Trends in the Use of Common Words and Patient-Centric Language in the Titles of Medical Journals, 1976-2015

Abstract

Importance: The language of medical research appears to be intrinsically tied to the culture of medical research and provides a unique window into broader trends in the culture of medicine. Objective: To analyze medical language from 5 premier medical journals and investigate broader changes in the culture of clinical investigation during the last 40 years. Design, Setting, and Participants: In this qualitative study using a data-driven analysis, 302 293 PubMed records were extracted from JAMA, The Lancet, Annals of Internal Medicine, the BMJ, and New England Journal of Medicine from January 1, 1976, through December 31, 2015, to identify key trends in medical language. A frequency analysis was applied across the 40-year time frame in JAMA to assess the major trends in all publication types. Patient-centered language was analyzed in clinical trials in the flanking time periods (1976-1980 and 2011-2015) across the 5 journals. Data were analyzed from November 16, 2016, through November 9, 2018. Main Outcomes and Measures: Increasing or decreasing frequency of words (monograms) and word pairs (bigrams) and the proportion of patient-centric words in journal article titles. Results: In JAMA, 50 277 articles of all publication types were included. In the frequency analysis, the most increased terms were reflective of the language of epidemiological research. The bigram analysis revealed a decline in causal language (-2.42/100 000 words to -2.03/100 000 words; false discovery rate [FDR], <0.01) and an increased description of patients in the plural form (6.92/100 000 words to 11.4/100 000 words; FDR, <0.01). A trend to separate patient from disease was observed; for example, there was a decrease in describing a patient as a diabetic (-2.21/100 000 words; FDR, <0.01) compared with a patient with diabetes. In the analysis of clinical trials in all 5 journals, 3125 titles were identified (range, 193-932 per journal). In 4 of the 5 journals, use of patient-centric keywords increased significantly (absolute increase, 18.9%-34.3%; P < .001 for 3 journals; P = .01 for 1 journal), with the New England Journal of Medicine as the exception. This finding reflects a change from shorter disease-centric titles to longer titles that describe patients with a disease. Conclusions and Relevance: Trends in medical language reflect the rise of evidence-based medicine, a shift in focus from individuals to populations, and a separation of patient and disease. Data-driven analysis of medical language provides a unique window into the changing landscape of medical culture.