## Doctors' denial

RR wrote:

I accompanied an elderly parent to a neurologist appointment recently.  As this was at a teaching hospital, the first meeting was with a resident who took a complete history and did an examination.  When the neurologist came in, the resident verbally reported the results of his history-taking as "The patient reports a sense of imbalance on standing.  The patient denies feeling dizzy." etc.  As my parent had few symptoms, the list of denials was quite long.

The use of 'denies' has a clear meaning in this medical context ("On being asked about symptom X, the patient said that they did not experience it"), but for the patient it carries unpleasant overtones (accusation, disbelief).

I tried to think of a more pleasant way that the same thing could be said, but couldn't come up with anything that wasn't cumbersome.  "The patient hasn't experienced…" doesn't make clear that the resident is only reporting what the patient has said, and 'The patient doesn't report…" allows for the possibility that the resident never asked).

A couple of years ago, I was involved in a project to interpret the free text (typically written by doctors) in patient records. So I can testify that the verb deny, in this sense of "I asked about symptom X and the patient said they hadn't experienced it", is a common feature of clinicianese.

One thing I'm not sure about, on reflection: does this clinical sense of deny take only symptoms as objects, or can it be used to describe a patient's negative response to queries about relevant things that in themselves are positive, e.g. "the patient denies getting regular exercise", or "the patient denies eating fruits and vegetables"?

The overtones of accusation and disbelief that RR notes are certainly present in most general uses of positive deny.  If we search the recent news for denied|denies we find things like

Goldman Sachs Group Inc. reported a stronger-than-expected first-quarter profit Tuesday as its executives again denied any wrongdoing alleged in last week's government lawsuit over complex securities.
Lebanese Prime Minister Saad al-Hariri denied Wednesday that Hezbollah had received long-range Scud missiles from Syria …
Iranian Defence Minister Ahmad Vahidi denied on Wednesday the Islamic republic is planning to develop ballistic missiles capable of striking arch-foe the United States, as alleged by Washington.
Espada denies stealing millions, attacks Cuomo 'steamroller'

In a majority of the examples, the object of deny is something generally evaluated in a negative way. Most of the rest are legal or bureaucratic uses, referring to the action of a judge or administrator independent of any moral evaluation of the object on the part of the writer: "Buncombe County denies bids to rezone", "Former Berwyn police chief's overtime pay request denied".  Only a small fraction of examples are morally neutral without describing administrative action,  e.g. "SPLM Official Denies Agreement to Accept Sudan’s Election Results".

A search for nominal collocates of [deny] via COCA turns up the same two basic classes of cases: those where the denier is exercising some assigned power (e.g. access, request, benefits, permission), and those where the denier is responding to an accusation of having done something bad (e.g. charges, wrongdoing, allegations, involvement). Doctors' denial doesn't fall into either of these two classes, which no doubt is why encountering it took RR a bit aback.

According to the OED, deny basically means "To say ‘no’", either in response "to a statement, assertion, doctrine", or in response "to a request or proposal". The association with official action and response to accusation is a pragmatic one — these are simply two common reasons for giving a negative response — but it creates a strong expectation that someone who denies is in one of those two situations. As a result, most people would find it odd to say (other than as a joke) that "X denied passing the exam", even if Y said "I bet you aced the exam" and X responded "no, in fact I flunked".

When a doctor asks a patient about a symptom, and the patient says "no", the core definition of deny applies, but the common non-medical connotations are missing.

[Note that there are some other semi-obsolete uses of deny, for example "to refuse to admit the truth of (a doctrine or tenet)", as in

1681-6 J. SCOTT Chr. Life (1747) III. 494 To deny the Resurrection of Christ. 1733 BERKELEY Th. Vision Vind. §6 They who deny the Freedom and Immortality of the soul in effect deny its being.

Also, negating deny in a modal context often seems to invert the usual negative connotation of the positive version's complement:

Whether you agree with Newt Gingrich or Bill Bradley, you can't deny the fact that these are brilliant guys.
Love him or hate him, you can't deny the awesome ubiquity of the Donald — or his buildings.
Even those of us who wanted Ordonez here long-term can't deny the success.
It's simply impossible to deny that rhyme has provided countless poems with a musical richness
Yet it is impossible to deny the extraordinary fondness millions of ordinary readers have shown for The Lord of the Rings

Not always, though:

And yet it is impossible to deny the sordid history that made their gathering in this new institution possible.
Nevertheless, it is impossible to deny that Alfred Ebner was actively involved in the Final Solution.
We can't deny that we have stories come out that raise questions about the administration …
But he can't deny embracing Col. Gaddafi on two trips to Libya …

]

1. ### Boris said,

April 21, 2010 @ 10:57 am

Why would you say that the "obsolete" sense of deny is indeed obsolete? Can't people deny that the earth is round, deny the holocaust, deny that global warming is real, etc?

[(myl) I said "semi-obsolete", by which I meant that in the cited cases (e.g. holocaust denial) the object is usually considered to be something bad. People who don't think that the earth is round are usually called "flat-earthers", not "round-earth-deniers"; people who believe in a literal interpretation of Genesis are "creationists", not "evolution-deniers" or whatever. In any case, my point was to try to explain RR's reaction (which I think most people share) in terms of the (I think increasing) ubiquity of the word's connotations.]

Also, you can deny something that is not bad. "Everyone knew he was the secret sponsor of the event, though he denied it vehemently?"

[(myl) You can, but it's rare. I cited one example of this sort from the recent news, but there aren't very many others. And even in these cases, there's usually a sense of something not quite right about the proposition being denied. In the example you cite, X's denial amounts to "vehement" (and perhaps repeated) lying about his (apparently evident) sponsorship. This is quite different from the situation in which the resident asks "do you feel dizzy?" and the patient turthfully responds "no".]

2. ### Thomas Westgard said,

April 21, 2010 @ 10:59 am

There's a particular structure to scientific inquiry that supports this usage, in the hypothesis-refutation model of scientific inquiry. You start with a simply hypothesis, like:

Fertilized plants grow faster than non-fertilized plants.

Of course, if you do a series of experiments, you can determine a long list of conditions that must be considered, like you also have to supply water and light, etc. The hypothesis is refuted when some new condition is determined, whereupon you rewrite the hypothesis to account for that piece of data.

Diagnosing a patient is an exercise of this type of scientific thinking. The patient presents with some data, including things that they can tell you that aren't immediately visible, like a recent history of fainting. If that symptom is present, it creates a list of possible diagnoses. Each is its own hypothesis. But each of those diagnoses will, in turn, have other conditions that have to be met. "Patient denies change in diet," (mostly) refutes the malnourishment in a previously healthy patient. It is a process of elimination, which is inherently negative.

That said, being a patient is often a disempowering experience and tolerance for disempowering language is lessened under those circumstances. Doctors could instead choose to report the data as, "patient reports no change in diet." But that would be a diversion from how notes of other scientific inquiries are commonly made.

3. ### Roger Lustig said,

April 21, 2010 @ 10:59 am

I thought about the German equivalent to the simple "say no" meaning: verneinen. But…its opposite is bejahen. Why the different prefixes? Ver- is a tricky one, as it can imply intensification, completion (verheilen) or negation/error (verlaufen, verführen, verkennen). Be- is much simpler to my ear, in that it implies application. As a native speaker with too little experience "on the ground" in German-speaking places I wonder whether there *is* some slight negative connotation attached to verneinen.

4. ### Stuart F said,

April 21, 2010 @ 11:03 am

Another way in which an old meaning of "deny" persists is in the telling of the Passion of Christ, where "St Peter denies Jesus". This wording is still commonly used even though it does not relate to other present-day uses of "deny" and its meaning is not immediately obvious (he is not denying the existence of Jesus, only denying that they know each other).

There are some words with a similar meaning to "deny", but most, like "disavow", "disown", or "disacknowledge", also carry connotations of deliberate ignorance, hiding something, or refusing responsibility. Possibly in our society it is considered bad to disclaim knowledge or experience of anything, even if bad; and possibly doctors like "deny" because they are annoyed at the absence of expected or tell-tale symptoms. Maybe "rebut" or "refute" could be used in the interests of patients' rights?

