Grammar and spelling pedants: this is why you're wrong

Martha Gill's "Irrational Animals" column.

I don’t mind other people’s bad grammar. I don’t care when people get “less” and “fewer” the wrong way round or say “James and myself” instead of “James and I”. I don't mind when people use “it’s” instead of “its” or use phrases such as “going forward” and “let’s action that” and “innit, though”. In fact I find it quite comforting. It feels like job security.

But I appear to be pretty much alone. Other people’s bad grammar, coupled with their “sloppy language” and “management speak”, might be the most common pet hate in the world. Emma Thompson is driven “insane” by bad grammar, David Mitchell hates it when companies say they have a "passion" for their products or services, when in their heart of hearts they probably don’t (at least, not a passion), and Stephen Fry once publicly ridiculed the acronym “CCTV” for being “a bland, clumsy, rhythmically null and phonically forgettable word, if you can call it a word”. (A bit unfair, Stephen – just listen to the words you use, such as “null”. That also sounds quite null.)

It's comedians, you see, who have the biggest problem with grammar and bad phrasing. It’s just such an easy source of material. Pick a common but counter-logical phrase, slowly repeat it several times, getting increasingly confused, then appeal to the audience: “What does that actually mean? What does that literally mean? I literally have no idea what that means.” Oh, come on, just put the phrase in context and have a bit of a think. You can probably work out what it means.

Now there’s nothing wrong with trying to be clear, but what's annoying about people advertising their hatred of small grammatical errors is that it’s fairly transparently a status thing. Where once the aristocracy used to make a point of getting twitchy when others poured the milk in before the tea or had supper at 6 rather than 8, the intelligentsia now mark themselves out by being, by nature, “unable to stand” certain phrases. Why? Well, they are simply anxious, they go on to explain, that language be preserved. Grammar in particular needs to be protected rigorously. Without patrolling, it could slip into disuse - and how would we understand each other without it?

But grammar is as naturally robust as DNA and it's actually the kids who are preserving it. The obvious example to reach for here is the development of Creole languages. People flung together with no shared language, such as groups of slaves from different places, develop what are known as pidgin languages to communicate with each other. These are not languages in the true sense – just a chaotic collection of words, often used inconsistently, with very little grammar. However, children born into these communities are not content merely to imitate the adults. Instead, they spontaneously impose a grammatical structure on to the words they’ve learned, creating a new language, a Creole, in one generation.

Language is fine – it’s thriving. It’s fairly hardy. Comedians and writers should just cross it off their list of worries and stop banging on about it. It’s one of my biggest pet hates.

B is for bad grammar. Photograph: Getty Images

Martha Gill writes the weekly Irrational Animals column. You can follow her on Twitter here: @Martha_Gill.

This article first appeared in the 17 December 2012 issue of the New Statesman, Will Europe ever go to war again?

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Want to know how you really behave as a doctor? Watch yourself on video

There is nothing quite like watching oneself at work to spur development – and videos can help us understand patients, too.

One of the most useful tools I have as a GP trainer is my video camera. Periodically, and always with patients’ permission, I place it in the corner of my registrar’s room. We then look through their consultations together during a tutorial.

There is nothing quite like watching oneself at work to spur development. One of my trainees – a lovely guy called Nick – was appalled to find that he wheeled his chair closer and closer to the patient as he narrowed down the diagnosis with a series of questions. It was entirely unconscious, but somewhat intimidating, and he never repeated it once he’d seen the recording. Whether it’s spending half the consultation staring at the computer screen, or slipping into baffling technospeak, or parroting “OK” after every comment a patient makes, we all have unhelpful mannerisms of which we are blithely unaware.

Videos are a great way of understanding how patients communicate, too. Another registrar, Anthony, had spent several years as a rheumatologist before switching to general practice, so when consulted by Yvette he felt on familiar ground. She began by saying she thought she had carpal tunnel syndrome. Anthony confirmed the diagnosis with some clinical tests, then went on to establish the impact it was having on Yvette’s life. Her sleep was disturbed every night, and she was no longer able to pick up and carry her young children. Her desperation for a swift cure came across loud and clear.

The consultation then ran into difficulty. There are three things that can help CTS: wrist splints, steroid injections and surgery to release the nerve. Splints are usually the preferred first option because they carry no risk of complications, and are inexpensive to the NHS. We watched as Anthony tried to explain this. Yvette kept raising objections, and even though Anthony did his best to address her concerns, it was clear she remained unconvinced.

The problem for Anthony, as for many doctors, is that much medical training still reflects an era when patients relied heavily on professionals for health information. Today, most will have consulted with Dr Google before presenting to their GP. Sometimes this will have stoked unfounded fears – pretty much any symptom just might be an indication of cancer – and our task then is to put things in proper context. But frequently, as with Yvette, patients have not only worked out what is wrong, they also have firm ideas what to do about it.

We played the video through again, and I highlighted the numerous subtle cues that Yvette had offered. Like many patients, she was reticent about stating outright what she wanted, but the information was there in what she did and didn’t say, and in how she responded to Anthony’s suggestions. By the time we’d finished analysing their exchanges, Anthony could see that Yvette had already decided against splints as being too cumbersome and taking too long to work. For her, a steroid injection was the quickest and surest way to obtain relief.

Competing considerations must be weighed in any “shared” decision between a doctor and patient. Autonomy – the ability for a patient to determine their own care – is of prime importance, but it isn’t unrestricted. The balance between doing good and doing harm, of which doctors sometimes have a far clearer appreciation, has to be factored in. Then there are questions of equity and fairness: within a finite NHS budget, doctors have a duty to prioritise the most cost-effective treatments. For the NHS and for Yvette, going straight for surgery wouldn’t have been right – nor did she want it – but a steroid injection is both low-cost and low-risk, and Anthony could see he’d missed the chance to maximise her autonomy.

The lessons he learned from the video had a powerful impact on him, and from that day on he became much more adept at achieving truly shared decisions with his patients.

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide