Health and medicine — C2

By B2 you owned everyday health vocabulary and the basic specialties. At C1 you added clinical-encounter vocabulary, common diagnostics, and the rough shape of the US system. At C2 you cross into the discourse where clinical reasoning, evidence-based medicine, and US health policy are taken apart in detail. You can read a New England Journal of Medicine perspective piece, a JAMA editorial on a major trial, a Kaiser Health News investigation of surprise billing, an Atlantic feature on healthcare disparities, and a Health Affairs policy paper on Medicare Advantage — without translation drag and without missing the technical or political subtext.

The vocabulary in this lesson sits at the intersection of clinical medicine, biostatistics, health-services research, and US healthcare policy. It is the working language of physicians, medical residents, public-health professionals, health-policy analysts at Kaiser Family Foundation and the Commonwealth Fund, and senior health-care journalists. Much of it is American-specific — the donut hole, prior authorization, step therapy, DRGs, the Stark Law — and these terms have no neat European equivalent.

A pragmatic note: medical language is asymmetric. Doctors use cancer-of-the-X shorthand in conversation but carcinoma of the X in writing; they say the patient clinically and they personally; they say MI (heart attack) and AKI (kidney injury) routinely. Knowing the registers — clinical talk, journal English, patient-facing language, medical-press style — is core C2 competence.

Clinical reasoning — how doctors think

• history / the history / HPI (history of present illness) — the patient’s story
• PMH (past medical history) / PSH (past surgical history) / FH (family history) / SH (social history)
• ROS (review of systems) — systematic symptom inventory
• the physical / the physical exam / PE — examination
• vitals / vital signs — temperature, BP, HR, RR, SpO₂
• chief complaint (CC) — the patient’s stated reason for visit
• presenting problem / the presentation
• acuity — how sick (the ED triages by acuity: ESI 1-5)
• the differential / differential diagnosis / the DDx — list of possible diagnoses
• leading diagnosis / most likely diagnosis / the working diagnosis
• rule out / r/o — exclude a possibility
• rule in — confirm
• pre-test probability — likelihood of disease before testing
• post-test probability — likelihood after testing, updated by Bayes’ theorem
• clinical pearls / the gestalt — accumulated heuristic wisdom
• a zebra vs a horse — rare diagnosis vs common (when you hear hoofbeats, think horses, not zebras)
• the workup — the planned set of investigations
• the disposition / the disposition decision (D/C, admit, transfer)
• AMA — against medical advice (leaving discharge without recommendation)
• the read / the wet read — the radiologist’s interpretation (formal vs preliminary)

Disease vocabulary at the right register

• etiology — the cause(s) of a disease
• pathophysiology / pathophys — mechanism of disease
• pathogenesis — process by which disease develops
• idiopathic — of unknown cause
• iatrogenic — caused by medical intervention
• nosocomial / hospital-acquired
• prognosis — expected course and outcome
• morbidity vs mortality — sickness vs death
• all-cause mortality vs cause-specific mortality
• case fatality rate vs infection fatality rate
• the natural history of a disease — its course without intervention
• comorbidity / multimorbidity — co-existing conditions
• acute vs subacute vs chronic vs recurrent
• insidious onset vs acute onset vs abrupt onset
• paroxysmal — sudden, episodic
• refractory — not responding to treatment
• intractable — resistant to relief
• palliative — symptom-focused, not curative
• the palliative-curative axis / goals of care
• end-of-life care / hospice
• DNR / DNI (Do Not Resuscitate / Intubate) / POLST (Physician Orders for Life-Sustaining Treatment)
• advance directive / living will / healthcare proxy

Diagnostic test characteristics — Bayes for clinicians

This is one of the most consequential vocabulary clusters at C2. Most clinicians use it loosely; the well-trained ones use it precisely, and the gap is visible in any medical discussion.