5. ### Grizzly said,

April 21, 2010 @ 11:05 am

Wouldn't it be simpler if reported speech were used? 'The patient said he didn't feel dizzy.' Etc. Saves a syllable worth of effort, even.

[(myl) As RR observes, this fails to distinguish between information that the patient volunteers, and information that comes in response to a question.

But anyhow, I count five syllables in "said he didn't feel", vs. four in "denied feeling". So it costs a syllable rather than saving one, not that this matters.]

6. ### Sam said,

April 21, 2010 @ 11:13 am

@Boris – in your example I get the impression that the event is in some way sordid, or else why would he be denying sponsorship?

I'd guess that the event RR witnessed — rich in reported denial — occurred because the resident was retreating into formal language. A physician would probably abbreviate "the patient denies X, the patient denies Y" to "no dizziness, x, or y" in a less formal context.

7. ### David L said,

April 21, 2010 @ 11:28 am

Instead of "the patient denies feeling dizzy," one could just say "the patient says he doesn't feel dizzy" (or hasn't felt dizzy in the last couple of weeks, as appropriate). A few more words, and therefore a dreadful waste of your doctor's valuable time, but my sneaking suspicion is that doctors would not embrace this sort of language precisely because it's more colloquial and therefore less scientific-sounding.

8. ### Sam said,

April 21, 2010 @ 11:37 am

Interestingly there are only 9 ghits at this moment for "denies feeling dizzy", — three of which are to this post! The rest are clinical vignettes or exam questions. For example:

"He denies any other symptoms and specifically denies feeling dizzy, having any palpitations or confusion, or having any chest pain."

[(myl) Physician's letters and similar documents are (by design) rarely exposed to web search.]

9. ### George said,

April 21, 2010 @ 11:43 am

I may have misread what you were getting at, but I don't think that "SPLM Official Denies Agreement to Accept Sudan’s Election Results" is a good example at all of a morally neutral use of 'deny' when one considers the nature of the Sudanese government and its degree of commitment to free and fair elections. To agree such a deal ahead of the completion of the actual voting/counting stage of the electoral process would strike many people as not just bad but stupid.

10. ### majolo said,

April 21, 2010 @ 11:47 am

Responding to your response to Boris: Google has 11,000 hits for "evolution denier", and over 9000 for "germ theory denier". There is a current sense of "denial" (and "denier", "denialism", "denialist") where the thing being denied can certainly be a neutral or positive set of beliefs. I think this sense grew out of the "Holocaust denial" sense.

[(myl) Right, but there are 810,000 hits for "creationist", 1.68 million for "creationism", 2.02 million for "intelligent design", etc. So "evolution denier" isn't getting a lot of mind-share.]

11. ### MattF said,

April 21, 2010 @ 11:51 am

The expression "in denial" certainly has negative connotations.

12. ### George said,

April 21, 2010 @ 11:52 am

@majolo, yes, but where the thing being denied (in the examples you cite) is a neutral or positive set of beliefs, then the denying is seen to be morally negative. It's as if the negativity has just shifted from what is denied (the usual sense) to the denier, but the negativity is still there.

13. ### Sam said,

April 21, 2010 @ 11:59 am

@myl – I don't disbelieve the construction. (My wife is a medical student so I have firsthand exposure to "pt. denies X" in her study materials). Google has hundreds of hits each for "denies dizziness" "denies syncope" [fainting] and "denies lightheadedness"; maybe NPs are preferred as the object?

I wonder if "denies" became popular in medical jargon because it can be construed as the opposite of "reports" (as in RR's example), and either can be used with a list of NPs:

"Patient reports fever, vomiting; denies lightheadedness and dizziness."

is much more succinct than

Patient's temperature is elevated, patient has been vomiting, does not feel lightheaded or dizzy.

14. ### Mark P said,

April 21, 2010 @ 11:59 am

I don't know how this occurs generally, but in the original case, the particular symptom being denied (feeling dizzy) is directly related to the chief complaint (lack of balance). It would be interesting to know how many denials of symptoms are related to the chief complaint. I presume that a physician being presented with a symptom would follow a progression of relevant questions to try to narrow the possibilities. A negative response essentially cuts off one avenue of investigation (or at least makes it less likely).

