Using articles "a" and "the" in medicine

boron · May 21, 2009

EDIT: Below are thoughts rather than claims. My aim is to find out, if there is some firm rule about using articles, mainly before body parts and diseases.

Medicine, as a science, is without an article. "The study of medicine is long".

Health is without an article. "The definitions of health may vary."

Life and death are without articles, when used as a general term: "Life is tough". "Death is inevitable", but with articles, when used in particular cases: "He was severily ill, but they don't know exactly what caused the death."

Doctors, nurses, specialists, and all medical staff are with articles: a/the doctor, a/the gastroenterologist.

Hospital, when used as as "a place for specific ativity" is without an article. "He was admitted to hospital".

Body parts
- Unique body parts are always preceeded by the: the heart, the stomach, the bowel
- Multiple body parts are with or without articles as appropriate: an/the arm, -/the arms, a/the hair, -/the hair, an/the eyelid, -/the eyelids...

Diseases
- The names of diseases are without articles: pneumonia, flu, measles, cancer (but with an article when refers to a cancer as a particular cancerous growth)
- The names of conditions, when considered as diseases, are without articles: jaundice, diarrhea
- Symptoms and signs (particular evidence of a disease) are with articles: a/the cough, a/the rash, -/the redness, -/the swelling (and also a/the jaundice, a/the diarrhea when they are described as symptoms)
- When a disorder appears as an event, it's with an article: a/the stroke, a/the heart attack

Investigations and therapeutic procedures
The names of investigations and therapeutic procedures are with articles: an/the ultrasound, a/the blood work, a/the stool culture, an/the endoscopy, a/the surgery

Now, I need to find the source..

ComicBent · May 23, 2009

Not exactly

Investigations and therapeutic procedures
The names of investigations and therapeutic procedures are with articles: an/the ultrasound, a/the blood work, a/the stool culture, an/the endoscopy, a/the surgery

Not exactly right. It all depends on how the terms are used. All the following are correct:

Endoscopy showed gastritis.

Stool culture revealed nothing.

He underwent surgery.

He had blood work done, which was normal.

And in the US we say "He was in the hospital," not "in hospital."

All native speakers handle these things correctly (with the rare regional difference, like "in hospital"). We also can say either "He had measles" or "He had the measles." Your generalizations just do not work reliably and would be very difficult to apply for anyone studying English as a second language. Sorry.

midnight candle · May 23, 2009

and in the UK we tend to drop the articles. we say 'he was in hospital' and make it more generic. whereas if we say the name of the hospital we would use 'the royal' etc..

so it seems the difference between UK and US english has struck again

ideagirl · May 23, 2009

ComicBent said:
Not exactly right. It all depends on how the terms are used. All the following are correct:

Endoscopy showed gastritis.

Stool culture revealed nothing.

He underwent surgery.

He had blood work done, which was normal.

And in the US we say "He was in the hospital," not "in hospital."

All native speakers handle these things correctly (with the rare regional difference, like "in hospital"). We also can say either "He had measles" or "He had the measles."

The first two examples would be fine on a medical chart, but not in a book, article, letter, etc. (in those venues it would be, depending on context, the or an endoscopy, the or a stool culture).

ComicBent said:
Your generalizations just do not work reliably and would be very difficult to apply for anyone studying English as a second language. Sorry.

I agree there.

ideagirl · May 23, 2009

boron said:
Medicine, as a science, is without an article. "The study of medicine is long".

Health is without an article. "The definitions of health may vary."

Life and death are without articles, when used as a general term: "Life is tough". "Death is inevitable", but with articles, when used in particular cases: "He was severily ill, but they don't know exactly what caused the death."

Doctors, nurses, specialists, and all medical staff are with articles: a/the doctor, a/the gastroenterologist.

Hospital, when usedas as "a place for specific ativity" is without an article. "He was admitted to hospital".

Body parts
- Unique body parts are always preceeded by the: the heart, the stomach, the bowel...
- Multiple body parts are with or without articles as appropriate: an/the arm, -/the arms, a/the hair, -/the hair, an/the eyelid, -/the eyelids...