• sensitivity — among diseased, the fraction the test correctly identifies (true-positive rate)
• specificity — among non-diseased, the fraction the test correctly rules out (true-negative rate)
• PPV (positive predictive value) — among test-positives, the fraction who actually have the disease
• NPV (negative predictive value) — among test-negatives, the fraction who actually don’t
• prevalence — how common the disease is in the population
• the prevalence dependence of PPV/NPV — PPV/NPV depend on prevalence; sensitivity/specificity (mostly) don’t
• likelihood ratio (LR+, LR−) — multiplies pre-test odds to give post-test odds
• ROC curve (Receiver Operating Characteristic) — sensitivity vs (1 − specificity) across thresholds
• AUC / AUROC (Area Under the Receiver Operating Characteristic curve)
• calibration vs discrimination — predictions match observed rates vs distinguish cases
• the Bayes factor

Trial vocabulary

• RCT (randomized controlled trial) / double-blind RCT — see also the methodology section in the science lesson
• phase I / II / III / IV trials — safety/dose finding / efficacy / pivotal / post-marketing
• adaptive trial — pre-specified modifications based on interim data
• basket trial vs umbrella trial — one drug across many tumor types vs many drugs for one cancer with different biomarkers
• platform trial — ongoing infrastructure for multiple comparisons (e.g., RECOVERY, REMAP-CAP)
• endpoint — pre-specified outcome
• primary endpoint vs secondary endpoint
• composite endpoint — combined outcome (death OR hospitalization OR …)
• MACE (Major Adverse Cardiovascular Events) — a common composite
• surrogate endpoint — measurable proxy for clinical outcome (LDL for cardiovascular disease)
• hard endpoint vs soft endpoint — death/MI/stroke vs symptom scales
• clinically meaningful difference vs statistically significant difference
• minimal clinically important difference (MCID)
• NNT (number needed to treat) — patients you must treat to prevent one event
• NNH (number needed to harm) — patients you must treat to cause one harm
• absolute risk reduction (ARR) vs relative risk reduction (RRR) — RRR sounds bigger and is more often quoted by industry
• hazard ratio (HR) — time-to-event analog of relative risk
• odds ratio (OR) — case-control standard
• intention-to-treat (ITT) vs per-protocol vs as-treated analyses
• modified intention-to-treat (mITT)
• non-inferiority margin — the worst acceptable difference vs comparator
• futility — pre-specified threshold for stopping early due to lack of effect
• DSMB (Data and Safety Monitoring Board) — independent oversight committee

Evidence-based medicine

• EBM (evidence-based medicine) — practice based on best available evidence
• the EBM hierarchy / evidence pyramid — see science lesson; in medicine: RCT > cohort > case-control > case series > expert opinion
• clinical guidelines / practice guidelines
• the GRADE framework — rates evidence quality and recommendation strength
• strong recommendation vs conditional recommendation vs weak recommendation
• shared decision-making (SDM) — clinician and patient deciding together
• patient preferences / values clarification
• medical paternalism vs patient autonomy
• informed consent — patient understanding of risks, benefits, alternatives
• the four pillars of medical ethics — autonomy, beneficence, non-maleficence, justice
• futility (ethically) — treatment unlikely to provide meaningful benefit
• medical overuse / low-value care / Choosing Wisely campaign
• deprescribing — stopping medications no longer beneficial
• polypharmacy — multiple concurrent medications
• medication reconciliation (med-rec)
• drug interactions / drug-drug interactions (DDIs)
• the Beers list / the START/STOPP criteria — geriatric prescribing tools
• adherence vs compliance — preferred newer term vs older paternalistic one
• medication persistence — staying on a medication over time

