Dr. Donnelly's well-referenced critique of questionable language practices commonly encountered in case historics at teaching hospitals [1] is an important call to arms for educators in internal medicine. Although none of the seven language maladies represents abject failure in and of itself, the total tends to dehumanize or minimize the patient and all too often ignores the patient's understanding of his or her condition.

Two points, however, require further emphasis. First, characterizing a patient as "a 55-year old self-employed architect who lives with his architect wife in their Westchester home" rather than simply as "a 55-year-old man" not only emphasizes the patient as a person but indicates that the physician was thorough and interested to know the patient's employment and occupational history, marital relationship, family status, and place of residence. This information is crucial not only in helping understand the patient and his illness but in giving the caregiver an opportunity to connect with the patient. The lack of this understanding leaves the caregiver little such opportunity; as a result, the patient is described purely in terms of symptoms, physical findings, and medical diagnoses. Second, the power of narrative in medical case histories relates to our fundamental roles as storytellers. When a case history is described in a narrative from the patient's viewpoint, it becomes a story. Suddenly, the large amount of detail necessary to provide a thorough medical evaluation becomes woven into a tapestry that often provides a clear image of the pertinent issues at hand.

Our teachers of medicine need to take heed of Dr. Donnelly's seven language maladies. As Donnelly himself points out, none represents the deadliest of sins, although the total may limit a physician's ability to connect with the patient and provide effective care.