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RfC about the ordering of sections within Diseases or disorders or syndromes

The consensus in #Should the Diagnosis section be moved up two slots in the suggested list? is no.

02:00, 9 February 2020 (UTC)

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

To my thinking, Diagnosis is intimately linked with Signs/symptoms/Characteristics/Presentation and should follow it (hence proposal is to move it up two slots to follow that section. I have come to this way of thinking when writing leads that the information flows more naturally that way. This also allows for (possibly) less duplication as similar material is adjacent in the article. I can't see that there was much discussion about the original order. Cas Liber (talk · contribs) 13:25, 7 January 2020 (UTC)

For those unaware, this stems from editwarring at Schizophrenia, where Cas had re-ordered the narrative of the article, and Doc James re-instated his preferred, set order. This re-ordering of content in the body and lead of articles according to a personal preference has been occurring for years, although I am mostly aware of the damage that results to Featured articles, when the narrative is forced to fit a certain order not prescribed by any guideline, and certainly not by policy.
I am unclear why we are !voting in a community-wide RFC on an issue that surfaced only hours ago, and has not even been discussed by the principals. In fact, it's apparent that the first respondents are not even sure what they are !voting for. Casliber I suggest you withdraw the RFC tag, so that you can re-submit a properly positioned RFC after Doc James has explained his rationale for edit warring, and discussed the specifics of the flow of the narrative at Schizophrenia. SandyGeorgia (Talk) 16:36, 7 January 2020 (UTC)

Should the Diagnosis section be moved up two slots in the suggested list?

I beg to differ as whatever the order (even if not proscriptive), there needs to be a default. Having no suggested order at all is problematic and having a suboptimal one we keep having to justify changing (as we are doing) is also problematic and wasteful of time Cas Liber (talk · contribs) 20:32, 7 January 2020 (UTC)
I accept that the "suggested" order may be a default for some articles. We don't know what "some" means here, though. Also, I am hesitant to alter the suggested order now, without having thoroughly looked at a number of articles to make sure we won't disrupt the narrative when someone goes around automatically changing the structure of every article to conform to a new suggestion. We have a suggested order that has been applied as if it were a mandated order. We need to a) get back to understanding it is a suggestion, b) allow for variances by topic, and c) carefully analyze how your proposal will affect other articles. And, even doing all that, we need to stop having people going around altering the structure of articles to suit a personal preference.
While I support the order you installed at schizophrenia, I oppose fiddling with MEDMOS until we've looked more carefully. MEDMOS does NOT prevent you from rearranging the narrative at schizophrenia, and I trust you on that. And your changes were edit warred away, which is a separate problem. SandyGeorgia (Talk) 20:54, 7 January 2020 (UTC)
For example, Casliber, I'd ask you to consider how long it is going to take me to have a careful look at all the FAs I watchlist to see how this will impact the narrative. Discussing before an RFC is a good thing. But do what you need to do at schizophrenia. SandyGeorgia (Talk) 20:59, 7 January 2020 (UTC)
  • Oppose Bludgeoning is not a substitute for discussion. Johnuniq (talk) 22:32, 7 January 2020 (UTC)
    Johnuniq could you possibly "bludgeon" just a small bit ... that is, give us something to work with in terms of moving this discussion forward? SandyGeorgia (Talk) 17:04, 8 January 2020 (UTC)
  • Not sure We have nearly 10,000 articles on medical conditions. The question is who would do the switch over / write the bot to do the switch over? And is all this effort worth the justification? Not so sure. Doc James (talk · contribs · email) 12:56, 8 January 2020 (UTC)
    Doc James did you read the entire discussion here? The section we are posting in says suggested list (of headings). Neither this list of headings, nor a forced order of those suggestion sections in articles, is required. Consensus is determined at each topic depending on how the narrative flows best for that topic. No one would "write a bot to switch over", and no editor should be making bot-like edits to enforce a suggested guideline as if it were Wikipedia policy. We should be seeing red flags going off all over the place when bot-like edits are disrupting the order of carefully crafted narrative that flows naturally by section according to the topic. It is hard to understand why some editors would even do this without first obtaining consensus, and even harder to understand why we would suggest that a bot could do that. A bot cannot read the narrative to see if reordering sections affects the flow of the narative. Wikipedia articles are not NIH factsheets, and shouldn't read like them. Further, bots are only approved for non-controversial edits, and for a bot or a real person to be making these bot-like edits is controversial. SandyGeorgia (Talk) 17:08, 8 January 2020 (UTC)
    Nope nope nope. Whether all the articles need to match is a totally different RFC for a totally different day. Or month.
    Doc James, please don't worry about implementation details at this stage. If you think that the proposed order is even slightly better for readers than the current order, then you should support it. If you think that a different order would be even better, then you should propose your improvement. The exact process for implementing it can be sorted out after we've decided whether any change needs to be made. There's no point in lining up volunteers to make the change if we conclude that it's a bad idea, right? WhatamIdoing (talk) 19:24, 8 January 2020 (UTC)
    Oppose as I agree with Ian below. Doc James (talk · contribs · email) 04:18, 9 January 2020 (UTC)
  • Oppose Imo, the general public seeking information asks themselves; what am I feeling, what am I seeing, do i have any of the risk factors, does this make sense for me; then progresses to how a diagnosis is made by their HCP. E.g. oral cancer signs, symptoms, and causes are all information someone will need to assess the disorder. Also, I think diagnosis needs to immediately precede treatment because of flow. This is especially true where treatment is dependent on diagnostic classification and staging. I don't know if this order works for every article (and I don't think it's unreasonable for editors of a specific page to come to consensus on something different) but as a guideline I think it should stand as-is. Ian Furst (talk) 20:48, 8 January 2020 (UTC)
  • Oppose Diagnosis can be done in two ways I can think of. Clinically by looking at signs and symptoms in a patient in front of you, or in a lab by looking for either the infectious agent, or antibody response, or the genetic fault, or some other marker, or screening or chance discovery in someone who may be symptomless (not just newborns but also cancer). Diagnosis can be a relatively unimportant feature of a disease or a critical one. So it may be necessary to discuss the cause (infections agent, genetic fault) and mechanisms (which lead to screening marker, say) before one can explain how a diagnosis is achieved (if one bothers at all -- think common cold, or tummy bug). The fact that the suggested section orders (and their inclusion/absence/naming) do not work for all disease/disorders is very much an integral part of the advice at MEDMOS and always has been. -- Colin°Talk 10:39, 9 January 2020 (UTC)
  • Oppose We should retain the flexibility of the current guidelines. In my field, a diagnosis of gastroenteritis is made based on signs and symptoms. There are several causes of gastroenteritis, bacterial, viral and parasitic for example. The initial diagnosis can be confirmed in the laboratory by identifying the causal agent. (If the illness is severe enough to warrant further investigation). So, Colin is correct in saying that (in this example) we need to tell the reader what the causes are before we can explain the methods we use in the lab to confirm our suspicions. Graham Beards (talk) 11:09, 9 January 2020 (UTC)
  • Oppose. Deviation should be acceptable depending on the condition being discussed, but Diagnosis very often requires concepts from "Causes" and "Mechanism"/"Pathophysiology" to make any sense; it is not always possible for these concepts to be developed in the introduction. For instance, the diagnosis of hypothyroidism depends on blood tests for TSH and thyroxine, and the mechanism for the elevated TSH in primary hypothyroidism and its uselessness in secondary or central hypothyroidism won't make sense without the "Mechanism" section. JFW | T@lk 20:51, 9 January 2020 (UTC)

