The University of Southern Mississippi

Honors College Theses: Analyzing the History and Evolution of the Medical Language: Should

There Be a Universal Medical Language?

by

Savannah Lacoste

A Thesis
Submitted to the Honors College of
The University of Southern Mississippi
In Partial Fulfillment
Of the Requirement for the Degree of
Bachelor of Interdisciplinary Studies
in the Department of Interdisciplinary Studies

December 7, 2016
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Approved by

_____________________________________
Allan Eickelmann, D. Min., Thesis Adviser
Professor of Interdisciplinary Studies

_____________________________________
Marek Steedman, Ph. D., Chair
Department of Interdisciplinary Studies

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 Abstract

Medicine is universal, but the medical language is not. Beginning with the Greek era,

medical language gradually shifted to the Latin era during the Middle Ages, then eventually to

the era of national medical languages, where nations created and spoke in their native language.

By allowing each nation to name diseases, create terminology, and invent medications and

dosages in their own speech, the medical language went from seemingly coherent to a melting

pot of interpretations. Although the effects are not directly seen in the United States, countries

with a variety of different languages experience the language barrier. Should there be one unified

language for medicine, and if so, which language is the best choice? If not, what actions can be

taken to effectively eliminate the effects of the medical language barrier? This thesis includes the

origin, history, and importance of the medical language, literature on the possible benefits and

consequences of unifying the medical language, theoretical solutions, field research from

medical professionals on the topic, possible steps toward solving this issue, and an execution and

conclusion on the research findings.

Key Words: Interdisciplinary Studies, undergraduate research, universal medical language,

origin, English

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 Acknowledgements

I would like to take a moment to thank my thesis advisor, Dr. Allan Eickelmann, for his

continued support and guidance throughout my journey in Interdisciplinary Studies. Not only did

his unwavering confidence push me to be better, but his encouragement to pursue goals like

joining Honors College, attending conferences, and becoming involved in my college and

community has enhanced my collegiate experience. Dr. Eickelmann has truly gone the extra mile

to ensure I reach my fullest potential during my time at The University of Southern Mississippi,

as well as being successful in my future endeavors. Thank you for everything you have done and

continue to do.

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 Table of Contents

List of Tables/

Illustrationsviii

List of Illustrations..ix

List of Abbreviations

viiix

Chapter 1: Introduction1

Chapter 2: Review of the Literature.2

Analyzing the Effects...3

Literature on Solutions.4

Literature on Possible Effects...5

Theoretical Solutions..11

Chapter 3: Statement of Methodology...14

Chapter 4: Execution of Research Design.16

Chapter 5: Conclusion....27

Chapter 6: Future Implications..30

Annotated Bibliography.32

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 List of Tables/ Illustrations

Table 1: Survey Results 24

Table 2: Survey Results ....26

Illustration I: Universal Medical Language Survey..........19

Illustration II: Time In Medical Field25

Illustration III: Survey Results...25

Illustration IV: Theoretical Solutions26

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 List of Abbreviations:

Unified Medical Language System (UMLS)

Office of International Medicine (OIM)

World Medical Association (WMA)

Medical Interpreters Association (IMIA)

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Introduction

In a world full of diversity, all people share one very important aspect that is solely

responsible for the continued existence and longevity of human life: medicine. Not only do

humans practice medicine and healing, but they study it, experiment with it, invent it, and

constantly try to improve what is already known to be effective. All around the world, people of

all nationalities study medicine and devote their lives trying to discover new and improved ways

to treat disease and improve the human quality of life. Not only do scientists and doctors study

and experiment with their own work, but they also grow from the work of other medical

professionals. While medical experts working together is a great thing and can result in new

revelations in the world of medicine, it becomes rather difficult when the languages in which

these studies are written are foreign and do not translate directly.

While medicine is very much universal, the medical language is not. The language of

medicine began with the Greek era, gradually shifted to the Latin era, and eventually became

nation-based (Catlin, 2008). For the most part, Medical English has become the international

written and oral language of communication because it is the language that is most commonly

used when writing medical journals or scholarly articles, but still there is no universal language

for medicine as a whole. To take on the issue of a universal medical language, the history and

advancements must be understood, the effects of not having a universal medical language must

be analyzed, and the advantages and consequences of designating English as the universal

medical language must be weighed.

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Literature Review

To understand the medical language, it is necessary to know its origins- the Greek era.

Greek physician Hippocrates was the first to attribute illness to physical causes and began

observing, treating, and diagnosing in the first distinguished medical practice (Dirckx, 2005).

Together, Hippocrates, Galen, and his other colleagues documented their knowledge into what is

now known as Hippocratic writings. These Hippocratic writings are the earliest form of a written

source of medicine, dating back from the fourth and fifth centuries B.C. (Wulff, 2004, p.1).

These writings documented the aspects of medicine as well as the first medical terms of

Hippocrates and his successors. This was the start of the era of Greek language in medicine even

through the early days of the Roman Empire. According to an article by ORahilly from

Dartmouth Medical School, these Greek doctors were the first to systematically study the field

of medicine and develop a suitable vocabulary (2008, p. 1). In fact, even at the beginning of the

first century AD, Greek stood as the language of medicine in the Roman Empire.

In the beginning of the first century A.D., a Roman aristocrat from Narbonensis, which is

now Narbonne in South France, created a medical encyclopedia (Wulff, 2004, p.1). Aulus

Cornelius Celsus authored De Medicina, containing medical knowledge and terms from Greeks.

However, because of his Latin background, he ran into the problem of translating certain terms

and concepts into Latin. To solve this language barrier, Celsus started by using some of the

Greek terms, and even their pronunciation. Then, he latinzed Greek words by replacing the

once Greek endings with Latin ones. Lastly, he translated Greek anatomical terminology in such

a way that kept the vivid imagery. This worked out great and became a very successful way for

doctors that may not all speak the same language to thoroughly understand and communicate

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well with each other (Drubin, 2012, p. 1). This is a major problem the medical field is running

into today.