@Thomas Westgard: I don't recall much if any use of "deny" in scientific usage. Is it more common in statistical usage?

15. ### Boris said,

April 21, 2010 @ 12:00 pm

I'm not saying the point in the article is not valid. I am simply providing other ways the word can be used. My example sentence was made up. I was going for someone denying doing something neutral or positive out of modesty or due to some requirement of secrecy.

I think the doctor's usage is jarring because in usual speech someone can generally only deny something that the speaker who used the word "deny" (or a significant part of the intended audince) believes to be true (except when exercising some assigned power). This is also why (to my ears) the phrase "I deny" sounds awkward in almost any circumstance. After all, why would you deny something that you yourself admit is true by virtue of using the word "deny"?

Google does not seem to support my feeling in the last sentence, providing similar numbers for "I deny" as for "He denies", but looking at the first two pages of results for "I deny", excluding text in the form of a question and obvious attempts to be funny or insincere, they either refer to denying a religious doctrine (Why I Deny the Virgin Birth of Jesus) or one of two song titles ("I Deny" and "I Deny You"). The two counterexamples are a statement by Ehud Olmert (I don't know what the commotion is about and I deny everything that was hinted at in relation to the case.) and the title of an article on economics (I Deny (the significance of) MV = PY). The search for "He denies" is full of things like "Is McCain on crack?: He denies ever being a maverick", "The thing that bugs me about George Lucas is that he denies ever considering a sequel trilogy", "Of course he denies it. Wink, wink, nudge, nudge. The man is a cowardly bigot, what else is he going to do?"

16. ### J said,

April 21, 2010 @ 12:19 pm

Although I can see clearly the disempowering features of using "deny" this way, doesn't it also leave open the potentially useful possibility that the patient is lying or misremembering? While such an accusation, even if only implicit or possible, may contribute to problematic feelings of (over-) righteousness on the part of doctors and unhappy and potentially problematic feelings of disempowerment from not being trusted or believed on the part of the patient, it is also true that the patient may be an "unreliable narrator." We can easily imagine a case where certain symptoms may help an important diagnosis, but, for example, "Patient denies suffering from impotence." Although it's perhaps uncricket to retain an implicit possibility that your patient is lying by using the "deny" formulation, it does also carry the useful valences of being both an accurate reporting of the patient's response and a way of reporting it allowing for the idea that the patient may, in fact, be in error, denial, or lying.

17. ### Dan T. said,

April 21, 2010 @ 12:30 pm

For he's a jolly good fellow
which nobody can deny!

18. ### Albert Vogler said,

April 21, 2010 @ 12:47 pm

I think "report" and "deny" are used to distinguish between symptoms (the patient's subjective evaluation of his history) and so-called signs, or what is actually observed by the clinician (e.g. heart & respiration rate, blood test results, etc.).

19. ### Albert Vogler said,

April 21, 2010 @ 12:49 pm

I should have said that is both "report" and "deny" refer to the patient's symptoms as defined above.

20. ### David Eddyshaw said,

April 21, 2010 @ 12:56 pm

At least in its medical jargon use (I'm a speaker) "deny" certainly has no more implication that the patient is untruthful or forgetful than "says not" would have.

I wonder if this might even go back to the grand days when we shut our patients out of the discourse even more effectively by talking Latin to one another in front of them? It's good idiomatic Latin to say "negare" instead of "dicere … non …".

21. ### Bloix said,

April 21, 2010 @ 2:55 pm

The meaning "to refuse to admit the truth of" is the standard meaning in law. For example, Rule 8 of the Federal Rules of Civil Procedure provides that a defendant must "admit or deny the allegations asserted against it by an opposing party, " and continues with detailed rules about how denials must be made, e.g., "a party that intends in good faith to deny only part of an allegation must admit the part that is true and deny the rest."

For example, if the Complaint says, "Defendant Bloix is a resident of Maryland and a member of the Maryland Bar," I would respond, "Bloix admits that he is a resident of Maryland and denies that he is a member of the Maryland Bar."