Diseases
- The names of diseases are without articles: pneumonia, flu, measles, cancer (but with an article when refers to a cancer as a particular cancerous growth)
- The names of conditions, when considered as diseases, are without articles: jaundice, diarrhea
- Symptoms and signs (particular evedence of a disease) are with articles: a/the cough, a/the rash, -/the redness, -/the swelling (and also a/the jaundice, a/the diarrhea when they are described as symptoms)
- When a disorder appears as an event, it's with an article: a/the stroke, a/the heart attack

Investigations and therapeutic procedures
The names of investigations and therapeutic procedures are with articles: an/the ultrasound, a/the blood work, a/the stool culture, an/the endoscopy, a/the surgery

Now, I need to find the source..

What you should do, actually, is just review normal English rules for articles and for count nouns vs. non-count nouns (since the status of a word as a count noun [e.g. "ultrasound"] or non-count noun [e.g. "health"] is a factor in determining what article, if any, it gets). There aren't special rules for medical words--they operate like other words, when it comes to the use of articles.

And then, once you've reviewed those rules, just read. That way you'll see how people actually use the words. For example, it's not true that "jaundice" and "diarrhea," when considered as diseases, don't get articles: you could say, "It was the diarrhea that killed him" or "It's the jaundice that's making her look yellow." And those are not the only exceptions to the rules you attempted to define in your post; I'm just using that as an example of the fact that those rules don't actually work.

Dale Emery · May 25, 2009

boron said:
Hospital, when usedas as "a place for specific ativity" is without an article. "He was admitted to hospital".

My sense of this is that you drop the article when you think of the thing as an institution. In the U.S., such institutions include school and city hall.

Whether "hospital" is an institution seems to depend on culture. I grew up (in southern Maine in the 60s and 70s) saying "go to the hospital," which leads me to believe that we didn't think of hospitals as institutions. I think it's the same way throughout the U.S., but I'm not certain. And it may be changing.

For some reason, we say "go to college" but "go to the university." That puzzles me, because it seems to me that either both are institutions or neither is an institution. But there ya go.

Dale

Dale Emery · May 25, 2009

ideagirl said:
For example, it's not true that "jaundice" and "diarrhea," when considered as diseases, don't get articles: you could say, "It was the diarrhea that killed him" or "It's the jaundice that's making her look yellow."

In those instances "the diarrhea" and "the jaundice" seem to refer not to the disease per se, but to specific, individual cases of the disease.

Dale

Tsu Dho Nimh · May 26, 2009

boron said:
Hospital, when used as as "a place for specific activity" is without an article. "He was admitted to hospital".

Only in Britain and maybe Canada. American usage would more likely be, "He was admitted to the hospital."

Diseases
- The names of diseases are without articles: pneumonia, flu, measles, cancer (but with an article when refers to a cancer as a particular cancerous growth)

That's variable and very idiosyncratic and can sometimes be with or without an article: he had the measles, he had measles are equally likely.

He had cancer, she had the flu, she had chicken pox, she had the pox (syphilis is always "the pox").

Same with symptoms - Jaundice made her pumpkin-colored, The jaundice made her pumpkin-colored ... no preference

boron · Sep 9, 2009

A medical diagnosis is the doctor's conclusion about which disease the patient is affected by.

Above is the first sentence of an article. My questions:

1. From which exact reason sometimes the a on the beginning of the sentence is omitted? May I omit it here?
2. A or the doctor (the same with physician?). A or the patient? Diagnosis, as above, obviously, is given by one particular doctor to one particular patient. Even, if it is not known who exactly the persons are, is this enough determination to use the, both for the doctor and patient?

Duncan J Macdonald · Sep 9, 2009

boron said:
A medical diagnosis is the doctor's conclusion about which disease the patient is affected by.

Above is the first sentence of an article. My questions:

1. From which exact reason sometimes the a on the beginning of the sentence is omitted? May I omit it here?
2. A or the doctor (the same with physician?). A or the patient? Diagnosis, as above, obviously, is given by one particular doctor to one particular patient. Even, if it is not known who exactly the persons are, is this enough determination to use the, both for the doctor and patient?