Analyzing the Effects

The medical language created by Celsus years ago was created from languages that are

essentially dead now and are of little use to modern day doctors and scientists. However, the

problems that were faced centuries ago are still problems today. New information and advanced

studies are discovered daily in foreign countries that are recorded in languages other than English

causing a great loss of information whenever these medical journals are translated (Breaking the

Language Barrier, 2001). The lost information takes away significant meaning and great impact

from the study which slows the advancement of medicine. Not only does the loss of information

happen at higher levels, but also in the most basic senses of medicine. While the majority of the

communication between doctors and scientists around the world is now almost exclusively in

English, doctors communicate this information to patients and colleagues in their own native

language.

Also, in medical schools and on college campuses across the map, students learn the

scientific terminology in English, but lectures and explanations of this terminology are all given

in their native languages. This becomes confusing and detrimental to the advanced levels of

information being portrayed when the translation dilutes the pure meaning that was originally

intended in the English writing especially considering the idea that the students in these

classrooms that are receiving large amounts of diluted information are the future of the medical

world.

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Without a universal language, there are many effects, some even fatal. In 2008, David

Gray, a patient from England, was prescribed ten times the suggested and safe dosage of his

medication which unfortunately resulted in his death. This prescription was written in English,

however, Grays doctor was a non-native English speaker. In his testimony, he claimed that the

error was a result of extreme confusion about the difference between the drugs and dosages from

the United Kingdom and Germany, his native land and language (Spicer, n.d., p.1). This is just

one example of what happens every day all over the world due to inaccurate translation of

languages in the medical field. Some of the most advanced professionals in the National Health

Service are non-native English speakers, and a majority of the obstacles they face and problems

they run into are caused by their lack of adequate communication skills in the medical field.

Literature on Solutions

Even though there is not a universal medical language that has been verified, there are

many projects in place to try and find the solution to this problem. One of the companies

attempting to tackle this task is known as the Standardized Language Examinations for Medical

Purposes team (Spicer, n.d., p.1). They began the program in 2011 with the purpose of creating a

language exam that would be used as the standard measurement for medical English competency

across the European countries. This system would require doctors and scientists working in the

medical field to take an exam before they begin communicating with other colleagues and

patients. A core partner in this project describes the system as being,

Iintended to promote, assess, and certify the command of professional English among

health care professionals world-wide. It will enable hospitals, and staff, research fellows,

or externs whose first language is not English, to obtain sound information about their

English language proficiency in a professional context. EASE endorses both

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standardization of scientific (including medical) terminology and the use of clear

language by all authors of scientific publications in English (Spicer p. 2).

Another program system with a similar mission is known as The National Library of

Medicines Unified Medical Language System (UMLS) Knowledge Source Server (Bodenreider,

1998, p. 1). It is an internet based tool that retrieves information concerning medical

terminology including things such as root, origin, history, and meaning. As this program grows,

the future editions are expected to improve medical terminology representation as it applies to

the global medical field. The goal is to establish consistency and understanding between all

doctors around the world in order to pull together and advance medicine daily (McCray, 1996).

Along with these two examples, many other programs are undergoing these same practices in

order to solve the problem so many people are suffering from all over the globe. Even though

they are working to find a way to integrate the multiple languages in the medical terminology

used today, this still leaves the question of which language should become the sole universal

language of the medical field.

Literature on Possible Effects

While the majority of those studying medicine communicate the science, terminology,

and studies in English, there is still a huge demand for writings in other languages. British

author, David Graddol, wrote, The dominance of English on the internet today is declining.

Other languages, including lesser-used languages, are now proliferating and remarks that many

other languages such as German and French are becoming more popular than in the past, not

only in medicine, but across the board (Baethge, 2008, p. 3). In the German National Library of

Medicine, almost one-fifth of the journals and periodicals are written in German language. This

is a large and continuously growing percentage. It is directly correlated to the need and demand

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for German-language written material in the field of medicine. The need for German writings in

the medical field is also expressed through polls that interviewed private practicing doctors and

physicians in German-speaking countries regarding the use of the internet for continuing their

medical education and research. Three hundred physicians were interviewed, and seven out of

ten reported it being very important that articles are written in German (Baethge, 2008, p. 1).

However, in the study, Penetration of the English Language in Science: the Case of a

German National Interdisciplinary Critical Care Conference researchers found that about one-

quarter of the abstracts presented at a German medical conference were written in English,

indicating a significant penetration of the English language into a German national

multidisciplinary conference (Falagas et al., 2005). These results are valuable for two reasons:

(1) the majority of the attendants at the conference were German-speaking, but still decided to

present their work to a German-speaking audience in English, and (2) the German language is so

historic and strong-rooted that it is thought to be one of the most difficult languages in Europe

to penetrate (Falagas et al., 2005).

While medical professionals all over the world would of course desire medical journals

be written in their native language, this becomes nearly impossible due to the high demand for so

many translations and the information that is left out due to merely picking the closest translation

there is over and over again as it goes from one language to another. The saying, lost in

translation is truest in this sense. The confusion of translating between languages is not only an

issue in the medical world, but in many other fields of study.

This was a very big issue in the classification of biology. All across the world, from the

days of Aristotle, scientists would study the same species, classify them into different categories

such as plants and animals, but refer to them as different names. This would cause massive

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confusion as the scientists from different regions communicated referring to the same species in

different terms. Classification in the world of biology started off in terms of survival. In all

regions of the world, plants and animals began to be classified as either harmful to human

survival or not. Classification began to advance to different categories such as blood and

bloodless, or their mode of transportation such as walking, swimming, or flying. As science

evolved and advanced, classification became more advanced and scientific naming, or taxonomy,

began to develop into intricate language. As scientists began to work together, differing names

of species caused issues in communication and research. Eventually, a universal language was

created that is still used today when species are referred to scientifically. Even though animals

may be called a wide variety of different names around the world, when discussed in scientific

terms, they all have only one name.

