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Lingua Medica: Dichotomous Disservice?

Richard A. Carleton, MD
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Memorial Hospital of Rhode Island, Pawtucket, RI 02860. Requests for Reprints: Richard A. Carleton, MD, Memorial Hospital of Rhode Island, Pawtucket, RI 02860.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;126(7):589-591. doi:10.7326/0003-4819-126-7-199704010-00031
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Physicians often prefer to think dichotomously about phenomena that are clearly continua. Examples include “febrile” or “afebrile,” “obese” or “not obese,” and “hypercholesterolemic” or “not hypercholesterolemic.” Many true dichotomies do exist in biology; examples include behavioral traits (“smoker” or “nonsmoker”) and genetic traits in which a certain polypeptide is or is not made depending on the presence or absence of a given gene. Most biological phenomena, however, are continua. Physicians, like other persons, prefer certainty to uncertainty and unambiguity to ambiguity. To label a phenomenon as being on one side or the other of a dichotomous distinction creates an aura of certainty and unambiguity that often cloaks the reality of imprecision.

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Grahic Jump Location
Figure 1.
One complex from lead aVF of five sequential electrocardiograms.

The patient was a man with an enzymatically and echocardiographically proven inferior-region myocardial infarction. The 1.3-mV R-wave initially present diminishes to less than 0.4 mV as a result of myocardial loss.

Grahic Jump Location




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