Discussion about the best order

Discuss other alternatives or elaborate on this option here - more specifically if anyone can come up with an exampled of a medical syndrome where Diagnosis is not intimately linked with Signs/symptoms/Characteristics/Presentation. I'm all ears. Cas Liber (talk · contribs) 13:33, 7 January 2020 (UTC)

well this isn't a syndrome, but a more general example of medical sections for a condition per NIH US Department of Health and Human Services NIH/GARD Neurofibromatosis-1
...….... 1.lede(summary)
2.Symptoms
3.Cause
4.Inheritance
5.Diagnosis
6.Treatment
7.Prognosis
--Ozzie10aaaa (talk) 14:20, 7 January 2020 (UTC)
@Casliber: I'm no expert on general medicine, but in the field of hyperbaric medicine, nitrogen narcosis is diagnosed by response to treatment (i.e. ascending), and a diagnosis of decompression sickness is only confirmed when the symptoms respond to treatment (i.e. recompression), so it's probably a bit more complicated than a standard "symptoms – diagnosis" link. Nevertheless, you make a good point and I wouldn't object to altering the order in our guidance to bring diagnosis just after symptoms if it seems that it would be beneficial in the majority of cases. Anyway, I believe we should treat this as "soft guidance", the sort of advice that is helpful in many cases, but is accepted as non-prescriptive whenever a good reason presents to deviate from it. --RexxS (talk) 18:26, 7 January 2020 (UTC)
Cas Liber, you can't use signs, symptoms, characteristics, and presentation to diagnose famously asymptomatic diseases, like garden-variety Hypertension. It usually works in your specialty; it doesn't work for everything.
(I've no objection to re-ordering the suggested list.) WhatamIdoing (talk) 19:43, 7 January 2020 (UTC)
Hmmm, not so sure it doesn't work for hypertension - the lack of symptoms and signs can be mentioned closely together, streamline and then other investigations. Cas Liber (talk · contribs) 20:36, 7 January 2020 (UTC)
I might start the Hypertension article with a section on ==Screening== (which it's missing). But that's only one article. Think about all the things that get diagnosed through primarily screening of aymptomatic. All of the Newborn screening tests are predicated on the notion that you'll hopefully catch these diseases before (often irreversible) signs and symptoms appear. It's not necessarily wrong to start Phenylketonuria with a section on symptoms, but that diagnosis is not intimately linked with the symptoms, and it would be just as good to start that article (which currently has no ==Diagnosis== section) with a section on newborn ==Screening==, and I might put ==Symptoms== after ==Management==, because you will hopefully see no symptoms if you can get the management worked out. Symptoms just aren't important for diagnosing most PKU babies, so why would we lead with them? "Here's all the scary things that hypothetically could have happened to your baby, except they won't, because the diagnosis came first?" That's not the narrative order I'd expect. WhatamIdoing (talk) 21:03, 7 January 2020 (UTC)
I've looked at Tourette syndrome, and I think the introduction of possible genetic relationships/subsets between TS, OCD and ADHD is helpful to have before discussing the importance during diagnosis of looking for comorbid conditions. I don't have time today to look beyond that. So, in the case of TS, the order that we now have works, except that I moved Classification after Characteristics. SandyGeorgia (Talk) 21:09, 7 January 2020 (UTC)
Ozzie's suggestion that we look at an NIH publication points out quite well one of the underlying tensions in all differences at WPMED. Some editors want to enforce guidelines as if they were policy, which yields leads of Featured articles that read like an NIH factsheet, aimed at 12-year olds. Others believe that a reader looking for that can go to NIH, and that Wikipedia should not be duplicating NIH facthsheets. Further, Wikipedia Featured articles are not intended to nor should they read like an NIH factsheet. This underlying tension has resulted in no Featured articles being produced in the health/medicine realm for five years, where there was once substantial participation in and growth of medical FAs. In this dispute, we see that bubbling over, with Cas (a prolific FA writer) attempting to install what he views as a logical flow to a featured article on a topic in which he is an expert, while another editor is allowed to editwar away those changes, before even discussing.
When this trend of enforcing guideline as if it were policy started about five years ago, some Featured article writers gave up, because it is not possible to comply with policy and WP:WIAFA, while also attempting to satisfy a local guideline that has been enforced as policy. There is no reason for a Featured article lead to read like an NIH facthsheet (which by the way, for Tourette syndrome was wrong for years if not decades).
Deciding what the guideline should say is one thing. The alienation of topic experts is yet another. Deciding if some editors are enforcing guidelines as policy is another. Learning how to discuss, listen, and build consensus should replace factionalized !voting that has occurred throughout WPMED for many years now. SandyGeorgia (Talk) 16:40, 8 January 2020 (UTC)

Two problems

  1. Problem #1 is Cas's RFC question. Problem #1 says that the suggested order currently runs (in part) "Symptoms, Cause, Mechanism, Diagnosis" and he thinks that it should run "Symptoms, Diagnosis, Cause, Mechanism" (or some other system that put the symptoms and diagnosis together).
  2. Problem #2 is SandyGeorgia's concern. Problem #2 says that the long-standing text in MEDMOS is being ignored. That text says, "The following lists of suggested sections are intended to help structure a new article or when an existing article requires a substantial rewrite. Changing an established article simply to fit these guidelines might not be welcomed by other editors. The given order of sections is also encouraged but may be varied, particularly if that helps your article progressively develop concepts and avoid repetition. Do not discourage potential readers by placing a highly technical section near the start of your article." (emphasis added).

Notice that it's possible to "support" changing the suggested order and "oppose" enforcing the suggested order on all articles, and to "oppose" changing the suggested order and "support" enforcing the old order everywhere, and all the other possible combinations. If you are going to "vote" (which you probably shouldn't be doing...), then please be clear what you're voting on. The RFC question is about what order the suggestions should be in. The RFC question is not about whether that suggested order should be enforced strictly. WhatamIdoing (talk) 19:48, 7 January 2020 (UTC)

The original format (with separate numbered sections to make vote-counting easier) is something that's discouraged by Wikipedia:Requests for comment/Example formatting. I've re-arranged it to the usual chronological order, and since folks are having such trouble figuring out what the actual question is, I've put that question right in the section heading. In particular, User:Blueraspberry may have voted "Support" on something he either opposes or has no opinion on, because his (nicely explained) comment has next to nothing to do with the question at hand. On the other hand, Ozzie10aaaa and QuackGuru dumped unexplained votes on the page, so nobody has any idea whether they were voting against Cas's proposal to improve the order, or if they are instead disagreeing with SandyGeorgia's view that they shouldn't force every single article into exactly the same order and don't actually care whether the recommended order has the diagnosis before or after the mechanism section.
I encourage everyone (including Cas Liber and Little pob) to read that question, decide if you have an opinion on that question, and make sure that your "vote" is accurately represented. And maybe you should even take a moment to explain why you think that a suggested order of "Symptoms, Cause, Mechanism, Diagnosis" is better or worse than an equally suggested order of "Symptoms, Diagnosis, Cause, Mechanism". That's what we really need from you. WhatamIdoing (talk) 20:01, 7 January 2020 (UTC)
The third problem is launching an RFC before we have even taken the time to analyze the structures of different articles. The RFC should be withdrawn until we've done that. SandyGeorgia (Talk) 20:02, 7 January 2020 (UTC)
Cas looked over some articles before starting this RFC. It might not be as detailed an analysis as you would have preferred, but it's probably more than most people do when making similar proposals. WhatamIdoing (talk) 20:14, 7 January 2020 (UTC)
Casliber if I could see such an analysis, I might change my stance on suggested order. But it is much more important that we reinforce that a guideline is a suggestion; that is, neither of these suggested orders work for Tourette syndrome. SandyGeorgia (Talk) 20:16, 7 January 2020 (UTC)

Malformed RFC, polling is not a substitute for discussion

WP:MEDSECTION says:

The following lists of suggested sections are intended to help structure a new article or when an existing article requires a substantial rewrite. Changing an established article simply to fit these guidelines might not be welcomed by other editors. The given order of sections is also encouraged but may be varied, particularly if that helps your article progressively develop concepts and avoid repetition. Do not discourage potential readers by placing a highly technical section near the start of your article.

Casliber you have started an RFC predicated on the notion that a set of order of section is mandated by MEDMOS, when no such beast exists. Further, there has been no discussion, even with the usual "Me, too" !voters lining up (without discussion), of whether one order even works at all. Please stop voting and start discussing, with specifics for articles. This is not a popularity contest; polling is not a substitute for discussion. MEDSECTION is quite clear that we have recommended headings; extension of guidelines to apply them as if they were policy, without discussion of specifics as they relate to the narrative of specific articles, is not going to be helpful. SandyGeorgia (Talk) 15:18, 7 January 2020 (UTC)

Bluerasberry claims: ... we should not have to debate on each of 10,000+ medical articles. We have a norm and an orthodoxy, and anyone who wants an extraordinary exception should explain what is different about any outlier cases. We do not have an "established norm and orthodoxy", we have recommended headings that have been enforced by fiat. What would be disruptive would be for every article to explain why its particular narrative differs from a set order. At Tourette syndrome, constraining "Classification" to come before "Characteristics", for example, makes it very difficult to talk about tics before they are even defined. There is not a set order that works for every topic. There is a suggested order that may work for many topics. Our "readers" do not go article to article to see what we put where: a typical reader most likely goes to a medical topic of interest to them, and expects to find a narrative in that article that works for that condition to make their reading work in a logical order. What works for one article may not work for another; that is why guidelines are guidelines. SandyGeorgia (Talk) 15:27, 7 January 2020 (UTC)
Came back to change !vote after realising that §Diseases or disorders or syndromes actually deals with separate a type of article to §Drugs, treatments, and devices or §Signs or symptoms etc – rather than separate sections within the same article (self-facepalm). And also noting that the suggested order for §Diseases or disorders or syndromes is largely reflected by the likes of Patient UK and Ozzie's given example. Have struck instead. Little pob (talk) 16:16, 7 January 2020 (UTC)
Little pob, that's how/why discussion works ;) :) SandyGeorgia (Talk) 16:19, 7 January 2020 (UTC)
Okay, now I am awake with coffee. Right then, the question is Is this list proscriptive? As Doc James thinks it is by this comment. As does Ozzie10aaaa. Cas Liber (talk · contribs) 20:00, 7 January 2020 (UTC)
Nope. That's a separate question. It is perhaps a more fundamental question, but please finish up this RFC and get the answer you wanted. Right now, it's completely uncertain whether the people dropping votes on this page had any idea what they were voting on. I've clarified that (I hope), but let's not even attempt to change the actual RFC question at this point. WhatamIdoing (talk) 20:04, 7 January 2020 (UTC)

The list has never been prescriptive and above I give a good reason why sometimes you want Cause and Mechanism first in order to be able to explain the Diagnosis, and sometimes you don't and sometimes Diagnosis is rarely done in any formal sense. When I and Steven and Sandy and others worked on this list, before many here had even joined the project, I compiled a list of section orders in Featured Articles: Wikipedia talk:Manual of Style/Medicine-related articles/Quick lists. There was no consistency. And we realised there was good reason to present topics within an article in a subject-appropriate way rather than requiring consistency. So the guideline was written very much saying these were suggestions to consider and "the spectrum of medical conditions is huge, including infectious and genetic diseases, chronic and acute illness, the life-threatening and the inconvenient". Indeed the guideline has always warned editors to first seek consensus for change prior to doing so on an existing article. See WP:NOTBUREAUCRACY and WP:NOTDEMOCRACY. Polling to change a guideline to stop an edit war reminds me of a tale of a little old lady who swallowed a fly. There are other forums to deal with edit wars.

Wrt formality of structure. It may not be obvious but many websites today are not written as articles with a title, section headings and footer. They are combined by software from database records, and formatted and laid out by website designers, not authors. Indeed a resource like the BNF which have book and website formats, are generated from the same source data. If Drugs.com wants to move prices out of the main monograph page into a sub-page (which I suspect they did in the past) then that is done with a few clicks and settings in some template and the website reformats itself instantly without a single author getting out their keyboard. The layout and structure of a book is very much more apparent than a hyperlinked webpage. Indeed when BNF changed the format of their book some pharmacists were very upset because they had memorised the structure. Nobody learns Wikipedia off by heart in order to pass their registration exams. It is used ad hoc and there is no harm in our articles being ad hoc. -- Colin°Talk 11:12, 9 January 2020 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Careful language

Could someone who is a better wordsmith than I am (well, that narrows it down) please add some wording under "Careful language" that encompasses this territory? An item related to the "social support aspect" of Tourette syndrome mentioned above is that it is harmful to the self-image of children with neurological differences to describe their symptoms in negatively loaded language. Specifically, we avoid saying things like tics get "worse" as that implies to the child that the severity of their tics is a bad thing, which does not work to reassure them. It is also useful to re-orient over-wrought parents from thinking of a symptom as "bad", and helps them learn to better support the child. This is an example, but the concept needs to be generalized and added to Careful language. The word "worse" is also unhelpfully vague, because tics are measured in so many different ways (number, anatomical location, forcefulness, frequency)-- so what does "worse" mean? One very forceful self-injurious tic like hitting yourself in the face can be very different from fifteen minor irritating little tics like blinking, coughing, grimacing. Careful languages means saying things like "average age of highest tic severity", "increase in frequency", etc. Paramount in the management of TS is that the vast majority of children outgrow their tics; supporting the "self under seige" (words of James F. Leckman) during the period of highest ticcing so that the child can emerge a healthy adolescent is emphasized. SandyGeorgia (Talk) 19:55, 17 February 2020 (UTC)

SandyGeorgia, I'm happy to help sort out some advice, either for this page or for a {{FAQ}} at the top of the relevant talk page.
Do you have an example of how a tic could become more "severe" while getting "better" (or at least "not worse")? I'm pretty sure that if I had a kid whose tics were self-injurious, then it'd be hard to convince me that hitting harder or more frequently didn't constitute "getting worse". WhatamIdoing (talk) 03:52, 18 February 2020 (UTC)
WhatamIdoing, sure; tics come in "bouts of bouts", and wax and wane in frequency, location, number and forcefulness. Suppose a child has one very strong tic of hitting themselves in the stomach while screaming for ten minutes that engages every day after coming home from school. (See HBO documentary-- it's a valid example. Not uncommon for children to let out tics when they come home from school. ) Let's call the child a "he" per four-to-one male-female ratio. He changes to having ten oralfacial tics a minute, a high-pitched mouse squeak several times an hour, along with a hopping-skipping tic every few minutes whenever walking, but loses the self-injurious tic. None of those hurt, but he got more frequency, less forcefulness, multiple anatomical locations, and higher number of tics. Did he get "worse" or "better"? The one self-injurious tic, that none of his classmates saw so they couldn't tease him about it, waned and in its place came tics that are likely to give him more discomfort because they will be disruptive in the classroom, his classmates may tease him, the more frequent but less forceful tics will make it hard for him to concentrate at school, and hard for him to engage in sports. Well-meaning teacher says, "Johnnie, I see your tics are worse today; would you like to take a break and go for a five-minute walk outside"? He gets a negative message about ticcing. Or when he comes home, and doesn't hit himself in the stomach and scream for ten minutes, mom comments that she notices his tics are "better". He might not feel like they're better and she is projecting that, for her, hitting herself in the stomach would be more painful than the social stigmatization and difficulty in concentrating at school or on the sports field that her son is enduring. Now, reverse the same scenario, and have him go back to hitting himself in the stomach, and ask again in whose mind that is "worse" or "better". No matter which way the tics are changing, non-judmental language is best to help reassure the child. When I get the interlibrary loan book, this is the sort of thing it will cover about Management. I'm not sure this is the kind of thing we want to add to the Management section of an article, but we should extend the TS example to some other conditions where language matters, and add a sentence to our Careful language section at MEDMOS about how we describe symptoms in terms of developmental disorders that impact children. In TS, the language is typically "increase" or "decrease" in the different measures of waxing and waning bouts of bouts, rather than "worse" or "better", which are less useful diagnostically or in terms of impact on daily function. SandyGeorgia (Talk) 04:57, 18 February 2020 (UTC)
PS, @WhatamIdoing:, apparently I did not make it clear that I am not asking for help at the article, rather that we add to the Careful language section of MEDMOS re how we describe symptoms. :) SandyGeorgia (Talk) 04:59, 18 February 2020 (UTC)
So, from TS, the Careful language example for MEDMOS is:
  • Do this:

    In a group of ten children aged eleven, almost four will see complete remission by adulthood. Another four out of those ten will have minimal or mild tics in adulthood, but not complete remission. The remaining two will have moderate tics as adults, but only rarely will they have increased severity of tics.

  • Don't do this:

    In a group of ten children aged eleven, almost four will be completely better by adulthood. Another four out of those ten will be somewhat better, but not in complete remission. The remaining two will stay the same or get worse.

We need a brief example, along with other scenarios from other conditions. SandyGeorgia (Talk) 05:13, 18 February 2020 (UTC)
  • I can think of some parallel with epilepsy, particularly in children, where multiple seizure types can be present. The type of seizure, how often it occurs, whether it occurs in clusters, when (in the day or situation) it occurs, and how long it lasts could all contribute to one's perception of 'worse' or 'better'. So I can see how this language is vague, and also see how it loads one's perceptions of the event in wholly negative terms. A seizure is perhaps more clearly a negative event than a tic, with consequences for brain development and learning, beyond the social issues that could be managed. Other medical conditions might include bed wetting, stuttering or forgetfulness? There must be others. Is there any official advice from charities on this? --Colin°Talk 09:11, 18 February 2020 (UTC)
I'm sure the book I'm after will have content and recommendations in this area (James F. Leckman is one of the editors, and it has multiple chapter contributors, all of whom are experts and highly reliable sources). But I can't get it on interlibrary loan ... I have to drive two hours to a library where I can download it. SandyGeorgia (Talk) 14:20, 18 February 2020 (UTC)
Also, with TS, this is not just an "advocacy" or "cultural" issue that the charities might take up; it's why a journal paper on the Yale Global Tic Severity Scale (which is designed to measure and quantify all of this) is the Number One Ever cited paper in TS research. (The reliable source for that is over at the talk page of Tourette syndrome.) SandyGeorgia (Talk) 14:23, 18 February 2020 (UTC)
In bedwetting, I found "how to" advice like this and this, which give us nothing useful in terms of what language we use to describe symptoms in Wikipedia articles. At nocturnal enuresis, I find no inappropriate use of the words 'better' or 'worse', but then there is no Prognosis section at all, which is where we might find such language. But I think bedwetting presents another clear example: rather than saying a child gets 'better', the article says things like, 'These alarms are considered effective, with study participants being 13 times more likely to become dry at night.' SandyGeorgia (Talk) 14:43, 18 February 2020 (UTC)
I'm thinking that "severity" sounds stigmatizing, too. So there is the potential for an increase/decrease situation (is that just about frequency?), and there are changing types. Is "disruptiveness" a reasonable term? I'm thinking of a sentence along the lines of "Sometimes, tics become more disruptive to the person's life". (We may have to wait until you can get that book.) WhatamIdoing (talk) 02:38, 19 February 2020 (UTC)
I hope to find time for the long drive tomorrow; today's editing darn near killed me :) Meanwhile, we could continue to gather samples for an addition to our MEDMOS Careful language section. SandyGeorgia (Talk) 03:06, 19 February 2020 (UTC)
Disappointment, not even worth the long drive. The 2013 book was edited by Leckman, but it appears that he assigned the Chapter on Social Support for Patients and Families to the weakest writer. Utterly trite, and from a German perspective only, with many statements that are outright false for the US perspective. That particular chapter stands out as dreadful. I will be able to use some bits and pieces, but it won't be the example that I had hoped for. SandyGeorgia (Talk) 01:48, 20 February 2020 (UTC)
At the moment, I'm thinking about general language, like Talk about "being in remission", not "getting better" or "increased frequency or intensity" rather than "getting worse". WhatamIdoing (talk) 07:30, 28 February 2020 (UTC)
That would work (although I was really hoping others would come up with broader examples). SandyGeorgia (Talk) 14:34, 28 February 2020 (UTC)
I think these are pretty broad. I'd give the same advice for talking about cancer or the common cold. It's partly about the precision: if your infection is "getting worse", does that mean you cough harder or more often, or does it mean that you've started running a fever? WhatamIdoing (talk) 16:45, 28 February 2020 (UTC)
"Getting worse" means different things to different readers. Consider a norovirus: those living alone might need only be concerned for their own well-being, discomfort, or lost income, while others need to be primarily concerned about onward transmission to family, clients, etc. Accordingly the former sees "worse" as "more symptomatic", while the latter may see it as "more infectious". LeadSongDog come howl! 17:07, 28 February 2020 (UTC)

Proposed change to title guideline

Right now, the title guideline says this: Where there is a dispute over a name, editors should cite recognised authorities and organisations rather than conduct original research.[4] and the footnote says this: Examples of original research include counting Google or PubMed results, comparing the size or relevance of the varieties of English, and quoting from personal or professional experience.

But this directly contradicts the WP:Original research policy, which says This policy of no original research does not apply to talk pages and other pages which evaluate article content and sources, such as deletion discussions or policy noticeboards. It's also odd in light of WP:TITLE's advice, which says A search engine may help to collect data on which name is most commonly used. It's also, to me, just plain over-restrictive. Editors ought to be given a reasonable amount of latitude to weigh sources.

I therefore recommend changing the guideline to:

Where there is a dispute over a name, it is generally best to cite recognised authorities and organisations. Citing search results should only be done with special care.

And I recommend changing the footnote to contain some practical advice about searching PubMed. This advice comes from my own digging into PubMed and its tutorials:

If you do cite search results, the best site to use is PubMed, which is a database of biomedical literature. However, note that PubMed adds keywords called "Medical Subject Headings" (MeSH) to most of the articles in its database. If you are trying to determine the frequency of various terms in the literature, PubMed's MeSH keywords will dramatically skew your results. You can bypass the MeSH keywords by: 1. going to "Advanced" search 2. selecting "Title/Abstract" and 3. making sure to put your search term in quotes.

WanderingWanda (talk) 02:46, 16 February 2020 (UTC)

During the discussion, Crossroads said that PubMed gives 696 results for "sex reassignment surgery", but only 60 for "gender confirmation surgery", an order of magnitude (10 times) difference. But I believe this is a good faith error. If you search for "sex reassignment surgery", you'll see that you get papers which use alternative terminology, like this one, where the abstract says gender-confirmation surgery; the term sex reassignment surgery only appears in the MeSH terms section. And the MeSH terms, to reiterate, aren't really part of the papers themselves, but part of the PubMed system.
If you restrict the search to "title/abstract", you'll avoid the MeSH keywords and get better results. (Why just search the titles/abstracts, and not the article bodies? Well, unlike Google Scholar, the main PubMed site actually isn't capable of searching article bodies.)
On the new main PubMed site, if you go to "advanced" and restrict your search to "title/abstract", you'll find that "sex reassignment surgery" gets 373 results, vs. 55 results for "gender confirmation surgery". A big difference, sure, but not quite a 10x difference that was presented.
Things get really interesting when you restrict the results to the past year. If you search without doing an advanced search, in the past year, "sex reassignment surgery" gets 78 results vs. 23 for "gender confirmation surgery". But again, if you dig into the results for "sex reassignment surgery", you'll see articles like this one, where the term "sex reassignment surgery" doesn't seem to appear. If you narrow the search to title/abstract, "sex reassignment surgery" gets just 24 results in the past year vs. 19 for "gender confirmation surgery": a very narrow margin.
Well, I think that about covers everything. I don't claim to be an expert in PubMed or databases, so would welcome any feedback, but I've spent a fair amount of time looking into this, and feel reasonably confident about my conclusions.
And on one last note, I am fine with Crossroads' proposed wording tweak. WanderingWanda (talk) 07:17, 25 February 2020 (UTC)
Ah, but the MeSH keyword itself being "sex reassignment surgery" could be counted as strong evidence in favor of that name rather than an alternative.
Also, it might be okay for it still to speak against original research, especially with regard to referring to personal experience, and perhaps synthesis as well could be added. To me, the main issue is that per WP:TITLE we should explicitly allow searching PubMed at least. Crossroads -talk- 05:19, 28 February 2020 (UTC)
  • Support As amended by Crossroads. ¶ I agree with WanderingWanda re: PubMed. Raw word/phrase counts don't tell us much without chronological context; knowing the specific search parameters used, along with other informative search strategies (parameters); and knowing the search engine's capabilities).   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 15:42, 25 February 2020 (UTC)
I suggest modifying the footnote to: If you cite PubMed search results, note that PubMed adds keywords called "Medical Subject Headings" (MeSH) to most of the articles in its database. If you are trying to determine the frequency of various terms in the literature, PubMed's MeSH keywords may skew your results. You can bypass the MeSH keywords by: 1. going to "Advanced" search 2. selecting "Title/Abstract" and 3. making sure to put your search term in quotes. Rationale: For what we might call "pure" or "true" biomedical articles, PubMed is the best. However, for many articles of interest to WP:MED, important articles are published in a variety of reliable academic journals, many of which are not indexed by PubMed (MEDLINE®). I am most familiar with this fact when it comes to psych-related articles, where PubMed indexes almost all psychiatry journals, but not all clinical psychology, clinical social work, public policy, law review, and other important journals.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 16:07, 25 February 2020 (UTC)
Conforming with MeSH (an independent and respected source on terminology) might actually be a goal. Saying to carefully exclude MeSH is sort of like saying that you need to carefully exclude keywords from the Dewey Decimal Classification or subjects in the Library of Congress Classification for fear of them being over-represented. However, it's good to know what you're seeing with the search results. "There are 100 recent articles using this term, and another 1,000 have [publisher-supplied, I believe] this MeSH keyword" is more accurate than "1,100 articles use this term". WhatamIdoing (talk) 07:26, 28 February 2020 (UTC)
User:Markworthen's suggestion works for Tourette syndrome, which is a classic case of where this kind of guidance is needed. The DSM calls it "Tourette's disorder" but NOBODY (who matters, among researchers and orgs) uses that term, but uses Tourette syndrome instead, in recognition that the vast majority (an overused term that is overused in the reliable sources :) are not distressed or impaired. Not the NIH, not the CDC, not advocacy orgs, and not the published research. If you search Tourette syndrome for "Tourette's disorder", you'll find that no source title uses that term, and the only time it occurs in the article is in reference to the DSM. Mark Worthen's suggestion for how to use PubMed bears this out by a factor of 10 to 1. I would, though, spell out how to use the advanced search function at PubMed explicitly.
  1. Go to PubMed advanced search
  2. On the first dropdown menu that says "All field", choose Title/Abstract instead.
  3. Put your search term in quotes. For example, "Tourette syndrome" returns 3,000 hits, while "Tourette's disorder", the DSM name, returns less than 300
In this case, best I can tell, MeSH seems to agree, but if MeSH did not agree, I'd be seriously opposing it. (Not to mention that whatever that stupid template at the bottom of Tourette syndrome is supposed to do, clicking on the MeSH takes me nowhere.) SandyGeorgia (Talk) 14:48, 28 February 2020 (UTC)
Here's the MeSH entry: https://www.ncbi.nlm.nih.gov/mesh/68005879 It uses "syndrome". WhatamIdoing (talk) 16:52, 28 February 2020 (UTC)
  • Oppose change to guideline (and IIRC I wrote that bit). WanderingWanda is not quoting the full text, which begins with "The article title is subject to the same sourcing standards as the article content" and here now it should be clear that Original Research Policy does apply because the title is not a talk page discussion. When trying to work out what something is called, we use reliable sources. We don't conduct our own research. WanderingWanda also misquotes WP:TITLE. The advice there "A search engine may help to collect this data" is not to enter the text into Google/PubMed and see the number of records returned, but "to observe the usage of major international organizations, major English-language media outlets, quality encyclopedias, geographic name servers, major scientific bodies, and notable scientific journals". In other words, it is really just suggesting you use Google to find high quality sources and determine the WP:WEIGHT within those. When editors are immersed in the article topic literature, they will recognise who the current or significant researchers are, or the key organisations, and give preference to those vs second-tier sources. There are some crap journals on PubMed, and people search for old and offensive terms on Google.
As an example from tuberous sclerosis: the rash on the person's face is called "facial angiofibromas" in all high-quality TSC literature. The original term was "adenoma sebaceum", coined by doctors in 1885. In 1981 it was noted that sebaceous glands were not involved so angiofibroma was more appropriate. A PubMed search shows the old term is still used, but not by the best researchers, and often the old term appears in brackets after the new term, thus boosting its count. So simply counting usages might simply record that a lot of people are noting the old term and may even be commenting that the old term is inappropriate.
So I think editors should examine what the highest quality literature on the article topic is using, while also taking note if some proposed new term has not in fact caught on or is regional in its adoption. I think the linked discussion is a good example of how counting search hits is a poor way to determine a name. -- Colin°Talk 15:32, 28 February 2020 (UTC)
And all of the original also works for Tourette syndrome, indicating to me that a change to original wording should be carefully considered before supporting based on one case. SandyGeorgia (Talk) 16:05, 28 February 2020 (UTC)

