Dear Colleagues,

I love words. That is a good thing for an editor. With that in mind, I am sharing some of my favorite examples of word choices to think about when you are writing a manuscript. The AMA Manual of Style: A Guide for Authors and Editors provides a chapter on correct and preferred usage of common words and phrases. I chose my examples from this reference either because I have caught myself not using the correct or preferred word or phrase or because I see them incorrectly used in manuscripts. Choosing the correct or preferred word or phrase can help provide clarity, promote consistency, and avoid miscommunication. As examples, consider how the words negative and normal, vaccinate/vaccination and immunize/immunization, and adverse drug reactions/events versus side effects should be used.

The words negative and normal are a good place to start. When describing a physical examination, it is correct to say a comprehensive examination was completed, but examinations are neither negative nor normal. It is not correct to say the examination was normal. Instead, say the examination findings were normal. As well, most laboratory tests are not negative or normal. Rather than saying the patient had a negative or normal wet mount, say the findings from the wet mount were negative. Exceptions include cultures and other tests for specific microorganisms or tests for specific reactions. It is not necessary to say the result of the patient’s treponemal test for syphilis was reactive. Instead, say the patient’s treponemal test for syphilis was reactive.

Additionally, when reporting laboratory values, the substance is not what needs reporting but rather the value that was obtained by measuring the substance. For example, say the hemoglobin level was 12.5 g/dL rather than the hemoglobin was 12.5 g/dL. If listing several laboratory results together, the word value does not need to be included for each result. Instead, say laboratory values were as follows and then list them.

The words vaccinate/vaccination and immunize/immunization have different meanings. Vaccinate refers to the act of administering a vaccine into the body to produce protection from a specific infectious disease. Immunize means to confer or induce protection from a specific infectious disease often by providing a vaccine. Vaccination is the process of administering an agent (vaccine) to produce immunity. Immunization is the process of causing the immune system to build up resistance to the disease. As an example, the clinic implemented strategies to improve vaccination rates with the goal of increasing immunization against human papillomavirus in populations at high risk for infection and related cancers.

Finally, US Food and Drug Administration prescribing information for any medication includes a section on adverse reactions. I often find a mixture of what by definition are adverse reactions and side effects. To be precise, consider which term to use because they describe two different drug effects.

Adverse drug reactions/events are unintended pharmacologic effects that occur when a medication is administered in doses normally used. An adverse reaction may be predictable when it is dose dependent, or it can be completely unpredictable, have nothing to do with doses, instead being influenced by patient susceptibility factors such as drug allergies and intolerances. Adverse drug reactions can be mild, moderate, or severe and require intervention. The effects of the adverse event might be reduced by lowering the dose or stopping the medication. Venous thromboembolism (VTE) is an adverse event that can occur when someone takes combination oral contraceptives (COCs). We cannot predict who is going to experience a VTE and make COC prescription decisions based on assessing the individual for other VTE risk factors. COC prescription decisions might be made based on the knowledge that higher doses of estrogen are associated with a greater risk for VTE.

A side effect happens beyond the primary desired action of a drug. Side effects can be predicted and are symptoms that are a natural consequence of the chemical reactions that take place between the drug and the body. Side effects are considered expected physiologic responses that are unrelated to the desired drug effect, often resolving on their own, even with continuation of the medication. Common side effects experienced with COC use include breast tenderness, nausea, and irregular bleeding or spotting. Although we generally think about negative or undesired side effects, a drug may be used in part for beneficial or therapeutic side effects beyond the chief effect of the drug. Improvement in acne is a positive side effect related to the estrogen component in COCs.

I hope these examples of word choices prove helpful when you are next writing a manuscript. In future, I look forward to discussing more, such as acute versus severe, dose and dosage, insure/ensure/assure, and imply versus infer.

Beth Kelsey, EdD, APRN, WHNP-BC, FAANP