1. Issel, L. Michele PhD, RN

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I'm all for the evolution of language, as long as that evolution leads to increased clarity and specificity. Unfortunately, from my point of view, the general need to appear novel, inclusive, encompassing, and aligned with current thinking has generated language of confusion and ambiguity. Let me explain.

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Recently, a reviewer critiqued an author for inconsistent use of heath care and healthcare. The author e-mailed me, asking which was the correct term. This reasonable question left me wondering. I immediately consulted the Oxford English Dictionary (OED), the definitive source on such matters. Although the word "healthcare" does not appear, "childcare", "eldercare," and "health care" do. The OED and Webster's Dictionary both designate "health care" as a noun. The AMA Style Manual gives "health care" and adds that it need not be hyphenated when used as an adjective, as in "health care organization." One comment posted at the Webster's Dictionary website mentioned that the Associated Press Style Manual also uses "health care," but I was not able to verify that. On the basis of this review of trusted English language sources, I have concluded that "healthcare" is not a word.


This got me wondering about other uses of language. The OED definition of health care refers to care provided by an organized health service, whereas Webster's specifies licensed and trained professionals but not organizations. More importantly, both the OED and Webster's define health care in terms of maintaining or restoring health. This focus on health contrasts with medical care, which denotes medical practice (diagnosis and treatment) by licensed and trained professionals. A search of HCMR article titles using the word "medical" yields 15 published articles, whereas the works using "health care" yields 37 published papers. Although a few of the papers that use health care in the title fell easily into the medical care realm, most papers used health care as a more encompassing, although less informative, term. For example, papers using "health care workers" in the title often only focused on nurses. Terms such as health care reform, health care management, and health care alliances have broader consensus on a specific meaning, whereas terms such as health care services and health care teams have some inherent ambiguity. The point is to use the most informative, specific, accurate language. This helps not only readers who focus only on titles but also scholars who conduct literature searches. Papers have to be findable to be cited.


I have similar concerns about the use of "practitioner" and "provider." The OED and Webster's both define these in relation to individuals. The distinction is subtle. Practitioner is about a person, whereas provider tends to include the array of employees involved in providing medical or health care.


In summary, henceforth, HCMR authors and reviewers need to follow these rules:


1. Use "health care" as a noun or adjective; do not use "healthcare."


2. Use "practitioner" only when it (a) refers to person and (b) is intended to include three or more categories of licensed professionals, otherwise specify the two categories, such as physician and nurses, or pharmacists and psychologists.


3. Use "provider" to refer to a person when the focus is not on the delivery of direct care, or to an organization of medial or health care practitioners.



L. Michele Issel, PhD, RN