Specialty vocabulary at C2 — a sampler

• cardiology: ACS (acute coronary syndrome), STEMI vs NSTEMI, troponin elevation, ejection fraction (EF), HFrEF/HFpEF (heart failure with reduced/preserved EF), AFib (atrial fibrillation), CAD (coronary artery disease), valvular disease, TAVR (transcatheter aortic valve replacement), the heart team
• oncology: solid tumor vs hematologic malignancy, staging (TNM, AJCC), grading, immunotherapy (PD-1/PD-L1 inhibitors, checkpoint inhibitors), CAR-T (chimeric antigen receptor T-cell therapy), tumor microenvironment, ctDNA (circulating tumor DNA) / liquid biopsy, MRD (minimal residual disease)
• neurology: stroke (ischemic vs hemorrhagic), tPA / tenecteplase, thrombectomy, TIA, dementia (Alzheimer’s, vascular, Lewy body, frontotemporal), Parkinson’s, MS, epilepsy, seizure semiology
• gastroenterology: GERD, IBD (Crohn’s vs UC), IBS, NAFLD (now MASLD), MASH (formerly NASH), cirrhosis, HCC
• pulmonology: COPD (emphysema and chronic bronchitis), asthma, ILD (interstitial lung disease), IPF, OSA (obstructive sleep apnea), pulmonary hypertension
• endocrinology: T1DM vs T2DM, GLP-1 receptor agonists (semaglutide, tirzepatide), HbA1c, MODY, hypothyroidism, hyperthyroidism, adrenal insufficiency
• infectious disease: sepsis (and the Sepsis-3 definition), septic shock, antimicrobial stewardship, MDR/XDR organisms (multi-drug-resistant / extensively-drug-resistant), the One Health approach
• mental health: MDD (major depressive disorder), bipolar I/II, OCD, PTSD, complex PTSD (C-PTSD), generalized anxiety disorder (GAD), schizophrenia spectrum, the DSM-5(-TR), the ICD-11
• rheumatology: RA, lupus (SLE), psoriatic arthritis, ankylosing spondylitis, the biologics (TNF inhibitors, JAK inhibitors)
• nephrology: AKI (acute kidney injury), CKD (chronic kidney disease) staging, ESRD, dialysis (hemodialysis vs peritoneal), kidney transplant

US healthcare system — the specifically American architecture

• the ACA (Affordable Care Act / Obamacare, 2010) — the major US health reform
• the marketplace / the exchange / healthcare.gov — ACA-mandated insurance shopping
• premium tax credit / APTC (Advance Premium Tax Credit) — ACA subsidies
• cost-sharing reduction (CSR) — additional subsidies for low-income enrollees
• the individual mandate — penalty for not having insurance (zeroed federally in 2017, state mandates remain in some states)
• Medicaid expansion — ACA-funded state expansion to adults under 138% FPL
• the Medicaid coverage gap — non-expansion-state low-income adults too poor for marketplace subsidies, too rich for traditional Medicaid
• dual eligible — enrolled in both Medicare and Medicaid
• CHIP (Children’s Health Insurance Program)

Insurance vocabulary

• premium — monthly payment
• deductible — annual amount paid out of pocket before insurance pays
• coinsurance — percentage of costs after deductible (e.g., 20%)
• copay / copayment — fixed amount per visit (e.g., $30)
• out-of-pocket maximum (OOP max) — annual ceiling on patient spending
• HDHP (high-deductible health plan) — usually paired with HSA
• HSA (Health Savings Account) — pre-tax savings for medical expenses
• FSA (Flexible Spending Account)
• HRA (Health Reimbursement Arrangement)
• PPO vs HMO vs EPO vs POS — plan types
• in-network vs out-of-network
• narrow network / ultra-narrow network — limited provider lists for cheaper plans
• balance billing / surprise billing — provider billing patient for the gap between billed and insurance-paid amounts (largely banned for emergencies by the No Surprises Act, 2022)
• prior authorization / preauthorization / preauth / PA — insurance approval required before service
• step therapy / fail first — insurance requires cheaper drug to fail before approving expensive one
• formulary — list of covered drugs
• tier — formulary stratification by patient cost
• rebate — manufacturer payment to PBM
• PBM (Pharmacy Benefit Manager) — intermediary between insurers, pharmacies, and manufacturers
• GPO (Group Purchasing Organization)
• the donut hole / the Medicare Part D coverage gap — partly closed by ACA, fully closed by IRA
• CMS (Centers for Medicare and Medicaid Services)
• Medicare Parts A, B, C, D — hospital, outpatient, Advantage, drug
• Medicare Advantage (MA) — privately administered Medicare; controversial for upcoding
• risk adjustment — payment adjustment for patient acuity
• upcoding — billing for higher complexity than warranted
• Star Ratings — CMS quality scoring for MA plans