In medicine, the pendulum often swings. Wikipedia luckily adapts fast and has appropriate names for Clostridioides difficile infection and Dementia with Lewy bodies. Neither MeSH nor a PubMed vote would favor these newer, more appropriate terms over their historical, still often used and better-known alternatives. In my view the current wording is appropriate and not very different from the proposed alternative, so I don't see a reason to change it. --Steven Fruitsmaak (Reply) 23:02, 4 March 2020 (UTC)

Good example on DLB. SandyGeorgia (Talk) 23:07, 4 March 2020 (UTC)

RfC: Adding sections on Psychological and emotional impact of health problems

Dear colleagues,

it has come to my attention from a recent study that there is still a long way to go to fix gender bias in Wikipedia's health information.

One of the important aspects is that WP:MEDMOS (which I was one of the creators of) implicitly discourages, or does not mention, the potential psychological or emotional impact of certain medical conditions. We likely treat this too much from a narrow, medical perspective whereas readers on certain topics (as was mentioned in this recent study, e.g. abortion, menopause, vaginal dryness, but also cancer etc.) are likely interested in emotional and psychological impact too.

Adding a recommendation for such a section to WP:MEDMOS would fix this problem throughout the broad area of health articles (not just those related to women's or men's health).

I propose to treat this of course like any other aspect according to standard policies such as reliable sources, but I'm sure that for many of these aspects there is a wealth of research on the personal, emotional and psychological impact of diseases.

I would value your input on this important discussion (call cross-posted at WP:Women's Health).

--Steven Fruitsmaak (Reply) 10:05, 9 February 2020 (UTC)