Since the creation of the universal language of science, many issues have been resolved,

and simple mistakes that were common in the past are rare. Applying this same idea to the field

of medicine would be extremely beneficial. While the question is not the effectiveness of a

universal language, but instead, in which direction should medicine go in the creation of the

universal language.

Even after the idea of a universal medical language is decided upon and created, there is

still a huge need to give meaning to this terminology. While the foundation of a universal

language is indeed the terminology, without a universal meaning behind these words, the words

are merely left up to further interpretation, which could actually cause more problems than

having multiple languages in the medical field (Huttner-Koros, 2015). In order for it to serve its

purpose and solve the current day problems that demand a universal language, medical

terminology must be correctly defined for each individual native language and given appropriate

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and effective meaning. No matter how skilled a doctor may be, what really matters in the

medical field is the proficiency and fluentness of the medical terminology. Without

understanding what is written on paper, a doctor simply cannot perform the necessary actions to

be successful in the health care profession. Even after a universal terminology is created,

universal meaning should take over and complete the creation of a universal medical language.

While the majority of medical research and writings are recorded in English, there are

both pros and cons to declaring it the universal language of medicine and many things to

consider before that extreme decision is made. English is undoubtedly one of the most important

languages in the world, if not the most. All over the world, people learn English in their homes,

and at the latest, in grade school even if it is not necessarily their native language. It is

absolutely, in some ways, a universal language in and of itself. English has evolved greatly

because of its dominance in many worldly matters such as economic power, a large and

represented military presence, and success in majority of worldly engagements.

Medical professionals are now aware that if they write their medical journals in English,

it will attract the highest volume of readers than it would if written in any other language

(Huttner-Koros, 2015, p. 4). This motivates all people, regardless of their native language, to

submit journals in English as well as subscribe to English scientific and medical databases. In

fact, in an article titled, Impact factor trends for general medical journals: non-English-language

journals are lagging behind, researchers measured the impact factors (IFs) of English journals in

comparison to non-English-language journals and found the IFs of the non-English journals were

significantly lower than the journals written in English (Vinther, Siri, and Rosenberg, 2012). Due

to these results, they concluded that, In an international scientific community with English as

the universal language of science, non-English-language journals should consider changing

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publication language, adopting either a bi- or a monolingual approach (2012). With English

already being such a key factor in the world of medicine, transitioning all texts and

communication to the English language would be considerably easier and more convenient than

switching all text including those written in English to another, less popular language (Fortuine,

2001, p. 373).

Another advantage to declaring English the universal language of medicine is the idea of

sharing the same universal language as the world of science and biology. David G. Drubin and

Douglas R. Kellogg from The American Society for Cell Biology write that by learning a single

language, scientists all over the world now are able to access, read, and thoroughly understand all

writings submitted through scientific databases. While this creates problems for those that are

not English speakers, adjustments must be made to ensure the success and accuracy of the

programs at hand. No matter what, certain people are going to be required to learn a new

language and new terminology in order to exist and flourish in the fields of science and

medicine. After options are weighed, picking the language that presents the field with the most

promising growth and results is necessary. In the case of science, the language that was selected

was English. With this decision having been made and currently being practiced world-wide, the

world of medicine must consider the effects when selecting a universal language of their own.

The fields of medicine and science are not only closely related, but intertwine constantly

throughout. Usually the same scientists and doctors studying medicine must research and

experiment with science just as scientists studying new scientific research will cross over into the

world of medicine. English as the universal language of medicine would ensure the smoother

transitions for scientists and researchers crossing over from field to field. While they have

decided on a solution, this does not necessarily mean that they are free of problems. The biggest

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problem the world of science faces after their decision to declare English the universal language

is the shocking percentage of people that actually are able to speak English fluently. Yes, as

previously mentioned, children everywhere begin learning English at a young age both in their

own homes and in their schools, but what percentage of these students actually grow up to

become fluent speakers of the English language?

Only fifteen percent of the worlds population reports speaking English fluently

(Summary by size, 2016). This percentage includes the five percent of native speakers that may

have been speaking English and only English from birth. This creates a huge imbalance when

looking at the number of people affected by the universalization of language. However, it is

projected that as of 2015, over half the worlds population will use English primarily in Science

and medicine (Falagas et al., 2005). While the argument for English greatly outweighs many

other options, the difficulty of the learning process that goes into becoming fluent in the English

language is extreme. English is commonly recognized and known to be the absolute most

difficult language to learn as a second language.

In a study titled, Moving Beyond the Language Barrier: The Communication Strategies

Used by International Medical Graduates in Intercultural Medical Encounters, researchers

concluded that language classes should be available for international doctors that focus on

culturally appropriate language and acculturation with respect to usage of slang words,

idiomatic English, and other colloquial terms (Jain, Parul, and Krieger, 2011, p. 103). As

consideration for declaring English the universal language of medicine grows, so should the

concerns with the burdens and extreme challenges that come with asking not only doctors and

scientists, but also nurses, secretaries, and anyone working in the field of medicine to learn the

most difficult language known to man.

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However, there is also evidence suggesting that pursuing the creation of a universal

medical language in the direction of Latin terminology would be best and most beneficial. While

many people view Latin as a dead language that is not used anymore, this is far from true.

Although the Latin language may not be used for verbal communication, it provides the basic

origin and roots of the most popular languages around the world including French, Spanish,

Portuguese, and Italian. Latin is also viewed as a popular choice for the universal language of

medicine because the majority of the medical terminology already roots from the Latin language.

Instead of completely destroying and rebuilding a vocabulary in order to create the universal

language, many believe it would be more beneficial to reframe and rework what is already in

place.

After all issues are weighed and examined, the evidence and research points to English

being the most logical and beneficial choice for creating a solid and reliable universal language

of medicine. With the language already being widely known, understood, and spoken across the

map, it is the most sensible transition to a universal language. Not only will the language be the

easiest to transition the medical terminology into, but it will match up and work consistently with

the universal language of science. While there is no right answer, and all possibilities present

many different advantages and disadvantages, it is important to weigh all options and do what is

best for the medical field as a whole. As human beings, the medical field is the most important

science studied and will not only ensure our growth, but our survival as a species.