When you are speaking of medical diagnoses in general, there is no need to use either a definite or indefinite article:
Medical diagnoses are the doctor's conclusions about which diseases the patient is affected by. [note: changes made to support diagnoses as a plural form]

Otherwise, follow the rule for definite/indefinite articles (see below).

Secondly, a or the doctor. Yes, it is the same usage for physician. Again, see the rule posted below.

Thirdly, no, if you do not know who exactly the doctor and paitent are, you can not use the unless you first refer to them as a. After that, you can refer to them as the, refering back to the initial reference.

"Say, Jim Bob, you ever figure out what that thing on your back was?"
"Yep. Saw a doctor, and he told me."
"Told you what?"
"Well, the doctor told me it was a pimple."
"Bet it hurts."
"What hurts?"
"The pimple."
"Oh."

In each case above, the first use of doctor and diagnosis uses an indefinite article: a. After that, you can refer to that specific instance of doctor and diagnosis by using the definite article the.

From an About.com article:

Here are the rules for when to use "A, An or The":

a = indefinite article (not a specific object, one of a number of the same objects) with consonants
She has a dog.
I work in a factory.

an = indefinite article (not a specific object, one of a number of the same objects) with vowels (a,e,i,o,u)
Can I have an apple?
She is an English teacher.

the = definite article (a specific object that both the person speaking and the listener know)
The car over there is fast.
The teacher is very good, isn't he?

The first time you speak of something use "a or an", the next time you repeat that object use "the".
I live in a house. The house is quite old and has four bedrooms.
I ate in a Chinese restaurant. The restaurant was very good.

DO NOT use an article with countries, states, counties or provinces, lakes and mountains except when the country is a collection of states such as "The United States".
He lives in Washington near Mount Rainier.
They live in northern British Columbia.

Use an article with bodies of water, oceans and seas -
My country borders on the Pacific Ocean

DO NOT use an article when you are speaking about things in general
I like Russian tea.
She likes reading books.

DO NOT use an article when you are speaking about meals, places, and transport
He has breakfast at home.
I go to university.
He comes to work by taxi.

boron · Sep 15, 2009

Duncan, I know the basic rules. I'm also aware of some "official" exceptions. But I don't know what to do here:

Spleen size can be evaluated by (an?) ultrasound or CT.

The same problem with most of other medical investigations: X-ray, laparoscopy, colonoscopy, even medical history...and some therapeutic procedures, like abdominal surgery, etc.

Is it like this:
When an investigation is mentioned as a general term, like when you want to describe "what is ultrasound", then there's no "a". When writing about an actual test, "a" should be used. Yes?

Maryn · Sep 15, 2009

I'm not Duncan, but yes. Either What is ultrasound? or What is an ultrasound? would be correct for US speakers/writers.

However, when I went to the doctor last week, I got an ultrasound. One. Over the years, I've had many.

Maryn, who really did get an ultrasound last week--woo-hoo!

boron · Sep 15, 2009

Maryn, you got an ultrasound? Can I use this in health articles?

Duncan J Macdonald · Sep 15, 2009

boron said:
Duncan, I know the basic rules. I'm also aware of some "official" exceptions. But I don't know what to do here:

Spleen size can be evaluated by (an?) ultrasound or CT.

The same problem with most of other medical investigations: X-ray, laparoscopy, colonoscopy, even medical history...and some therapeutic procedures, like abdominal surgery, etc.

Is it like this:
When an investigation is mentioned as a general term, like when you want to describe "what is ultrasound", then there's no "a". When writing about an actual test, "a" should be used. Yes?

The rules I posted still apply, so in your example, yes -- in general 'ultrasound' does not take an article. If you refer to a specific ultrasound, then 'an' or 'the'.

For the previous medical investigatory procedures, if referenced in general, they do not take an article. So: 'Speen size can be evaluated by ultrasound or CT.' is correct.

boron · Sep 15, 2009

What about pain?

As I see in Google, pain is usually without "a".

Duncan J Macdonald · Sep 15, 2009

boron said:
What about pain?