22. ### Erik said,

April 21, 2010 @ 2:55 pm

A search of CoCAE for "denies the existence of" turns up the following (unedited list follows):

any specific Christian ethics
secret prisons run by the United States' Central Intelligence Agency
gods, souls, and spirits
love
a separate, categorically different supernatural realm
any abducted people or POWs
the supernatural
either the individual or God
casual interaction between created substances
a moral law
any singular Japanese "love of nature"
outside itself of another consciousness with equal rights and equal responsibilities
a cultural center
the first of these factors (internal structural maturation)
the shadow and its creative potential
the Black card
a common good
an instinctive and ineradicable preference for one's own
universal truths, universal insights, or transtemporal wisdom
those things which it can not prove

Whether these are positive or negative certainly depends on your point of view, but I think this is evidence against the claim that deny is more frequently used to deny the existence of "bad" things than "good" or neutral things.

Personally, I think that you see creationist instead of evolution denier but no good equivalent for holocaust denier because most who deny evolution believe in the existence of an alternative (creation), but the holocaust denier isn't posing a particular, simply-described alternative event (their position is simply a denial of the existence of something). The same goes for the flat-earthers who have an alternative theory. From the above sample, those who are willing to entertain the belief in a deity seem to frequently speak of strong atheists as "denying the existence of" God, although as a noun, we do have atheism. But I can't think of a word or phrase you might use to describe one who doesn't believe in ghosts or angels that would get more play than one using deny.

23. ### Mr Punch said,

April 21, 2010 @ 4:11 pm

"Denies" certainly carries a negative connotation that might upset or confuse the patient. I suggest "nixes" — no more syllables, clear meaning although an extension of current usage.

24. ### ...just don't call me late for dinner! said,

April 21, 2010 @ 5:07 pm

The problem with that, Punch, is getting an entire medical profession to stop using a word that it's [presumably] used for many years isn't costless. The problem identified in this post — that a patient might glimpse his chart and misconstrue the use of 'deny,' thereby feeling offended — isn't really worth such a solution.

April 21, 2010 @ 6:12 pm

Roger Lustig:

I thought about the German equivalent to the simple "say no" meaning: verneinen.

The German word that shares many senses of deny and also carries negative connotations is leugnen. From what I remember from previous discussions on de.etc.sprache.deutsch, there is disagreement in the speaker community if a statement that the accused leugnen the charges implies that they are lying and are in fact guilty, or if it is simply a case of saying no.

And a holocaust denier is a Holocaustleugner.

As a native speaker with too little experience "on the ground" in German-speaking places I wonder whether there *is* some slight negative connotation attached to verneinen.

To me, verneinen is neutral and really just means to "say no".

26. ### George said,

April 21, 2010 @ 8:28 pm

'The patient "says" or "reports"' leaves open the possibility that the patient volunteered the information, but if you want to convey that the patient was asked a question about it, perhaps the 'patient "replied," "answered," or "responded?"'

27. ### Peter said,

April 21, 2010 @ 8:51 pm

Boris:

I think the doctor's usage is jarring because in usual speech someone can generally only deny something that the speaker who used the word "deny" (or a significant part of the intended audince) believes to be true (except when exercising some assigned power). This is also why (to my ears) the phrase "I deny" sounds awkward in almost any circumstance. After all, why would you deny something that you yourself admit is true by virtue of using the word "deny"?

I disagree with this assessment. I would say that someone can deny anything which has been claimed by another party. For instance, I see nothing wrong with the statement "I deny your scurrilous accusations." There's also the old intelligence agency cliche "I can neither confirm nor deny…"

28. ### Golias Bauknecht said,

April 21, 2010 @ 9:07 pm

I actually *am* a neurology resident, so it was fun to think for a moment I had been referenced anonymously.

We generally use the word "deny" because, as has been stated, it tersely expresses that we asked about a symptom and got a negative reply. In particular, residents prefer to show how complete their history was, and waffling on whether you asked about a symptom and got a "no" or that you just didn't ask and presume the answer was no can be a big deal, esp. if the attending considers it a salient fact.

Another way using the word is helpful is because of coordination. In a written note, for instance, after delineating the main historical findings, the "pertinent positives and negatives" of the review of systems can be expressed as comma-separated lists, with negatives introduced as, "Patient denies X, Y, Z, A, B, and C." These are often symptoms that are potentially pertinent to an entertained diagnosis, but overshadowed by primary findings from history.