Theoretical Solutions

A possible step toward the universalization of the language of medicine would be the

creation of an organization focused on medical language internationally. Although there are

universal medical organizations such as Office of International Medicine (OIM) and the World

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Medical Association (WMA), there is no specific organization whose focus is medical language.

According to the OIM website, their purposes include global policy development, the

development of health care programs, and the intervention in the violation of human rights

(Office of International Medicine). Although this organization unites the medical field

internationally, it does so on a policy-based level.

In a similar way, the World Medical Association (WMA) is an organization that focuses

on the representation and rights of physicians worldwide. The WMA does unify medical

physicians worldwide, but their focus is on their rights, not their medical practicing. According

to the WMA website, the organization was created to ensure the independence of physicians,

and to work for the highest possible standards of ethical behavior and care by physicians (World

Medical Association). Although both organizations focus on the medical field internationally,

neither focus on the language barrier.

The only major international organization that deals with bridging the medical language

gap is the International Medical Interpreters Association (IMIA). This organizations purposes

include providing medical interpreting of over seventy languages, promoting research of the

issues of cross-cultural communication in medicine, and promoting medical interpreting

(IMIA-About Us). This organization acts as a temporary preventative to some

miscommunication and healthcare errors, but does not ultimately work toward eliminating them.

The proposed organization would not only work toward bridging the language barrier worldwide,

but gradually create a universal medical language.

The proposed universal medical language associations purpose would not only be to

bridge the medical language gap, but to gradually universalize medical terminology and their

meanings. The organizations efforts would include making language classes available for

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international physicians, provide interpreters for training physicians, and unify medical terms

and interpretations by ultimately creating a universal medical language. The associations efforts

would be over a span of years, possibly decades, but the steps toward medical language

unification must start somewhere.

Another theoretical solution that would be a step in unifying the medical language is

preparing students who plan on entering the medical field earlier on in their education. As a pre-

med undergraduate student, the only medical language I know stems from Anatomy and

Physiology, the Latin classes I took in high school, and the television series Greys Anatomy.

Aside from nursing majors, students pursuing the medical field are left to teach themselves

before being thrown into medical school with no concrete medical knowledge. Along with the

list of required classes for medical, nursing, physical therapy, and other professional schools,

requiring a Medical Language Origin and History class would be beneficial for everyone. After

this course, students would not only understand the influence of Latin and Greek on the medical

language evolution, but have a better understanding the naming of terms, and be more

comfortable as they enter their professional programs. This would also be helpful for non-native

English speaking students to begin to feel comfortable with the language, and have a more in-

depth understanding of its origins.

Whether the most effective universal medical language chosen is English, Latin, Greek,

German, or another language entirely, a choice must be made and action must be taken. Medicine

is a necessity mankind will forever be improving on, changing, and understanding, so taking on

the field as a whole will only make the advancement stronger. After further research,

interviewing, surveying, and analyzing this thesis will make a statement on the most logical

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universal medical language, and provide professional opinion-based ways to begin unifying the

medical language as a whole.

Statement of Methodology

In order to suggest logical solutions for such a complex problem, they must first be tested

and backed up through professional opinion and research. The first research method to be used

will be the qualitative method of face-to-face interviews and focus groups. There are many pros

to holding interviews and focus groups because it would provide information, opinions, and

experiences from experts in the field of medicine, which would strengthen the ethos of the final

paper. A focus group would be ideal, seeing that a group of two or more medical professionals

would be discussing this question with guidance on topics from specific questions.

For my focus group, the participants will include a doctor, nurse practitioner, and nursing

student. This will provide perspectives from not only a student who is still learning and

experiencing the medical language along with a doctor and nurse practitioner who work in

hospitals and private practices, allowing them to interact with other medical professionals daily.

In this focus group, the topic will be presented by asking the question Should there be a

universal medical language?. After initiating conversation on the topic between the participants,

I will make sure to record the responses from each individual. Once each participant states their

opinion on the topic, the next question asked will be, If so, what language should be the

universal medical language, and why?. This will provide the participants an opportunity to back

up their opinions, and for me to be able to decipher between personal bias and fact-based

opinion.

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For the last question in the focus group, I will ask for any experiences where language

barriers caused confusion or mistakes when treating a patient, researching a case, or

communicating with another medical professional. Asking these questions will give me a better

understanding of their awareness of the problem, opinion on possible solutions, and experience

as a medical professional. Having these three different professional opinions will not only

strengthen the ethos of my argument, but also provide another interdisciplinary aspect by

providing multiple perspectives.

The second research method that will be used is a quantitative survey with specific

questions that will strengthen, inform, and help break down the complex issue of a universal

medical language. This survey will be given to doctors, nurses, nurse practitioners, physicians

assistants, or anyone who works in the medical field daily. The survey will get background

information on the participant, as well as their opinions on the language barrier, the importance

of a unified language in medicine, and so on. Attached is a survey with possible sample questions

that will be given to participants. It is important that these questions are unbiased, direct, and

informative enough to strengthen my thesis and back up the research.

The most beneficial research method for my specific research question will be face-to-

face interviews with medical professionals. However, a combination of interviews, focus groups,

and surveys would be the best possible methodology sequence in order to fully understand, break

down, and provide logical solutions to the research question. Each method brings to the paper its

own strengths and improvements to answering and possibly deciding which actions are the most

logical step in the direction of solving the issue of the medical language barrier. Within this

methodology, the following proposed action will be discussed and its potential effects will be

analyzed.

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The limitations to my methodology is acknowledging that even though I can research,

conduct interviews, and survey medical professionals, I am limited not only to the United States

of America, but also limited to English speaking professionals and research written or translated

in English. I cannot fully represent both the American and international opinions of medical

professionals because my information is limited to the language I know and can understand. As I

have run into during the execution of this research question, not being able to access information

internationally creates a weakness in my thesis, just as it does in the medical field. Not being

able to speak to medical professionals globally in a unified language weakens the medical field,

allows for miscommunication, and ultimately prevents growth by not allowing international

collaboration.