As I see in Google, pain is usually without "a".

What kind of pain?

Pain can be considered generic.

"I have pain in my fingers."
"What kind of pain? A sharp stab, or a dull ache?"
"An ache."

boron · Sep 16, 2009

Duncan J Macdonald said:
What kind of pain?

Pain can be considered generic.

"I have pain in my fingers."
"What kind of pain? A sharp stab, or a dull ache?"
"An ache."

I'm asking specifically about pain.

Gallstones may be present without pain.
I have pain in the left leg. The(?) pain never goes away.
A Pain in the Neck (from a book title)

What a pain!

Duncan J Macdonald · Sep 16, 2009

boron said:
I'm asking specifically about pain.

Gallstones may be present without pain.
I have pain in the left leg. The(?) pain never goes away.
A Pain in the Neck (from a book title)

What a pain!

Pain is generic, and therefore doesn't take an article, unless you are refering to a specific pain, e.g. 'A Pain in the Neck'

boron · Sep 18, 2009

Duncan J Macdonald said:
Pain is generic, and therefore doesn't take an article, unless you are refering to a specific pain, e.g. 'A Pain in the Neck'

When exactly is a term generic? OK; when it's not specific, but this doesn't help me in below cases:

I've searched on Mayoclinic.com and got controversal results:

1.
This keeps moisture in the stool...
Undigested food in stool generally isn't a problem...
Not having a bowel movement every day doesn't necessarily mean you're constipated.

2.
Many diuretics decrease potassium in the blood.
High levels of protein in blood can have many causes.

3.
Blood in the urine may make it look red or brown.
Crystals that form from chemicals in urine may be a sign of kidney stones.

4.
Oil-based creams leave a slight residue on the skin.
A small white patch on skin may have several causes.

5.
Swelling in the hands or feet.
Numbness...in hands or feet.

6.
How to administer first aid for a foreign object in the eye.
Comprehensive overview...treatment of broken blood vessel in eye.

...and so on on other health sites, like merck.com, medicinenet.com

I've heard that "the" should be used before organs when they are described as a part of the body, so I always use "the liver", "the blood".

Comments?

girlyswot · Sep 18, 2009

boron said:
When exactly is a term generic? OK; when it's not specific, but this doesn't help me in below cases:

I've searched on Mayoclinic.com and got controversal results:

1.
This keeps moisture in the stool... Fine
Undigested food in stool generally isn't a problem... Needs an article. Either would be fine.
Not having a bowel movement every day doesn't necessarily mean you're constipated. Fine

2.
Many diuretics decrease potassium in the blood. Fine, though you could drop the article if you want.
High levels of protein in blood can have many causes. Fine

3.
Blood in the urine may make it look red or brown. Fine, but again doesn't need the article.
Crystals that form from chemicals in urine may be a sign of kidney stones.
Fine
4.
Oil-based creams leave a slight residue on the skin. Fine, with or without article
A small white patch on skin may have several causes. Fine, though I think I have a slight preference for the article here.

5.
Swelling in the hands or feet. Fine
Numbness...in hands or feet. Fine

6.
How to administer first aid for a foreign object in the eye. Fine
Comprehensive overview...treatment of broken blood vessel in eye. Needs the article here.

...and so on on other health sites, like merck.com, medicinenet.com

I've heard that "the" should be used before organs when they are described as a part of the body, so I always use "the liver", "the blood".

Comments?

In general, when 'the' is used, it makes these sound more formal - like a textbook. Whereas in everyday English we normally wouldn't say 'the blood', 'the urine', 'the hands'. HOWEVER, when you are referring to a discrete part of the body (such as an eye, but not liquids like blood or urine) you MUST use an article, and in everyday English it would usually be a/an.

boron · Sep 18, 2009

girlyswot said:
In general, when 'the' is used, it makes these sound more formal - like a textbook. Whereas in everyday English we normally wouldn't say 'the blood', 'the urine', 'the hands'. HOWEVER, when you are referring to a discrete part of the body (such as an eye, but not liquids like blood or urine) you MUST use an article, and in everyday English it would usually be a/an.

