As I was editing a manuscript on patients undergoing surgery for brain tumors, I came across the sentence, “Patients who required emergency care were admitted to the hospital and classified as needing emergent or urgent surgery.” As I reread the sentence, the terms emergency, emergent, and urgent started to swim before my eyes, each backstroking to take the place of the other. Soon I was reading, “Patients who required urgent care were admitted to the hospital and classified as needing emergency or emergent surgery.” And then, “Patients who required emergent care were admitted to the hospital and classified as needing emergency or urgent surgery.” What was going on? Was my late-night habit of perusing stylebooks and usage guides before bedtime starting to produce side effects (oops, I mean adverse effects)? Was I no longer able to delineate the difference between commonly used medical terms? I had to take action.
Diligent medical copy editor that I am, I turned to my bookshelf, which is chock full of dictionaries and grammar, usage, and editing books. Now I would be able to solve this conundrum. I would take this problem step by step, or rather word by word, and find the resolution. Here’s what I found:
Stedman’s Medical Dictionary1 defines emergency as “an unexpected development or happening; a sudden need for action.”
Dorland’s Illustrated Medical Dictionary2 defines emergency as “an unlooked for or sudden occurrence, often dangerous, such as an accident or an urgent or pressing need.”
Merriam-Webster’s Collegiate Dictionary3 defines emergency as “an unforeseen combination of circumstances or the resulting state that calls for immediate action.”
Consensus! There’s nothing a copy editor likes better.
Resolution: An emergency is basically an unexpected event that requires immediate action.
Dorland’s defines emergent first as “pertaining to an emergency” and second as “coming into being through consecutive stages of development, as in emergent evolution.”
Stedman’s omits the definition stemming from the term emergency and defines emergent first as “arising suddenly and unexpectedly, calling for quick judgment and prompt action” and second as “coming out; leaving a cavity or other part.”
Merriam-Webster’s defines emergent as “arising unexpectedly” or “calling for prompt action.”
This one’s a little trickier. Dorland’s relates the term emergent to emergency and Stedman’s and Webster’s simply define emergent as the adjectival form of the noun emergency. So, is there a difference between these 2 words or are they synonymous? It was time to reach deeper into my bookshelf.
I first turned to the classic text A Dictionary of Modern English Usage by H. W. Fowler.4 I knew Fowler wouldn’t let me down. Fowler’s entry on emergence and emergency reads as follows, “The two are now completely differentiated, -ce meaning emerging or coming into notice, and -cy meaning a juncture that has arisen, especially one that calls for prompt measures.”
After some additional research, I found this entry in Common Errors in English Usage by Paul Brians5: “The error of considering ‘emergent’ to be the adjectival form of ‘emergency’ is common only in medical writing, but it is becoming widespread. ‘Emergent’ properly means ‘emerging’ and normally refers to events that are just beginning—barely noticeable rather than catastrophic. ‘Emergency’ is an adjective as well as a noun, so rather than writing ‘emergent care,’ use the homely ‘emergency care.’”
Eureka! Emergent means beginning to arise and emergency means arising unexpectedly.
Resolution: Use emergent to mean emerging (as in Dorland’s section definition of “coming into being through consecutive stages of development, as in emergent evolution”) and emergency to mean an unexpected event that calls for immediate attention.
But then what about urgent?
Neither Dorland’s nor Stedman’s defines the term urgent.
Merriam-Webster’s Collegiate Dictionary defines urgent as “calling for immediate action.”
So, can urgent and emergency be used interchangeably? The Children’s Hospital of Wisconsin website provides a list of surgery types. It groups urgent or emergency surgery and defines it as surgery “done in response to an urgent medical need, such as the correction of a life-threatening congenital heart malformation or the repair of injured internal organs after an automobile accident.”6 However, the website Trivology.com states, “There is major difference between elective, urgent, emergency surgery. In urgent surgery we can wait until the patient’s health is unwavering but it has to be performed in 1-2 days. But emergency surgery needs to be performed without any impediment otherwise there will be colossal risk to patient’s life.”7
Therefore, in medical editing, be careful of changing emergency to urgent because emergency means immediate attention is required and urgent indicates quick but not immediate action is required. There is no such thing as emergent surgery unless you mean surgery that is just beginning.
Resolution: Although emergent and urgent both indicate calls for swift action, urgent is more, well, urgent.
Well, there you have it. I guess that original sentence I was editing makes sense after all. “Patients who required emergency surgery [immediate surgery because of the unforeseen nature of the incident] were admitted to the hospital and classified as needing emergent [with a few hours] or urgent [within 24 hours] care.”— Laura King, MA, ELS (January 2013)
1. Stedman’s Medical Dictionary. 26th ed. Baltimore, MD: Williams & Wilkins; 1995.
2. Dorland’s Illustrated Medical Dictionary. 32nd ed. Philadelphia, PA: Elsevier Saunders; 2012.
3. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003.
4. Fowler HW. A Dictionary of Modern English Usage. 2nd ed. Oxford, England: Oxford University Press; 1965.
5. Brians P. Common Errors in English Usage. 2nd ed. Sherwood, OR: Williams James & Co; 2008.
6. The Children’s Hospital of Wisconsin website. Types of Surgery. http://www.chw.org/display/PPF/DocID/22082/router.asp. Accessed January 10, 2013.
7. Trivology.com. http://www.trivology.com/articles/209/what-is-elective-surgery.html. Accessed January 10, 2013.