…but words will never hurt me… Short reflections on negative descriptors in the International Classification of Diseases 2010 (ICD10)

Mark ZY Tan is an anaesthetics and intensive care medicine trainee, an academic clinical fellow, and is a writer and broadcaster.


…but words will never hurt me…


As in cardiac, kidney, or any other organ failure. In the case of the heart, the “inability to pump enough blood to meet the body’s needs”. He blames the overwork, over-time, over many years. He thinks it’s over now – a poor prognosis from a single diagnosis. The label taken as gospel, fulfilment of the prophetic phrase “men’s hearts failing them for fear” (Luke 21:26). How profound the effect of a single word. Does it encompass my failure of explanation as much as his failure of interpretation? 

“Sticks and stones may break my bones…” isn’t it about time we challenge the phrase that follows?


In anatomy, also known as caudal, away from the head, lower (down the y-axis). The opposite of superior, but not superiority, nor oneupmanship. Yet, she thinks her inferior myocardial infarction a mere petty pathology. Not like the heart attack that killed her dad. No, not quite, but not far off. The ST changes, troponins, and PCI (Percutaneous Coronary Intervention), conveniently forgotten. For the term “inferior” surely meant it was not bad enough to kill her…never mind the short stint of CPR (Cardiopulmonary Resuscitation).


Abnormal delay in development, referring to mental, physical, or foetal growth. Centred on what society considers “normal”. No longer used as a pejorative slur for those with intellectual disabilities. Good riddance, as with other derogatory terms – some racial and homophobic epithets come to mind. Now instead fuelled by our obsession with longevity, as in age retardation. An industry worth at least $60 billion. Nationally a market worth many times the entire health budgets of low-income countries. Still, global health inequalities continue to widen. It is those countries that require strengthening, capacity-building, international support. Perhaps only thinly veneered spins on delayed development, slow growth, abnormal progress. The histories of slavery, colonialism, oppression conveniently ignored.


A broad descriptor of impaired function. Applied to organs or structures. May explain a range of signs and symptoms. For example, pituitary insufficiency to describe one or more hormone deficiencies, or aortic valve insufficiency to describe innumerable eponymous signs. Reveals little about aetiology. Indistinguishable between congenital, infectious, malignancy, ischaemic, or other causes. Thus, a perfect descriptor of itself – insufficient. Insufficient and inadequately human. 

“Sticks and stones may break my bones…” isn’t it about time we challenge the phrase that follows?


Featured Photo by Rachel Powell on Unsplash


*This article was edited on 19 June 2023 to remove the actual racial epithets and replaced with the text “- some racial and homophobic epithets come to mind.” Although it was clear from the article that these were inappropriate derogatory terms, after some feedback, an editorial decision was made to remove them. 

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