In answer to a previous question, I haven't heard it used nearly as much to express answers to questions that aren't symptoms, such as *"patient denies eating vegetables," unless he actually wasn't supposed to eat vegetables for some reason and his doing so or not doing so had some bearing on a proposed diagnosis. However, there's some overlap here with the use of the word "deny" when talking about drug use, where a large proportion of patients who do use illicit drugs often hedge about it, and where symptoms and circumstances suggest that they may be using drugs even if they say they aren't: "Patient denies using illicit drugs." So there are different senses to the word even within the artificiality of clinical argot.

There's lots of interesting (as in, interesting-to-geeks) aspects to clinical jargon. If there isn't a good monograph or book about it out there, there should be.

[(myl) Thanks for this — I'm glad to see that my guesses about the value of "deny" were approximately correct. And your response with respect to e.g. "eating vegetables" confirms my vague impression.

Leaving aside the obvious technical biomedical terminology, and perhaps also little jokes like "serum porcelain level", what sorts of clinical jargon do you have in mind? I'm genuinely interested.]

29. ### John said,

April 21, 2010 @ 9:10 pm

How about denying someone something, as in food and water?

Should we see that as an implicit reply to the question: "Can you give me food and water?"

(I too thought of the Latin "negare" which we usually tell students to translate "X says that…not…"

30. ### Gordon Campbell said,

April 21, 2010 @ 9:50 pm

What Mr Punch said! Nix sounds right to me. 'Negate' almost works – but has the complication of meaning both 'nullify' as well as 'deny'.

31. ### Garrett Wollman said,

April 21, 2010 @ 11:28 pm

My PCP had me visit an online medical-history-by-filling-in-lots-of-Web-forms site at my last visit. I had it send me a copy of the results (faxed to the doctor's office, natch, none of this new-fangled EMR stuff for us) and noted that it used the same terminology, in exactly the same way as Golias suggests above: "Reports A, B, C. Denies D, E, F, G." Of course, conditions A-G were expressed in medical jargon that one might well need to look up, rather than in the plain English of the on-line "interview".

32. ### Aaron Davies said,

April 21, 2010 @ 11:38 pm

@Boris: Regarding the exceptions: first, any indication of whether Olmert's statement was originally in English? Second, the economics title seems a clear reference to the religious usage—"MV = PY" is implied to be dogma. (Gratuitous snark about surprisingly clever wordplay for an economist omitted…)

33. ### Sarah said,

April 22, 2010 @ 12:28 am

Working as a medical transcriptionist, I see "patient denies x, y etc." all the time. Mostly "patient denies any previous medical history or family history, allergies, history of sphincteric disturbances". No positive examples (like the "denies eating vegetables" example) comes to mind.

We've had one patient take issue with that enough to send a complaint, saying that the doctor accused her of lying. Mind you, this same patient also took issue with being diagnosed with Tennis Elbow, saying that she didn't play tennis.

April 22, 2010 @ 4:29 am

At least here in Scotland, there is a similar curiosity in the positive reports. On going through my medical notes after an illness a few years ago, I found that I "admitted" certain symptoms, as well as "denying" others. Again, all this means is that I said "yes", but the everyday connotations are rather different.

[(myl) A good point. Are there any other members of this semantic cluster that have a special pattern of usage in medical notes?]

35. ### Thomas Westgard said,

April 22, 2010 @ 8:43 am

@Mark P –

I guess this would be more interesting if geologic recordkeeping included statements like, "Rock denies calcium content," or veterinary records said things like "turtle denies suicidal ideation."

36. ### Bloix said,

April 22, 2010 @ 9:27 am

"You say the capitalist is necessary and I deny it. The capitalist has become a profit-taking parasite."
Eugene V. Debs
(at Labor and Freedom: The Voice and Pen of Eugene V. Debs, p. 114,

37. ### Dunromin said,

April 22, 2010 @ 9:41 am

If I remember right, "does not admit" in English legal pleadings prepared by a defendant means that he requires the applicant/plaintiff to prove the point, whereas "denies" indicates that the defendant will produce evidence to prove the applicant/plaintiff wrong.