Using "the" to make things formal, yes, it sounds reasonable. I copy-pasted all those examples from Mayoclinic.com, including "the blood" , "the urine"...which usually refer to blood and urine tests.

Duncan J Macdonald · Sep 20, 2009

Sorry to be getting back to you so late -- long weekend of activities not related to AW.

I'll do what Girlyswot did and reply in quote.

boron said:
When exactly is a term generic? OK; when it's not specific, but this doesn't help me in below cases:

I've searched on Mayoclinic.com and got controversal results:

1.
This keeps moisture in the stool... This is a specific mention of 'stool', being the location of the 'moisture' that whatever procedure the 'this' refers to does.

Undigested food in stool generally isn't a problem... Generic
Not having a bowel movement every day doesn't necessarily mean you're constipated. This is a specific kind of movement.

2.
Many diuretics decrease potassium in the blood. Generic 'potassium', specific location.
High levels of protein in blood can have many causes. Generic -- the 'many causes' is an indicator.

3.
Blood in the urine may make it look red or brown. Specific location
Crystals that form from chemicals in urine may be a sign of kidney stones. Generic, as we don't know what chemicals we're talking about.

4.
Oil-based creams leave a slight residue on the skin. Specific location of the residue.
A small white patch on skin may have several causes. Again, generic due to 'several causes'.

5.
Swelling in the hands or feet. Specific location.
Numbness...in hands or feet. I can't tell, too much context lost due to the ellipsis.

6.
How to administer first aid for a foreign object in the eye. Specific location of the foreign object.
Comprehensive overview...treatment of broken blood vessel in eye. I can't tell, too much context lost due to the ellipsis, but it certainly does look wrong.

...and so on on other health sites, like merck.com, medicinenet.com

I've heard that "the" should be used before organs when they are described as a part of the body, so I always use "the liver", "the blood".

Comments?

Really, aside from jargon and quite a few latin phrases, medical writing follows the same rules of English grammar as everyone else does.

semilargeintestine · Sep 20, 2009

I'm assuming you're writing something information because of an earlier post; however, in case you're not, there are also situations in which people colloquially use things incorrectly. There is a big part of the patient population who frequent emergency departments (and in general, I'm sure) who put an article in front of the name of a disease.

For example, there are plenty of people who say that they have the diabetes. This is not correct, but it's how they speak. You can use it to help paint a picture of the character. But, if you're writing something like an article, definitely do not do that.

boron · Sep 21, 2009

semilargeintestine said:
For example, there are plenty of people who say that they have the diabetes. This is not correct, but it's how they speak. You can use it to help paint a picture of the character. But, if you're writing something like an article, definitely do not do that.

Writing "something" like online health articles, yes.

Duncan, here:

2.
Many diuretics decrease potassium in the blood. Generic 'potassium', specific location.
High levels of protein in blood can have many causes. Generic -- the 'many causes' is an indicator

..blood is specific location in both cases...anyway, in all these cases: "in the blood" , "in the urine", we talk about tests, even if no actual test is mentioned in the sentence. So, I think (not that I claim) that always when we write about a patient (not necessary a known patient, may be a patient in general), we should use "in the blood", "in the urine", since in all such cases we actually mean "in a sample of their blood or urine", what makes blood or urine somewhat specific...Doesn't it?

From biological viewpoint, "protein in blood" (not patient's blood) sounds appropriate. Or what?

--------------------------

About diseases. On Merck.com (a refernce textboox for GP doctors, written by US authors; I've found (through Google search):

5x "a pneumonia", 40x "the pneumonia" (mostly in the "experience" part of the site) and 1,000+ x "pneumonia".
No example of "a jaundice", 4x "the jaundice" and 3,000+ x "jaundice".

About the same ratio on patient.co.uk

Examples:
Gilbert's syndrome can cause mild jaundice from time to time.
Breast milk jaundice: baby is well and the jaundice usually resolves by six weeks.

I think that a name of a disease, like pneumonia, when used in health articles, is always a general term, abstract term, so no article before it.

Using articles "a" and "the" in medicine

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