Dr. Donnelly has catalogued seven language maladies in the clinical case history [1]. We agree with his list and would like to suggest two additions:

1. Using jargon and cliches. In addition to biomedical language, case histories often include stock phrases that are uninformative and depersonalizing. Examples include such terms as "social admission" or "nursing home admission." Particularly troublesome is the use of age-inappropriate terms, such as ascribing a diagnosis of "failure to thrive" to an elderly person. The remedy for this malady is simple: Such terms have no place in the case history.

2. Blaming the patient for deficiencies in the case history. Too often, histories begin with the phrase "the patient is a poor historian." Sometimes, the presenter should more accurately admit that "I took a poor history." Other histories may be difficult to elicit because patients are confused or aphasic or speak a different language than the interviewer's. However, the use of frankly insulting language to describe these situations is unbecoming to the physician and demeaning to the patient. A better option is for physicians to say, "I was unable to take a complete history because the patient was confused" or even "... because time was limited." Physicians can better recognize the context of a patient's illness by acknowledging their own limitations.

Dr. Donnelly's arguments can be extended to examine the power relationship between patients and physicians. To patients, oral case histories are often the translation of their intimate experience into an impersonal and incomprehensible code. The danger in "taking" a history is that physicians may also take control of telling the patient's story. Many patients grant this permission willingly, but we believe that physicians should have as much respect for this part of the patient encounter as they do for the physical examination.