-, from the Greek root for kidney, and -ectomy, from the Greek root for surgical excision. By knowing roots like these, I can decipher the meaning of a new term.

Thus, a ureterectomy is the surgical removal of a ureter. A nephroureterectomy is the surgical removal of a kidney and a ureter. An appendectomy is the surgical removal of the appendix. Similarly, I can tell from its name that the supraclavicular artery runs above the clavicle, and that the ovarian artery supplies the ovary. It’s fantastic.

But even this approach can run me into trouble. In 1806, a dermatologist named a particular skin disease mycosis fungoides, from the roots for mushroom and fungus, because it looks like a fungal infection. We now know that it is a type of lymphoma, with nothing to do with fungus or infection. But the name has stuck. Similar examples abound.

Often a medical term has no connection its meaning. Sometimes this is because the disease is named after its discoverer. Berger’s disease affects the kidney, while Buerger’s disease affects the small arteries of smokers.

The worst offenders are when medical terms are simply numbered in the order of their discovery. Our white blood cells have a category of proteins on their surface called cluster of differentiation. The various proteins have been numbered from CD1 up to CD350. For some CD proteins, we need to have memorized which subcategories of cell types express them.  For example:

CD3: T-cell
CD4: helper T-cell (depleted in AIDS)
CD8: killer T-cell
CD15: Reed-Sternberg cell (seen in certain leukemias)
CD30: Reed-Sternberg cell
CD56: natural killer cell

Exams like our national boards are chock-full of questions that test whether you realize that lupus anticoagulant is erroneously named, or that IL5 stimulates allergic reactions while IL10 tamps them down. Memorizing all of this takes a lot of time.

I maintain that time spent memorizing these silly names is time not spent learning other things, like how to heal patients. Medical nomenclature is needlessly complex. We should try to make our names for things easier to decipher.

“Reflex Hammer” is a medical student who blogs at The Reflex Hammer.

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  • Dave

    Agreed. Some eponyms are already being gently shown the door, but it is a slow process. Other terms stem from the basic science world, ie CDx and CDy were numbered as they were discovered. Perhaps we need some international consensus for terminology when thing move from research to clinical use. Thing will only get worse as science progresses!

    • Andrew Levin

      This is generally a good trend. I’ll miss some eponyms, though, such as Wegener’s granulomatosis (now called granulomatous polyangiitis)

      • Mengles

        You do know why Wegener’s granulomatosis was renamed right?

        • Andrew Levin

          Yes. He was a Nazi and may have performed unethical experiments. I didn’t say I liked the guy; I just enjoy how the name of the disease rolls off the tongue. I’m not certain it’s the best reason to abandon the eponym, however. We still perform works of Richard Wagner even though he was a racist/anti-Semite. Regardless, I still think it’s best that we disband eponyms altogether and move in favor of more descriptive terminology.

          • Mengles

            I guess my point was that that the name change was more due to political pressure, not due to an actual motive for descriptive terminology. I happened to like the original name of Wegener’s granulomatosis for the same reason as you.

          • Guest

            There are more than 50 buildings in West Virginia named after Robert Byrd, despite the fact that he was a recruiter for the Ku Klux Klan in his 20s and 30s and later rose to the position of Kleagle and Exalted Cyclops.

            “It is what it is.”

  • buzzkillerjsmith

    It’s a learned profession, medstud. That means you have to learn.

  • QuardeMD

    this post made me smile. Your observation does not exist only in medicine my young learned friend. It occurs in all the other sciences…it is even worse in botany :) . Medicine is an exact science and riddled with mysteries. Your burden is to know how to navigate the many turns and complexities. They are all relevant in research and not necessarily direct patient care in your office. As a budding doctor you need to know all these minute details in order to appreciate the bigger picture in your later years of practice. So when i see an abstract and it reads “activated factor Xa inhibitor” i know what the drug does.
    Have a nice day budding doc. :)