Payment and delivery

• fee-for-service (FFS) — payment per service rendered
• value-based care (VBC) — payment tied to outcomes
• capitation — fixed payment per patient per period
• bundled payment — single payment for an episode
• ACO (Accountable Care Organization) — provider group accepting shared risk
• MSSP (Medicare Shared Savings Program)
• the triple aim — better care, better health, lower cost (Berwick); sometimes extended to quadruple aim (with clinician well-being) or quintuple aim (with equity)
• DRG (Diagnosis-Related Group) — Medicare inpatient payment classification
• RVU (Relative Value Unit) — Medicare physician payment unit
• the conversion factor — RVU-to-dollars
• the Sustainable Growth Rate (SGR) — defunct Medicare physician-payment formula
• MACRA / MIPS / APMs — post-SGR payment frameworks
• CON (Certificate of Need) laws — state regulation of new facilities
• the Stark Law / the Anti-Kickback Statute (AKS) — physician self-referral and kickback regulation
• EMTALA (Emergency Medical Treatment and Labor Act) — emergency stabilization mandate
• HIPAA (Health Insurance Portability and Accountability Act) — privacy regulation
• PHI (Protected Health Information)

Healthcare disparities — vocabulary at C2

• healthcare disparities / health disparities / health inequities
• social determinants of health (SDOH) — non-medical drivers
• structural racism in health
• the Black-white maternal mortality gap — major US disparity
• redlining and health — historical residential segregation effects
• ZIP-code destiny — health outcomes vary sharply by neighborhood
• food desert / food swamp — limited healthy food access
• medical mistrust — partly justified by historical abuses (Tuskegee, Henrietta Lacks)
• implicit bias in clinical decisions
• race-based eGFR adjustment — abandoned in 2021 as racial-essentialist
• community health workers (CHWs) / promotoras
• federally qualified health centers (FQHCs) — safety-net primary care
• safety-net hospital — primary serves uninsured/Medicaid
• the 340B program — drug discount for safety-net providers

EHR/EMR — the documentation regime

• EHR (electronic health record) / EMR (electronic medical record) — terms used loosely; EHR is technically broader
• Epic / Cerner (Oracle Health) — the dominant US EHRs
• the chart / the note
• SOAP note — Subjective, Objective, Assessment, Plan
• the H&P (history and physical) — admission note
• progress note / daily note
• the consult note
• the discharge summary
• CC (chief complaint) / HPI / PMH / PSH / FH / SH / ROS / PE / A/P (assessment and plan)
• note bloat — bloated notes from copy-forward and template overuse
• upcoding through documentation — documenting more elements to justify higher E/M code
• E/M codes (Evaluation and Management) — CPT codes for cognitive work
• ICD-10 (and the coming ICD-11) — diagnosis codes
• CPT — procedure codes
• interoperability — data exchange across systems
• the Cures Act — 21st Century Cures Act with information-blocking provisions
• open notes / patient-portal release — patients seeing their notes (now mandatory)
• clinical decision support (CDS) — EHR-embedded alerts
• alert fatigue — clinicians ignoring excessive alerts

AmE-specific vs international vocabulary

Collocations

• present with symptoms, complaints, findings
• rule out / rule in a diagnosis
• work up a patient
• admit to the floor, the ICU, the step-down
• discharge home, to a facility, to hospice
• transition to comfort care, palliation
• start / hold / titrate / wean / taper a medication
• dose / dose-adjust / dose-reduce / dose-escalate
• prescribe / order / write for / refill / authorize
• order labs / draw labs / send labs
• image / scan / x-ray / cross-section / contrast
• biopsy / sample / cultivate / culture
• resuscitate / code / call a code / run the code
• intubate / extubate / ventilate / oxygenate
• suspect / consider / favor / lean toward / lean away from a diagnosis
• achieve / fail to achieve / meet the primary endpoint
• enroll / consent / randomize / blind / unblind

Phrases and locutions

• the prudent layperson standard — emergency-care entitlement test
• the patient is in extremis — gravely ill
• circling the drain — clinical deterioration (informal)
• status post / s/p — after (s/p MI = after heart attack)
• comfort measures only (CMO)
• goals-of-care conversation
• futile but not unethical treatment
• the empty-suit consult — courtesy consult expected to say what was already planned
• the curbside consult — informal opinion
• the medical-legal exposure
• defensive medicine
• the standard of care
• the eyeball test — clinical gestalt
• looking sick / looking well
• a soft call vs a hard call
• above my pay grade — out of one’s scope
• the patient is failing to progress
• the patient is medically optimized — ready for discharge from acute care
• non-actionable findings — incidentalomas not requiring action