I really don't see how gender bias plays a role here, and framing it that way seems really unecessary. If you want to allow for/encourage sections tackling psychological impacts of various medical conditions and situations, that's just addressing a lack of information about the psychological impacts of medical conditions. It's got nothing to do with unconsciously or systematically favouring/disfavouring topics concerning mostly men or mostly women. Headbomb {t · c · p · b} 13:14, 9 February 2020 (UTC)
Thanks, Steven for raising the issue concerning the paucity of coverage of psychological and emotional impacts of medical conditions. Although I agree with Headbomb that I don't yet see evidence for a disproportionate effect on women, there is still a case to be argued for including that coverage in articles where MEDRS sourcing is available. I would welcome a comprehensive debate of the issue in order to arrive at a sensible question prior to opening an RfC. --RexxS (talk) 14:37, 9 February 2020 (UTC)
I, too, find it most unfortunate that this is positioned as a gender issue, since almost all of the medical areas in which I work have a male predominance. I have not found a problem incorporating emotional impact to the extent that is covered by MEDRS sources. For example, at dementia with Lewy bodies, I worked that kind of content in to Prognosis and Management: Caregiving and some in to Characteristics. I also had no problem working content in to Tourette syndrome, generally at Characteristics, Management and Prognosis. I am uncertain that a specific, separate suggested heading is warranted, but am open to being convinced. It would help to see an example of MEDRS information that has not been incorporated, and to discuss whether such content might fit into the existing suggested headings. SandyGeorgia (Talk) 15:27, 9 February 2020 (UTC)
User:Stevenfruitsmaak could you please share here the study you mention as singling out gender bias in medical content? I would be interested in reading it and understanding the methodology. SandyGeorgia (Talk) 18:28, 9 February 2020 (UTC)
I agree that we need to improve our content. "Patient experience" is one of the ways that I think of it. In the case of conditions primarily diagnosed in children and older adults, the primary caregivers are usually women. So, User:SandyGeorgia mostly writes about subjects whose patients are predominantly male, but their mothers are the ones taking most of them to the clinic, explaining their needs to their schools, etc. WhatamIdoing (talk) 20:18, 9 February 2020 (UTC)
Or in the case of dementias, the spouses. I did need to address that in Caregiving, which I added to Management. SandyGeorgia (Talk) 20:22, 9 February 2020 (UTC)
I like the idea of a ===Caregiving=== subsection of ==Management== (or just a paragraph without a heading, if there isn't much to be said). That coordinates well with our oft-overlooked suggestion of a ===Self-care=== section (or paragraph, if it's short).
I don't want to see this relegated to the ==Society and culture== section. We've been cramming too much stuff in there in general. I can imagine "scary" conditions getting a subsection in ==Diagnosis== to talk about how people react to a scary diagnosis. Our ==Prognosis== sections usually need some love anyway, and talking in those sections about how people respond to their life-threatening and terminal conditions would be appropriate. WhatamIdoing (talk) 21:32, 9 February 2020 (UTC)
Sample at Dementia with Lewy bodies#Caregiving, as a sub-section of Management. SandyGeorgia (Talk) 02:17, 10 February 2020 (UTC)
I agree that framing this as a problem with gender bias distracts from what seems to be the main point, i.e., including more about information about the patient experience, psychological aspects of a disease, self-care strategies, etc. (as long as reliable sources are available, of course).   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 22:23, 9 February 2020 (UTC)
  • Guidelines follow action, not vice versa I oppose any effort to change guidelines in the absence of editing activity. WikiProject Medicine is friendly to experiments and so far as I know, there is only encouragement for everyone to add this kind of content to articles. I am not aware of anyone making attempts to add this content and getting opposition as a response. Why not start with the edits, which I feel is the usual wiki way, and if anyone identifies the rules which are a barrier then we talk that over. Anyone who tries to add this content has my support to build out examples of how this should work and how guidelines should manage this. Blue Rasberry (talk) 00:46, 10 February 2020 (UTC)
    The problem with that reasoning, Lane, is that newish editors creating articles and developing stubs will very often look to the guidelines given in the relevant MoS about structure. I know I did when I first started working on medical articles. If we omit useful sections from our guidance, many editors may well settle for the structure they see now, thus reinforcing the structure that informs the guideline. Breaking that cycle could be helped by giving guidance (as opposed to guidelines), which might well be just a suggestion to consider a shortlist of additional topics that editors have found to be valuable additions to some articles. I think giving smarter advice will serve us better going forward than rationing it to that which is merely most common. --RexxS (talk) 03:22, 10 February 2020 (UTC)
    Some new editors (especially students) come here to get that advice. It's true that we're not generally following that advice in ways that minimize women's health issues. For example, most articles for diseases seen in adults should include a ==Pregnancy== section. We have about 10K articles about diseases. About 300 include that section. Influenza is not one of them. Obesity is not one of them. Asthma is not one of them. Type 1 diabetes is not one of them. Autoimmune disease is not one of them. Major depressive disorder is not one of them. Eating disorder is not one of them. Bacterial vaginosis is not one of them. Hepatitis B is not one of them. Candidiasis is not one of them. These are all relatively common problems in pregnant women, and yet some of them do not mention the word pregnancy at all. This is looking like a pattern, isn't it? WhatamIdoing (talk) 20:55, 10 February 2020 (UTC)
It seems there are issues within article topics that are not getting mentioned, though that isn't necessarily solved by proposing a section heading. I have noticed that many articles lack discussion on community or care issues, mainly dealing with diagnosis/treatment. I suspect this comes from articles being appended over the years from journal papers, which are not comprehensive in their scope and tend to be focused within the comfort zone of their authors, rather than from professional textbooks on the topic, which may tend to be more comprehensive on all aspects of a disease, and invite chapters from multiple authors. -- Colin°Talk 08:09, 11 February 2020 (UTC)
I've also found that nursing textbooks can be pretty useful for that problem, as they address questions like what should be done for someone who's surgery was successful, but who can't walk 10 steps to the toilet. I don't ever expect to see truly high-quality scientific evidence on how self-toileting ability should affect hospital discharge decisions. Nobody's going to run double-blind randomized controlled trials over that. (How would you? "No, honey, I can't tell you which study group you're in, but just lay there and pretend that you can't get up and walk to the toilet, okay? This is for science!") We have spent so much of the last few years chasing EBM that we've really narrowed our focus, as if nothing actually happens in between "choosing treatment" and "outcome". WhatamIdoing (talk) 22:13, 11 February 2020 (UTC)
  • I agree with Bluerasberry. Guideline should follow best-practice. Our MEDMOS suggested sections followed from examination of featured content at the time (and there wasn't much consistency to suggest the sections are anything more than arbitrary choices that should be freely deviated from if that helps any article). Perhaps there is a concern because one or two WP:MED editors wrongly interpret WP:MEDMOS suggested sections and go around enforcing "per MEMDOS" on articles in a robotic fashion, ignoring how existing editors have chosen to develop the article material. This is a wiki and we should be free to craft articles how we see best, and this may include "non-standard" sections. If we have some articles in mind for change, there is no harm in the community discussing how best to tackle the issue for those examples, and then we can see if there is any pattern or whether what is learned can be turned into advice. --Colin°Talk 08:16, 10 February 2020 (UTC)
    • I like this idea in theory, but the previous RFC on this page shows that we've had a problem with some editors resisting the idea that it's okay to vary the order of suggested section headings, even though the guideline explicitly says that the order should be changed to fit the subject. I can guess what those same editors' response would be to an "unauthorized" section heading, and it sounds a lot like "edit warring". WhatamIdoing (talk) 20:42, 10 February 2020 (UTC)

User:JenOttawa and I have looked at women's health versus men's health and we found based on a number of markers women's health coverage is better. Of course covering emotional / psychological impact when good sources are avaliable is perfectly reasonable. Would either go under signs and symptoms or prognosis. Doc James (talk · contribs · email) 01:26, 10 February 2020 (UTC)

This is based on a count of the total number of women's health articles (like cervical cancer and contraceptives), and not based on content, like whether Cardiovascular disease mentions pregnancy at all (it doesn't), or whether the differences between males and females in terms of their pathophysiology, treatment, and other areas are adequately described in Myocardial infarction, right? I don't have a great solution to the problem of presenting men's MI symptoms as the 'normal' ones and women's symptoms being relegated to a Separate but equal section, but surely we can all agree that pregnancy ought to be mentioned more than once on the page, and that other factors such as poverty or being of African or Asian descent should be mentioned at least once in those articles. We can do better than this. WhatamIdoing (talk) 21:05, 10 February 2020 (UTC)

@WhatamIdoing: Go easy! Only "when good sources are available" on the variables of gender, poverty, African-Asian-Latino descent, etc, etc, from the medical profession itself. Up till recently, they haven't. Good Luck! Shir-El too 07:33, 11 February 2020 (UTC)

High-quality sources about health disparities have been been available longer than Wikipedia has existed. WhatamIdoing (talk) 22:16, 11 February 2020 (UTC)
Discussion on moving above few paragraphs of text to here
I think the above responses to Steven should have been posted to Wikipedia talk:Manual of Style/Medicine-related articles#RfC: Adding sections on Psychological and emotional impact of health problems. Would you consider moving them please? -- Colin°Talk 08:00, 11 February 2020 (UTC)
@Colin: You're welcome to copy mine there if you think it fits. Besides, the lack of balanced research and reporting in various medical areas does not originate with WP: it has been inherent in the medical profession as a whole for lo these many hundreds - if not thousands - of years. Cheers! Shir-El too 11:12, 11 February 2020 (UTC)
Thanks Shir-El. WhatamIdoing would you consider copying this because I can't? I think the claim that "women's health coverage is better" and the responses, deserves exposure at the RFC page. -- Colin°Talk 21:52, 11 February 2020 (UTC)
I have moved this accidentally forked discussion here from WT:MED. WhatamIdoing (talk) 22:16, 11 February 2020 (UTC)

Feedback please

I am (hopefully) embarking on a venture to address this at Tourette syndrome (TS) and to provide us with an example that can be used along with the example at dementia with Lewy bodies (DLB). I have to get a book via interlibrary loan, and hope I can get it in time to add a "Social support" section under Management at TS before it runs mainpage on 3 March. So, DLB already has "Caregiving" and TS can have a section that will cover caregiving, educational and various aspects of social support and impact on social functioning. I have located a book that covers the territory well, and whose authors I am familiar with, but the book is six years old and I have to go via interlibrary loan; I am familiar with their work, the content of the book should be good, but this content is rarely found in journal publications. SandyGeorgia (Talk) 05:25, 18 February 2020 (UTC)

Am I on the right track, here? If so, I can add about that same amount again. SandyGeorgia (Talk) 01:37, 21 February 2020 (UTC)
I think you are on the right track. It needs a good copyedit. For example, I don't quite understand the "right not to be informed". Imagine that a father has TS and is wrongly blaming the mother for their child having TS, e.g., by drinking coffee while pregnant. In the article, it sounds like the best response would be nodding your head and saying that the causes are unknown and caffeine may have a slight effect, because he has the right not to be informed that you noticed him ticcing. However, you can only invoke the right not to know if you are giving informed consent (which sounds like "I have a 50% chance of having Huntington's disease, but I don't want to be tested now"), which is not what's happening in the scene that I'm imagining. WhatamIdoing (talk) 20:27, 24 February 2020 (UTC)
Expanded (the text applied to only those cases where neither parents nor child are aware, which is typical ... Outriggr will come along and clean up my icky prose). [1]SandyGeorgia (Talk) 20:32, 24 February 2020 (UTC)