Execution of Research Design

For the qualitative research creating a focus group, the participants included a doctor,

nurse practitioner, and newly graduated nursing student. In this focus group, the opening

question asked was, what are your thoughts on the fact that there is no universal medical

language, but in areas like science, the universal language is English?. The physician brought up

the first point that because we all live in America, where the main language is English, the only

way we experience the effects of a language barrier is physician to patient conversation. He

comments that as a physician he is not typically involved in international studies and

correspondence, which is an interesting point to be taken into account when answering this

question. The nursing student also adds that technology such as an iPad translator makes

speaking to non-English speaking patients easier, but access to this iPad is difficult to come by.

She also comments that even the English second language physicians who have been in the

countries for years still experience language barrier due to heavy accents.

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When asked if international collaboration is essential to the growth of medicine, the nurse

practioner responded that, I dont think we are really affected because we are in America,

however I do run into that, in the clinic world, with patients, and I do find that because of the

language barrier that there is failed medications and dosage errors. She adds, Im not sure if a

universal medical language would benefit unless it was taught to the patients as well, so if youre

not able to teach the laypeople, then you lose your effectiveness. This is an important point that

is later brought up in the focus group: changing the universal medical language to English would

essentially mean changing the universal language to English, which is a tall order. From this

focus group, it is clear that not only are American medical professionals not impacted by the

language barrier internationally in comparisons to those in other countries, but the idea that

changing the universal medical language would be equivalent to changing the universal language

as a whole.

The focus group was then asked about the importance of knowing the origin and history

of the medical language as a student before entering professional school. While the nurse

practioner and newly graduated nursing student both agreed knowing the roots, meanings, and

origins were important as pre-professionals, the physician disagreed. He comments, there are

probably a lot of diseases I dont know the exact origin of where it came from, that doesnt really

matter as long as I know how to recognize and treat it. The nursing student adds, the patient

outcome is the same whether you know the root or not, but I think that school has advanced since

then. They want you to not only know what it is and how to treat it, but where the name

originated and why. Its not necessary to patient care, but extra knowledge they want you to

know.

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For the final question, the focus group was asked whether or not there should be a

universal medical language, and if so which language would be the most logical choice. The

physician feels that the easiest language to learn is Spanish, but given the popularity of English

in everyday life and journals, it would probably be a better choice. The nursing student feels that

there should be a universal medical language and it should be English, even though it would be a

serious transition phase for those who have been practicing for a long time, who have to learn

something new. The nurse practioner answered that asking for a universal medical language of

English would be more helpful to ask for English as a universal language. That would then

benefit not only medical professionals but also patients.

Overall, the focus group was challenged to decide which is the best way to solve the

language barrier: a universal medical language, or something else. The nursing student answered

that technology is our best bet. She comments that, Although it would be ideal to say, I need all

my patients and all my physicians to speak just like me you have to be culturally appropriate in

your practices and asking people to be just like you is too much to ask. Lastly the physician

chimes in that, there should be an app for that. While each participant feels the language

barrier is an issue, their overall thoughts on the universal medical language is that it is not as

likely as they would hope.

The quantitative aspect of the methodology is the process of conducting surveys on the

topic of universal medical language to give to professionals in the medical field. This survey

(Illustration 1), made up of sixteen questions, included matrix rating scale style, multiple choice,

and check all that apply questions on the topic of universal medical language. From this survey

given to one hundred and fifty medical professionals one hundred and fifteen were returned and

the results were analyzed and compiled into Table 1 below. This provided information on

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medical professionals opinions on the importance of international communication, international

research, and medical journals, as well as their views on the language barrier and thoughts on the

medical language.

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Illustration 1:

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Table 1:

Questions: Strongly Disagree (1) Strongly Agree (5) Mean

Communication between medical professionals worldwide is not that important 1.7

Medical research is necessary in the growth of the medical field 4.3
Miscommunication due to a language barrier causes severe, sometimes fatal, mistakes 4.3
Having an understanding of the Greek and Latin influence on the medical language is not 2.7
necessary
Staying current on medical research around the world is important for everyone in the 4.0
medical field
There is no language barrier in the medical field globally 2.0
Knowing the origin and meaning of medical terms is important and beneficial 4.0
Medicine is universal worldwide 3.6
The medical language is universal worldwide 2.8
Publishing Medical Journals is a great way to get medical research noticed 4.3
It is easy to get medical information from medical professionals in non-English speaking 2.6
countries
Having a universal medical language is necessary in the progression of medicine globally 3.7
I have never witnessed or experienced confusion between medical translations (diagnoses, 2.3
medicine names, dosages, etc.)
Students pursuing a career in the medical field should be educated on the origin of medical 4.1
language and terminology as undergraduates
Having a universal medical language is unnecessary 2.1

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Illustration II:
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Time in Medical Field

40%
40%
35%
30%
30%
25%
20%
20%
15%
10%
5%
0%
1-5 Years 10-20 Years 20 plus Years
Illustration III:

Survey Results
100% 0.9 90% 90%
90%
80% 70%
70%
60%
50%
40% 30%
30%
20% 10% 10% 10%
10%
0%
0%

Yes No Does Not Apply

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T he o re tic a l S o lutio ns
60% 50%
50% 40%
38%
40% 30%
30% 20% 20% 20% 20%
20%
10% 5% 2%
0%
0% 0% 0% 0%

Possible Solutions Most Effective Solution

Table 2:

Question Popular Answer

How long have you been in the medical field? 1-5 years 30%
5-10 years
10-20 years- 20%
Over 20 years 40%
Student in the medical field- 10%
How often do you reference medical journals? 70% answered sometimes, often, or very often
Have you ever attended a medical conference? Yes- 70%
No- 30%
Have you ever attended a medical conference out of the Yes- 10%
country? No- 90%
If yes, was the conference primary spoken in English? Yes- 10%
Does not apply- 90%
No- 0%
Have you or someone you know experienced confusion due to Yes- 90%
a language barrier? No-10%

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Check all that apply: which do you consider possible solutions 1. 5%

in eliminating the effects of the medical language barrier: 2. 50%
Do nothing there is no language barrier 3. 30%
Provide medical professionals and training physicians easy 4. 20%
access to medical interpreters 5. 0
Create a Universal Medical Language Association to make 6. 40%
global efforts in transitioning to English as the Universal 7. 0
8. High quality interpretation app
Medical Language
Require undergraduate students entering the medical field
to take a prerequisite Medical Language Origin and
History class to have a full understanding of the
influences and growth of the language
Only hire non-native speaking medical professionals who
pass a language proficiency test
Make the Universal Medical Language System (UMLS)
more easily accessible by medical professionals
Only hire native speaking professionals
None of the above- write in
Which of the following do you consider the most effective 1. 2%
solution in eliminating the effects of the medical language 2. 38%
barrier? 3. 20%
1. Do nothing there is no language barrier 4. 20%
2. Provide medical professionals and training physicians 5. 0
easy access to medical interpreters 6. 20%
3. Create a Universal Medical Language Association to 7. 0
make global efforts in transitioning to English as the 8. 0
Universal Medical Language
4. Require undergraduate students entering the medical
field to take a prerequisite Medical Language Origin
and History class to have a full understanding of the
influences and growth of the language
5. Only hire non-native speaking medical professionals
who pass a language proficiency test
6. Make the Universal Medical Language System
(UMLS) more easily accessible by medical
professionals
7. Only hire native speaking professionals
8. None of the above- write in

Conclusion

After analyzing the data gained from the qualitative and quantitative aspects of the field

research conducted, each brought new ideas and perspectives to the idea of a universal medical

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language. For the focus group, the idea that requesting a universal medical language is in essence

requesting a universal language is something not taken into account before. Making English the

universal medical language would only be truly effective if medical professionals and laypeople

could speak it. Secondly, the statement that not having a universal medical language does not

have an effect on Americans as much as it does in other countries because the primary language

is English already. The only true medical language barrier American medical professionals

experience is through patient conversation and care. Unlike no-English speaking doctors in other

countries, American physicians do not struggle with medical journals, research, education, or

career success. The medical language barrier is an issue, but from what was gathered from the

focus group, it is not our problem to solve. The focus group agreed that although a universal

medical language would be useful, the most plausible solution would be an increase in

translation technology.

When analyzing the data from the surveys, medical professionals agree that staying

current on medical research internationally is important, and that medical research is necessary in

the growth of the medical field, but are not directly affected by the language barrier. The survey

results show the professionals surveyed believe a universal medical language is necessary, but

then again are split when it deciding whether the medical language is already universal. Yet

again, this shows how American medical professionals already see English as the universal

medical language, because the only language barrier they experience is with patients, not with

disease names, medication, and dosage conversions.

As far as a solution, when asked which would be the most effective solution in

eliminating the effects of the medical language barrier the most popular answer was Provide

medical professionals and training physicians easy access to medical interpreters. In fact,

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seventy-five percent of medical professionals who have been in the medical field for over twenty

years felt this was the best solution. On the other hand, seventy-five percent of students in the

medical field feel requiring undergraduate students entering the medical field to take a

prerequisite Medical Language Origin and History class to have a full understanding of the

influences and growth of the language is the most effective solution. These results are interesting

when compared. Older and more experienced medical professionals are against change and

instead want to use technology to close the language barrier. Younger medical professionals who

are newly trained are more likely to believe early education is the best option in combination

with technology.

Taking all research and field research into account, I would conclude that as of now there

should not be a universal medical language. Although only professionals can work in the medical

field, the field of medicine affects everyone daily. If the medical language changed to English

universally, not only would the professionals working in the medical field have to learn English,

those being administered medical help would need to know English as well. Working toward

making English the universal medical language would in turn be working to make English the

universal language as a whole. Instead, I believe this complex problem can more effectively be

taken on in multiple ways. As previously stated, there are many programs and organizations that

work to lower the effects of the language barrier. Creating an international organization that not

only acknowledges the issue of the medical language barrier, but makes efforts to put solutions in

place to close that gap is the best option. This organization would put into action the possible

solutions these medical professionals agree will help eliminate the effects of the medical

language barrier. These steps include: providing medical professionals and training physicians

easy access to medical interpreters, requiring undergraduate students entering the medical field to

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take a prerequisite Medical Language Origin and History class to have a full understanding of

the influences and growth of the language, and even working to create technology that will easy

the struggle of translation both written and orally.

Although the focus of this thesis has been on the medical language barrier and how to

solve it, my continuous research has caused a change in my initial way of thinking. Instead of

having the perspective of everyone needing to be on the same page by speaking the same

language in order to progress, my perspective is using the diversity and challenge of multiple

languages as a way to create, invent, and progress without sacrificing culture and history. As an

interdisciplinary thinker, I began this research project failing to look at multiple perspectives.

Instead of thinking of the language as a barrier, this can be used as an opportunity for more

growth. Why force everyone to speak one language when what is so phenomenal about the

history of medicine is that it is always changing and advancing, just as its language is.

Embracing the language barrier as a challenge to improve is the most effective way to eliminate

its negative effects, for not only English speaking professionals, but medical professionals

worldwide.

Future Implications

Trying to answer a question that is so multifaceted cannot be solved with a simple one-

step solution. To take on such a complex topic, not only must every perspective be represented

and taken into account, but the possible solutions must be weighed. Deciding whether or not to

have a universal medical language is not only a difficult question to answer, but also difficult to

put into effect. Saying yes to a universal medical language would mean years of transitioning

such a large group of people. Getting the entire world on the same page would be a tall order, so

instead of assuming the only way to solve the language barrier is to have a universal medical

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language, this conclusion of this thesis is to choose diversity to fuel advancement.