Surely a doctor, speaking in the presence of a patient, should use everyday English and avoid technical jargon which could offend if misunderstood. The same applies to any professional jargon, eg a lawyer should not use terms like tort and consideration in a conversation with, or in front of, a client, without explaining the meaning.

38. ### Boris said,

April 22, 2010 @ 9:56 am

@peter,
"I deny your scurrilous accusations" sounds wrong to me unless it's a response to a question "Do you deny my scurrilous accusations??"

"I can neither confirm nor deny…" doesn't really contradict my thesis since:
1) It's in the negative (I don't deny it because I know it to be true) and
2) It has a "can" in front of it (I can hypothetically deny something that's true, but I don't)
3) It's a statement of ignorance or impossibility (I can't deny it because I don't know if it's true or because it's in my best interests not to answer the question)

@Aaron,
I don't have an answer for you about the Olmert quote. I also don't know economics well enough to agree or disagree with you. I find the whole religious thing odd, however. There's no reason to have an exception there unless it preserves an older meaning that is no longer current.

39. ### Sam said,

April 22, 2010 @ 7:28 pm

Another medical resident here. Deny is indeed incredibly common with this meaning, although I have encountered a few senior physicians who object to the usage for the reasons Mark cited (patient perception of accusation).

The phrases admits to X or endorses X are also used for I asked the patient whether they had experienced X and they said yes. For example, "The patient endorses a 20-pound weight loss" implies that the speaker asked the patient about weight loss, while "The patient has had a 20-pound weight loss" leaves it ambiguous as to whether the patient volunteered the information or they were specifically asked. The words complains of/about X are used to explicitly mark information that was volunteered — e.g., "The patient complains of a 20-pound weight loss" has the implication that the patient brought this up without the speaker inquiring about it.

As for the semantic restrictions on X: when used with admit or deny, X seems to be restricted to historical information that could be construed as contributing to some disease, although it does not have to be a symptom — it can refer to risk factors for disease, bad habits, family history, living situation — anything that could potentially contribute to producing an illness. In other words, X usually has some sort of negative health implication when used with admit or deny. The semantic range of X seems more open when used with endorse. For example, I agree that both "*Mr Jones admits to exercising" and "*Mr Jones denies exercising" sound odd. "Mr Jones endorses exercising", however, sounds alright, as a way of communicating that the speaker asked Mr Jones whether he exercises and Mr Jones said yes. In contrast, "Mr Jones admits to eating three Big Macs daily", "Mr Jones endorses eating three Big Macs daily", and "Mr Jones denies eating Big Macs" all sound fine.

Although these words can make patients uncomfortable, I think the usage has persisted because it provides a useful distinction in meaning. Information that the patient volunteers without prompting tends to be more reliably linked to the disease process because patients tend to emphasize new or different experiences when they come to the physician's office. One of the key parts of taking a good medical history is sifting out which of the patient's experiences are truly relevant to the disease process. When we ask leading questions in what we call the "review of systems", we can often draw out relevant information that the patient didn't realize was relevant, but there is also a danger of interpreting too much into fleeting, infrequent, or equivocal symptoms that can be a normal part of everyday life and are brought out by asking these type of questions. Therefore there is utility in clinical discussions in marking patient-volunteered information versus physician-induced "review of systems" responses.

40. ### Golias Bauknecht said,

April 22, 2010 @ 9:07 pm

Other interesting aspects of clinical language:

As Sam said, the use of the word "endorse."

The ways in which medical note writers refer to themselves and other parties, in what seems like an attempt to retain objectivity. The little old man with lumbago, Mr Little, becomes "the patient," "Patient," or just "Pt." The person writing the note, usu. denoted "I" in other genres, is frequently expressed as a plurale auctoritatis, or via notations such as "Writer," or "Examiner." In cases where the patient cannot directly provide a history, the relative or acquaintance who does is "Historian" or "Informant."

The ossified formats of clinical notes (usually either so-called SOAP notes—an acronym for the terms "subjective," "objective," "assessment," and "plan," which are its main sections—or H&Ps, also known as a history and physical). These make possible templating systems in electronic medical record systems. About which—thank God.

The use of set phrases and abbreviations esp in the description of the physical exam, such that a "normal" exam is often stereotypically expressed with a fairly long phrase.