Common Russian-speaker mistakes

1. Inflammation / inflammatory used loosely*. In English clinical context inflammation is the specific physiological process (heat, redness, swelling, pain, loss of function — calor, rubor, tumor, dolor, functio laesa); inflammatory disease has a specific meaning. For general swelling use edema (medical) or swelling; for irritation use irritation or redness. Russian воспаление maps to both inflammation and broader irritation; in medical English be specific.
2. Insult meaning stroke. Extreme false friend with Russian инсульт. In English insult is verbal abuse or, in medical jargon, a biological injury (a neurological insult), but not the everyday word for stroke. For the cerebrovascular event use stroke (the everyday medical term), CVA (cerebrovascular accident — slightly outdated), ischemic stroke / hemorrhagic stroke (typed). He had an insult in everyday AmE means he was offended.
3. Infarct as everyday word*. AmE infarct is technical (myocardial infarct); the everyday word is heart attack (myocardial infarction) or stroke (cerebral infarction). He had an infarct in lay context will be incomprehensible; he had a heart attack is the everyday phrasing.
4. Operation loosely*. AmE distinguishes operation (the surgical procedure) from procedure (broader; includes diagnostic and minor) and intervention (any clinical action). For minor things use procedure (colonoscopy is a procedure, not an operation); for major surgery use surgery or operation (open-heart surgery, hip-replacement surgery).
5. Polyclinic / clinic for outpatient department. Russian поликлиника doesn’t map cleanly. AmE clinic is a general outpatient facility; a doctor’s office / the practice / the office is what an individual physician operates from. Polyclinic is rarely used in AmE; it sounds Soviet. The hospital outpatient department might be the outpatient clinic or the ambulatory care center.
6. Pharmacy / drugstore distinction*. AmE pharmacy is the prescription-dispensing function; drugstore is the retail store (CVS, Walgreens) that contains a pharmacy. I’m going to the pharmacy and I’m going to the drugstore are largely interchangeable in AmE everyday speech; I’m going to the apothecary is archaic.
7. Therapy loosely for treatment in everyday speech. In AmE medical context therapy is broad (drug therapy, radiation therapy, physical therapy, psychotherapy); treatment is even broader (any clinical action toward improvement); regimen is a specific schedule. Russian терапия maps to all of these; in AmE pick the right one. Cancer doctors say the patient is on chemotherapy or on systemic therapy; psychiatrists say the patient is in therapy; primary-care doctors say let’s start treatment for hypertension.

Summary

• Clinical reasoning vocabulary covers the history-physical-workup-disposition sequence, the differential diagnosis, pre/post-test probability, and the clinical gestalt.
• Disease vocabulary distinguishes etiology, pathophysiology, and pathogenesis; comorbidity, multimorbidity, acuity, and natural history shape the language of severity and course.
• Diagnostic test characteristics (sensitivity, specificity, PPV, NPV, likelihood ratios, ROC/AUC, calibration vs discrimination) underpin Bayesian clinical reasoning.
• Trial vocabulary spans phases, endpoints (primary/secondary/composite/hard/soft/surrogate), NNT/NNH, ARR vs RRR, hazard ratios, and ITT vs per-protocol.
• EBM hierarchy, GRADE, shared decision-making, and the Choosing Wisely / deprescribing agenda define modern evidence-based practice.
• US-specific system vocabulary includes the ACA architecture, Medicare Parts/Advantage/star ratings, insurance plumbing (premium/deductible/coinsurance/PA/step therapy), payment models (FFS/VBC/capitation/bundled/ACO/MSSP), and the regulatory layer (Stark, AKS, EMTALA, HIPAA, the 340B program).
• Disparities vocabulary covers SDOH, structural racism in health, ZIP-code destiny, food deserts, medical mistrust, and the safety-net architecture.
• Russian false friends: insult for stroke, inflammation used loosely, infarct as everyday word, polyclinic for clinic, operation for any procedure, therapy for any treatment.

Next theme: Arts and culture — C2 — aesthetic, ekphrasis, mimesis, the sublime, kitsch, camp, postmodernism, hyperreality, the gaze, ideology critique.