In a country with English as the primary language, Americans rarely run into medical

professionals who speak a different language. The main language barrier the medical field in

America encounters is within the realm of patient care. To ask the rest of the world to speak

English is not only egocentric, but not the most effective solution. Instead of requesting

uniformity throughout the world of medicine, the most effective solution is to encourage

diversity, and use it to challenge and encourage growth.

The most recent generations are so technologically advanced that not only is all

information accessible at ones fingertips, but inventions and advancements to make life easier

are being thought of daily. Making technology that simplifies translation as accessible as an app

on a smart phone that anyone can use is just one way to decrease the language gap. Creating an

international medical language organization whose purpose is to take make technology,

interpreters, and tools to help training physicians more accessible globally will not only be a

more achievable goal, but a more effective way to keep diversity while growing globally.

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Annotated Bibliography

Baethge, C. (2008, January 18). The Languages of Medicine. Retrieved April 19, 2016, from

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696676/

This journal article from one of the leading international medical journals, this German

medical journal contains enormous amount of information that will be used in my literature

review. This journal article covers the history of medical language, analyzes the positives and

consequences of English as the assumed leading medical language, and provides information on

the Anglicization of medicine. It is interesting because this journal article is published by a

German journal. They state their opinion of making a complete switch to English, and

acknowledge the importance of English in Medicine.

Bodenreider, O., Burgun, A., Botti, G., Fieschi, M., Beux, P. L., & Kohler, F. (1998). Evaluation

of the Unified Medical Language System as a Medical Knowledge Source. Journal of

the American Medical Informatics Association, 5(1), 76-87.

doi:10.1136/jamia.1998.0050076

This article published in 1998 from the Journal of American Medical Informatics

Association evaluates the design, effectiveness, and quality of the Unified Medical Language

System (UMLS) as a source of international knowledge. This review of the UMLS system

provides critiques of this attempt to bridge the language gap between doctors internationally.

This article being considered dated is important also because it shows the continuing

improvements of the UMLS over time in order to comprehensively solve the issue of lacking a

universal medical language.

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Breaking the language barrier. (2001). Nature Cell Biology, 3(4). doi:10.1038/35070145

In this editorial from the Nature Cell Biology, English is examined as the universal

language of science. In addition to how English became the universal language of science, the

pros and cons of having this universal language is analyzed. From both sides, there are major

positives, as well as negatives that come along with condensing an entire field of study to a

single language. Some of these are identified, such as restricting possibilities, communication,

and advancement. The use of a universal language for communication in science is

unavoidable, and resisting this concept for the sake of cultural differences would seem to be

counterproductive.

Catlin, B., MD, & J. L., MD. (2008). Etymology. Retrieved April 19, 2016, from

https://www.dartmouth.edu/~humananatomy/resources/etymology.htm

This article from Dartmouth Medical School focuses on the etymology of medicine,

specifically human anatomy. This provides a history about medical terminology in detail along

with a deep analysis of Latin and Greek influence in medical terms. This will be useful in

providing history about medical language and possibly drawing similarities and differences

between the influence of Latin and Greek in medical terminology.

Dirckx, J. H., MD. (2005, August 13). Greek and Latin in Medical Terminology.

This article provides a history of medical terminology as well as information about Greek

medical terms, remnants of classical grammar, and the modern pronunciation of Latin. This

knowledge will benefit me as a writer to be more informed about my topic and will be beneficial

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in understanding the origins of medical terms. This source can be used in explaining the history

of medical language. It can also aid in analyzing where certain medical terms originated and how

they evolved over time.

Drubin, D. G., & Kellogg, D. R. (2012, April 15). English as the universal language of science:

Opportunities and challenges. Retrieved April 19, 2016, from

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341706/

This article from Molecular Biology of the Cell, provided by the American Society for

Cell Biology gives information and statistics about English as the international language of

science. This is important because Medicine and science go hand in hand. English being the

language of science can further my argument that English should be the language of Medicine as

well. This article also provides the opportunities and challenges faced with having English as the

universal language of science. These opportunities and challenges may apply to the field of

medicine as well.

Falagas, Mattew E., Eufemia Fabritsi, Fotini C. Chelvatzoglou, and Konstantinos Rellos.

"Penetration of the English Language in Science: The Case of a German National

Interdisciplinary Critical Care Conference." BioMed Central. N.p., 16 Sept. 2005. Web.

05 July 2016.

In this article from BioMed Central, the authors described the presence of English in

science, medicine, conferences, and journals internationally. This article explains how English

has become very prominent internationally in multiple fields of study, and its penetration into the

German national medical conference was studied. In a number of meetings ranging between

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thirteen years, the number of English journal articles increased. Although the majority were

German, the growth of English was obvious. This helps the authors to argue that English is

rapidly taking over the fields of science in medicine in even the most difficult and traditional

languages.

Fortuine, R. (2001). The words of medicine: Sources, meanings, and delights. Springfield, IL,

U.S.A.: Charles C. Thomas.

This large book by Charles Thomas covers the words of medicine in extreme depth. The

information I found valuable for my literature review included a history of English medical

vocabulary, the place of Latin in medicine, the period of old English, the period of middle

English, the renaissance and restoration of English, medical English in the scientific age, and

medical English of the early modern era. This information along with the conclusion and

importance of English in science and I medicine will aid my review of the question of a universal

medical language.

Hull, M. (2016). Medical language proficiency: A discussion of interprofessional language

competencies and potential for patient risk. International Journal of Nursing Studies, 54,

158-172. doi:10.1016/j.ijnurstu.2015.02.015

This article from the International Journal of Nursing Studies argues that medical

language assessment and proficiency should be requisite for working in health disciplines, as

well as giving a description of the purposes of medical language. Medical English is also

analyzed for its pros and cons. This will be valuable in explaining that medical language is

important, and useful in highlighting some consequences to having English as the medical

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language.

Huttner-Koros, A. (2015, August 21). The Hidden Bias of Sciences Universal Language.