And others

41. ### Peter said,

April 22, 2010 @ 9:55 pm

I've always interpreted "I can neither confirm nor deny X" as meaning roughly:

There's a rumour that X is true. I would normally be expected to say whether or not it is, but because X would be classified if it happened to be true I am not allowed to.

In other words, I interpret the word "deny" in that statement as having the same meaning as in the doctors' jargon reported – simply stating that X is not true with no positive or negative connotations necessary.

42. ### Tamara said,

April 23, 2010 @ 9:05 am

Seems to me that if the resident had just said, "When asked, the patient reported no dizziness…" etc., the information would have been accurately conveyed in a formal tone without insulting the patient.

(I always hear the denial thing as an insult even though I'm related to a bunch of doctors and I know exactly what it means. It is a pet peeve of mine that doctors are often insensitive to the way their jargon sounds to non-doctors. This is typical of that kind of thoughtlessness.)

43. ### Sam said,

April 23, 2010 @ 1:59 pm

Tamara, in total agreement with you that these uses are best avoided when the patient is one of the parties to the conversation. I think what you're referring to fits under the umbrella of what has been described elsewhere on Language Log as nerdview — use of jargony terms for a wider audience without consideration of how that audience will interpret them. The best physicians avoid this.

Another crucial part of the doctor's role is compassion and empathy for the patient, and that involves developing an ability to switch off the jargon when the audience may be more than just other medical professionals. The intent of my post was to describe the usages, not to endorse them (non-jargon meaning).

44. ### Assistant Village Idiot said,

April 29, 2010 @ 4:30 pm

I work in an acute psychiatric hospital, and this comes up often when a patient reads her record. "Denies use of alcohol, street drugs" certainly does carry a strong sense in everyday usage of "patient lies about substance abuse we are sure of." As other symptoms we ask about directly are hallucinations, suicidal and homicidal thoughts, keeping appointments and taking medications, this use of "denies" does indeed cause misunderstanding and impaired trust.

Of course, we actually get more folks who are mistaken or deceitful about these things.

The positives noted above in the comments are quite real. "Denies" shows that we asked, that the information comes directly from the patient, and that the clinician is not offering an opinion on the truth of the matter. It is brief, widely understood, and specific in our context. Whether this offsets the problems the patient experiences from its use is something else indeed.

Incidentally, on psych reports "average intelligence" often means "at least average intelligence," rather than "no better than average intelligence."

45. ### Noreen Esposito said,

August 27, 2010 @ 10:30 am

I am faculty in a nurse practitioner (NP) program where students must develop the same presentation and writing skills described by Golias. I agree that the term "denies" is a clear way of saying that the patient was asked or stated they do not have a particular symptom or issue. But the rationale that this is a standard way of communicating in medical records does not remove the common (lay) meaning of those terms and the possibility that "admits" or "denies" indicate some type of judgment. I’ve noticed that some students (and healthcare providers) use these terms primarily when writing about socially stigmatized health issues. For example, when describing pertinent negatives, a student might write "∅ (no) cough, shortness of breath, fever" or in another section of the note "no social support". But the same student might write “denies illicit drugs,” “admits tobacco use, alcohol use," or "admits marital discord.”
I discourage students from using those terms unless they can demonstrate that they are doing it in a nonjudgmental manner. My goal is that they become more reflexive in how they communicate about (and with) patients. And I warn that in the unlikely event that a medical record ends up in court, for example a lawsuit by someone who smokes, seeing the phrase "admits to tobacco use" can be very persuasive to a jury in a way that was not intended by the provider who originally wrote the statement.
A trend toward greater access to one’s own medical records and the proliferation of electronic medical records increase the likelihood that patients will read what we write about them. And that we, as patients, will read what others write about us.

46. ### Eric said,

March 21, 2014 @ 7:53 am

Why not just say "the patient notes no headache, drug use, alcohol use, etc" ? Doesn't this serve the same purpose of noting pertinent negatives and covering your a legally without making it sound like the patient is lying? Maybe it is just semantics, but by influencing attitudes semantics can be important. Or am I just missing the point that "deny" serves a pointed purpose of reminding us that we should regard everything patients tell us with suspicion?