Dear all, especially Headbomb and SandyGeorgia. I apologize for not being clear. You are totally right that this has nothing to do with gender issues per se. The study I am referring to investigated gender bias in Wikipedia. It was a qualitative survey among Wikipedians at Wikipedia:WikiProject Women's Health and not yet published so I cannot go into further details. I will provide a link once it is published. However, tangentially this point was raised and I thought it was a good point: we probably don't encourage enough discussion of psychological, emotional consequences, caregiver burden etc. in MEDMOS even though there is often good scientific evidence in these areas. Surely we need more action in these areas than guidelines, but I don't think this should prevent us from defining best practices, since these are very often neglected yet important aspects. As the person who started MEDMOS I totally agree that it should not be enforced rigorously, it's there to help. Psychological, social and emotional elements may be needed in many sections including signs and symptoms, prognosis and management. Maybe a separate section isn't useful but we really need to do a better job at laying down our medical glasses and and looking through general audience lenses to incorporate psychological and emotional aspects in every section. --Steven Fruitsmaak (Reply) 22:52, 4 March 2020 (UTC)

Hello again, Stevenfruitsmaak; it's always good to see you back. Having now included this kind of content in two articles-- dementia with Lewy bodies (DLB) and Tourette syndrome (TS)-- I have several observations. First, everything I have wanted to add has fit within the framework of our existing suggested headings. Second, probably the only reason I hadn't added this kind of content before was that I thought it might be frowned on, ala advocacy, support group type of info (but psychoeducation IS the main "treatment" for TS, and caregiving IS a huge part of DLB). Third, a very effective way to demonstrate our best practices is to show the Featured articles that include this kind of content.
So, in that sense, I don't believe we need to change anything at MEDMOS, and we have our examples. We might expand the definitions under each suggested section where we say things like "This might include ... " For example, I added a psychoeducation and pregnancy section to Management at TS, and a Caregiving section to Management at DLB. I took the time to think more about psychological impact under Characteristics, Quality of Life, etc. I don't think our general framework needs to change; maybe just a few more explanatory words, which Colin and WhatamIdoing should be able to come up with. SandyGeorgia (Talk) 23:01, 4 March 2020 (UTC)
IMO we should add some advice. In particular, I wouldn't want psychosocial content to get shoved under ==Society and culture== because someone thinks that's where "social" content goes. WhatamIdoing (talk) 00:17, 5 March 2020 (UTC)
Agree with that-- I made zero changes to Society and culture to accommodate this text. It generally belonged under Characteristics, Management (Psychoeducation/Caregiving) or Prognosis (Quality of life). SandyGeorgia (Talk) 00:25, 5 March 2020 (UTC)

No active discussion

There is no active discussion so this is not appropriate.[2] Doc James (talk · contribs · email) 01:21, 13 April 2020 (UTC)

MEDLEAD

With an inconclusive close to Wikipedia:Manual of Style/Medicine-related articles/RFC on lead guideline for medicine-related articles, a pandemic upon us, and an arbcase that will deal with issues that include MOSLEAD, I question whether this is the best timing for another edit war over an issue that pales in comparison to the rest, or the best time to begin discussion of LEAD.[3] SandyGeorgia (Talk) 01:23, 13 April 2020 (UTC)

As I already stated above Sandy there is no active discussion of this. If you wish to tag you need to start a discussion.
This issue ties in to all the others agree. Doc James (talk · contribs · email) 01:26, 13 April 2020 (UTC)
Absolute nonsense. The only reason that the discussion isn't more active is because of the ArbCom case. --Hipal/Ronz (talk) 02:04, 13 April 2020 (UTC)
Since the matter is before Arbcom, and the pre-existing dispute has never been resolved, there is clearly still discussion and dispute, and the tag should be reinstated until such time as effective dispute resolution can be established. James, are you aware that further discussion of the LEAD issue was put off because of many comments throughout the drug pricing RFC, similar to this one, advocating that we NOT start more RFCs at this time? The discussion has been started, and is here; I could bring it back out of archives, but that hardly seems productive. I can do so if you wish. SandyGeorgia (Talk) 13:58, 13 April 2020 (UTC)

Brief feedback from an uninvolved editor

2019 Wikipedia reader, blue native (only English), brown native (multilingual), green non native

Clearly there has been a lot of debate about how to best phrase the lead section. I did not try to understand all the issues as my brain started to hurt after reading a few paragraphs. ;^) I simply want to offer a little feedback about two things. (1) SandyGeorgia's edit today (diff) is an improvement because the prose exhibit's greater clarity and consistency after SandyGeorgia's edit. The only term I'm not sure about is "hard data" - I don't know what that means exactly. This is a minor point, but every improvement in comprehension helps so I want to at least mention it. (2) The language chart is not necessary because the point is made clearly in the text; the chart lacks a caption, i.e., there is no explanation about what the numbers represent; and the survey actually measures user languages across all Wikipedias, not just the English Wikipedia. Therefore, the chart is not relevant to the article.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 02:49, 14 April 2020 (UTC)

Agree the language chart does not belong. It isn't even medicine-related. It is not the job of a MOS page to persuade editors of anything, but to state the consensus on article content. -- Colin°Talk 08:53, 14 April 2020 (UTC)
Thank you, Mark. Yes to removing the chart, for the reasons you give and more. We should not be using a chart here that is not even about the English Wikipedia.
Unsure how else to rephrase “hard data”. Generally, text in the lead is a summary of text in the body, and might not precisely reflect any individual citation, but numbers are precise and should. Open to rephrasing, or even dropping that part. The edit I made, by the way, is not text I prefer (I do not believe we need this section at all), rather a “meeting halfway” from the RFC. If conflict erupts again, my preference is that the section be entirely deleted, as WP:LEAD covers everything already. SandyGeorgia (Talk) 09:27, 14 April 2020 (UTC)
Sandy, I see you added a citation-needed tag on "Around a third of readers of English Wikipedia, have English as a second language". This doesn't need a citation, it needs removing. There is nothing medicine-related about our readership or their needs. This sort of commentary belongs on a talk page of a wiki-wide MOS, not on the actual guideline page and not on a medicine one. If WP:MEDLEAD had consensus to deviate from standard MOS WP:LEAD, which it doesn't, we wouldn't see this sort of in-text advocacy polluting guidelines pages. -- Colin°Talk 10:26, 14 April 2020 (UTC)
I agree, but thought that whether it is even accurate might be determined as well. (I had not realized until Mark pointed it out that the graph didn't even apply to the English Wikipedia, and original research comes up.) But yes, I agree it should be removed. SandyGeorgia (Talk) 14:53, 14 April 2020 (UTC)
I think the numbers are more or less correct (if anything, they may understate the number of readers who normally use a non-English language), but if you want a real answer, then we will need to decide what 'second language' means for a person who lives in a country where it is perfectly commonplace to speak more than one language. My plumber grew up speaking seven languages (and then he tried to tell me that he's not very smart). Which one is the 'second' language? WhatamIdoing (talk) 22:06, 15 April 2020 (UTC)
So the source is here[4] I have cut out the bit that is specific to English Wikipedia.
We have an article on second language and it is simple all languages that are not the native language. Doc James (talk · contribs · email) 22:14, 15 April 2020 (UTC)
That source shows my concern; do we really think that is an adequate sample size? I think we are best to leave this data out and just say "many of our readers" or something vague. I don't believe we really know, based on "reader surveys", which is a sample with all manner of bias, etc. SandyGeorgia (Talk) 22:19, 15 April 2020 (UTC)
Sure works for me.[5] I have no great attachment to that image so trimmed. In the text is fine. Doc James (talk · contribs · email) 22:21, 15 April 2020 (UTC)

Further discussion ?

This is not my preference (which is to see the entire section deleted to avoid repetition of existing guideline pages), but I can live with this version. But "hard data" needs a better term. SandyGeorgia (Talk) 22:28, 15 April 2020 (UTC)

"numerical data"? Doc James (talk · contribs · email) 22:29, 15 April 2020 (UTC)
Works for me (although I am unsure if even this is grounded in current guideline. I thought it used to be present somewhere, but now I can't find it. SandyGeorgia (Talk) 22:41, 15 April 2020 (UTC)
Found! Wikipedia:When to cite -- data and statistics. SandyGeorgia (Talk) 22:43, 15 April 2020 (UTC)
Sure. Doc James (talk · contribs · email) 22:55, 15 April 2020 (UTC)

Women, females, patients, people

I cleaned up a well-intentioned problem caused by a new editor removing the word "women" from a medical condition that falls squarely into the women's health category. Unfortunately, the new editor made changes like turning "80% of women" into "80% of individuals", which results in an article that is factually wrong, rather than one that's gender-neutral.