Retrieved April 19, 2016, from

http://www.theatlantic.com/science/archive/2015/08/english-universal-language-science-

research/400919/

This article from The Atlantic, Adam Huttner-Koros examines the hidden bias of

sciences universal language of English. This English bias extends from research journals to the

advancement of science and education in non-English speaking countries. This will be useful in

the literature review by providing consequences of having English as a universal medical

language. The consequences that are present in the field of science will more than likely coincide

with the field of medicine, so this information is extremely important.

"IMIA -About Us." IMIA - International Medical Interpreters Association. N.p., n.d. Web. 05

July 2016.

This website is the home page of the International Medical Interpreters Association. This

page describes the association, what it does, why, and its history. Although this is not a scholarly

journal, it will benefit my proposal in offering solutions, suggestions, and examples of what

associations are working to close the language barrier in medicine. These interpreters help close

the language gap and the errors caused by communicating to doctors for other doctors, nurses,

and patients.

Jain, Parul, and Janice L. Krieger. "Moving beyond the Language Barrier: The Communication

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Strategies Used by International Medical Graduates in Intercultural Medical Encounters."

Patient Education and Counseling 84.1 (2011): 98-104. Science Direct. Web. 01 July

2016.

This article by Parul Jain and Janice Krieger analyze the struggles international medical

graduates have to overcome and how they do so in a work environment. Interviews were done to

understand how these medical graduates were able to overcome language barriers. This will

benefit my proposal by helping argue that medical graduates that are not native to the English

language learn and adjust in that setting. Although not perfect, the students were able to learn and

adjust to the language and culture over time.

Jevtic, A. (n.d.). 10 Most Advanced Countries in Medicine. Retrieved April 19, 2016, from

http://www.insidermonkey.com/blog/10-most-advanced-countries-in-medicine-364917/?

singlepage=1

This article describes the most advanced countries in medicine, and what makes them so

advanced. This is a valuable article because it not only shows the presence of English in

medicine (three out of the top five countries are English-speaking), but shows the presence of

medicine in different countries. This article can provide insight for advantages of having English

as a universal language, as well as why it should not be.

McCray, A. T., Razi, A. M., Bangalore, A. K., Browne, A. C., & Stavri, P. Z. (1996). The UMLS

Knowledge Source Server: A versatile Internet-based research tool. Retrieved April 19,

2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2233094/?page=1

This article from the National Library of Medicine gives information about the Unified

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Medical Language System (UMLS) project. The information about this system and Knowledge

Source Server is important in describing the attempts being made to unify language without

declaring a universal one. This article gives an in depth description of how the UMLS works and

how people can use and apply it in the future.

"Office of International Medicine." Office of International Medicine. N.p., n.d. Web. 05 July

2016.

The Office of International Medicine is described as an association that involves medical

health leaders in international medical affairs. This is the closest association that represents

medicine globally. However, it deals more with the rights of countries and health care, than

medical discoveries or the problem of a universal medical language. This will be used to provide

an example of what is already present, but not working toward the efforts of closing the language

gap in medicine.

Soutis, M. (2006). Ancient Greek terminology in pediatric surgery: About the word meaning.

Journal of Pediatric Surgery, 41(7), 1302-1308. doi:10.1016/j.jpedsurg.2006.03.011

This article from the Journal of Pediatric Surgery focuses on the origins of pediatric

surgery terminology. The ancient Greek and Latin origins are talked about as well as the history

of language advance. This article talks about ancient Greek word formation, classification, and

similarities. This will be helpful in the historical section.

Spicer, S. (n.d.). A Universal Standard in Medical English. Retrieved April 19, 2016, from

https://www.elanguest.com/content/Elanguest-school-Blog/a-universal-standard-in-

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medical-english.htm

In this article from 2008, David Gray was accidentally prescribed ten times the normal

dose of his medication, resulting in his death. His doctor, a non-native English speaker, testified

that the mistake was the result of confusion over differences between drugs used in Germany and

those used in the UK. This is one of many instances where a language barrier causes confusion

and leads to mistakes, a lawsuit, or even death. This organization has begun a project to make

medical English a universal standard. This paper will aid my argument in consequences of not

having a universal medical language, and act as an example of what is being done to bridge the

language gap in medicine.

Summary by language size. (2016). Retrieved April 21, 2016, from

https://www.ethnologue.com/statistics/size

This website provides information about the size of languages across the world. The

tables break down how many countries speak what languages, and how many millions of people

speak that language. This is extremely helpful because although English does not have the

highest number of speakers in the world, it has the highest number of countries. And Chinese, the

language with the most speakers, is made up of over ten different dialects of that language. This

will aid me in advantages of having English as the universal medical language.

Vinther, Siri, and Jacob Rosenberg. "Impact Factor Trends for General Medical Journals: Non-

English-language Journals Are Lacking behind." Swiss Medical Weekly (2012): n. pag.

Web.

This article from the Swiss Medical Weekly focuses on the impact of not having medical journals

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written in English. Authors point out that this is just one of many drawbacks to medical

knowledge not being written in English. If the authors are unable to put the journals into English,

they are often overlooked or not able to be used like they would if they were published in

English. This will help argue that although having medical journals in different languages is

traditional and may benefit the native speaker, the point of the journal is to spread the knowledge

and information found, and if the language used is preventing that, it must be changed.

World Medical Association. N.p., n.d. Web. 05 July 2016.

The world medical association is a representation of physicians that helps ensure the

independence of physicians around the world. One would think that this world medical

association would focus on the coherence of medicine worldwide, but instead this associations

mission is to promote professional freedom among physicians. This website will provide another

example of associations that include international medicine, but do not focus on the issue of not

having an international medical language or even association that recognizes it.

Wulff, H. R. (2004). The language of medicine. JRSM, 97(4), 187-188.

doi:10.1258/jrsm.97.4.187

This article from the Journal of the Royal Society of Medicine focuses on the language of

medicine, specifically the history and advancement of language in the medical field. This goes

into great depth about the Greek era, the Latin era, the era of International languages, and the

advancement of medical English. This article will be a vital source in describing the history of

language and its advancement through the eras.

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