This guideline doesn't mention Wikipedia:Gender-neutral language. Do we need to, or is the problem rare enough that it's not worth it? WhatamIdoing (talk) 02:40, 21 June 2020 (UTC)

We had an RfC a discussion (that was essentially an RfC) on this at Wikipedia:Village pump (proposals): Wikipedia:Village pump (proposals)/Archive 161#Gender-neutral language in human sex-specific articles. Consensus is for sex-specific language in cases like the one you described.
The "people who menstruate" wording has recently received substantial media attention due the J.K. Rowling transgender controversy. I mentioned the RfC village pump discussion at Wikipedia:Biographies of living persons/Noticeboard#J. K. Rowling (a permalink for it is here). Flyer22 Frozen (talk) 03:44, 27 June 2020 (UTC)
I also think WP:UNDUE is relevant in this circumstance.--Tom (LT) (talk) 04:19, 6 July 2020 (UTC)

Proposal to change "Medical uses" to just "Uses"

The term "medical uses" is recommended as a subject heading in #Drugs, treatments, and devices, #Surgeries and procedures, and #Medical tests. It was changed by Doc James from the harder to understand "Indications" back in 2014 (Wikipedia_talk:Manual_of_Style/Medicine-related_articles/Archive_8#Indications_versus_medical_uses) with a prior discussion back in 2011 (Wikipedia_talk:Manual_of_Style/Medicine-related_articles/Archive_6). Pretty much all of the discussion has related to drugs with the idea being that it distinguishes between clinical and other uses (such as recreational, as a stimulant, etc.)

However, I am editing in the surgical and medical test space at the moment and I really feel that this needlessly disambiguates as a section title. For example, editing Lithotomy or Lithotripsy it just feels weird to add "Medical uses" (as these are surgical procedures) or, when editing Antibiotic sensitivities, it's weird to add "Medical uses" as the article is in relation to antibiotics and, why do I need to mention medical everywhere? And what about veterinary or epidemiological use of these tests?

I would like to propose that we replace "medical uses" with just "Uses" at the very least for the surgeries and medical tests areas, for the following reasons:

  1. It needlessly disambiguates the section titles. A section about how a procedure or test is used is clearly about how that surgery or test is used.
  2. Our encyclopedic mission is to describe how things are used via secondary sources etc., not to provide a list of how they should be used (ie. the indications). I say this because of WP:NOT referring to "not a textbook" and "not a how to"
  3. It is weird and clunky to describe a surgical procedure as having a medical use (as opposed to a surgical use)
  4. The use of tests is more than just medical, as mentioned above

If there are many uses then, as per usual, we can split the section into subsections; however for the vast majority of articles I think this simplification makes sense

I note that after the notification about the change in 2014, a number of editors also described "uses" as being equally acceptable. I'd like to hear what other editors think about this suggestion.--Tom (LT) (talk) 07:58, 4 July 2020 (UTC)

I'm not opposed to "Uses" when it's the better heading. WP:MEDSECTIONS is clear that we don't have to be strict with headings. And in the Condom article, "Uses" "Use" is currently there because what is mentioned in that section are are not just medical uses. But "Medical uses" might be best in some cases. I definitely agree about unnecessarily disambiguating. I don't see "Medical uses" or "Uses" as conflicting with WP:NOT, or "Medical uses" conflicting with "surgical procedures", though. Flyer22 Frozen (talk) 05:45, 6 July 2020 (UTC)
I have no objection to trying this. It could be a very good idea. WhatamIdoing (talk) 18:10, 6 July 2020 (UTC)
Try what, though? Which specific aspect of the proposal? We could also state "Medical uses or Uses." We do use "or" in the guideline to present an alternative title. Flyer22 Frozen (talk) 19:15, 6 July 2020 (UTC)
I think we should try "Use" (or "Uses"). I think we also need to retain "Medical uses" when there are non-medical uses. ==Uses== could in some cases be sub-divided into ===Industrial uses=== and ===Medical uses===. WhatamIdoing (talk) 15:13, 7 July 2020 (UTC)
I would think that changing the guidance to state "Medical uses or Uses" per Flyer22 Frozen makes sense. For articles like surgical procedures, "Uses" would be preferred, and for articles on chemicals that have other uses, "Medical uses" would be the sensible choice for the section that discusses those medical uses. Editors will surely be able to use common sense on which is better for a given article. --RexxS (talk) 21:42, 7 July 2020 (UTC)
Exactly. Flyer22 Frozen (talk) 21:46, 7 July 2020 (UTC)
Agreed. Johnbod (talk) 23:32, 7 July 2020 (UTC)
Agree. --Tom (LT) (talk) 00:27, 9 July 2020 (UTC)

 Done Special:Permalink/967734442 --Tom (LT) (talk) 00:02, 15 July 2020 (UTC)

Some anatomy edits

I have made some minor edits to parts of the guideline that refer to anatomical articles, based on my experience about what happens in practice (diff here: Special:Diff/967735076/967736285):

  • For the title, clarify that TA assists finding the English language title; remove reference to 'developmental anatomy' as an area of difficulty (hasn't been while I've been here), and insert reference to 'common name', as this usually IS an area of difficulty
  • In the anatomy guideline, remove "There is no need to duplicate information provided in the infobox". This usually results in uncited and noncontextualised information within the infobox, so I have removed it. It is better for the information to also be included in the article so that it can be cited, and details about that thing can be included (for example, listing External iliac artery as blood supply is not as useful as detailing how the blood travels through smaller arteries to get to that point, and use of reliable sources to verify that statement)
  • In the anatomy guideline, in "Structure", remove "brief" from "including a brief description of location and size". I don't think "brief" has assisted any editors in practice and it's weird to have it there, seeing as the whole article is about an anatomical structure, and it should be covered in as much depth as required. --Tom (LT) (talk) 00:25, 15 July 2020 (UTC)
  • In the anatomy guideline, put "Microanatomy" as the first term to "Histology", reflecting most of our articles (it's also more easy for lay readers to understand)
  • In the anatomy guideline, insert in "Development" that it can also be used to cover changes in later life where appropriate (eg for Prostate and Thymus)
  • One or two small grammatical changes

Hope these are not too controversial, --Tom (LT) (talk) 00:21, 15 July 2020 (UTC)

Tom, I'm fine with most of the changes. But regarding this? "Microanatomy" is used in most of our anatomy articles now because you led the way on that. Also, you commonly change "Histology" to "Microanatomy" when you see it. I'm not complaining. I understand wanting to be consistent across articles. But in the 2018 discussion we had on it, there was no consensus to use "microanatomy" instead, and it was pointed out in that discussion that "histology" is still significantly more common than "microanatomy." I still think that readers will understand "histology" better than "microanatomy." And in the #"Impact" section above, you did complain about "drive-by article reformatting."
As for this? I prefer that the development section be about the development in the womb (and early life development if the material is available on that and the content fits better there). That has been standard, including for the Human brain article. I think that aging material beyond that typically fits best in a different section, such as the "Clinical significance" section that may include an "Aging" subsection. And why would the development section need to be separate from the structure section if "lengthy"? It seems you are saying it might be better to have it separate if the structure section is already lengthy (with subsections) and the development section is also lengthy due to subsections it may have? Otherwise, I don't see why it wouldn't just be a subsection of the structure section. Yeah, the Human brain article currently has them separated, but that's not necessary. A compromise could be to have the guideline state that aging material can go in the development section or in a separate section. Flyer22 Frozen (talk) 02:17, 15 July 2020 (UTC)
And speaking more on "development" with regard to an organ/body part, sources are usually speaking of development in the womb when speaking on the matter. Our Development of the reproductive system and Development of the urinary system articles, for example, are reflective of that. Flyer22 Frozen (talk) 02:35, 15 July 2020 (UTC)
Thanks Flyer22, you make some good points
Regarding microanatomy and histology you are right to identify that I have a point of view relating to the use of microanatomy, for the reasons stated in the previous discussion (ie. that it's more understandable to lay readers, micro + anatomy, as compared with histology which they have no linguistic point of reference other than 'ology')... I had forgotten about that discussion however. I respect your reversion and happy to hear what other editors think about this particular matter
Regarding development, you do make a good point that development is commonly taken to mean just until the structure is developed (ie before adulthood). I have occasionally mentioned aging, but the most prominent example I did use got its own subsection (Thymus#Involusion). So I can see where you're coming from here... happy to leave this one lie, and given it is quite occasional I wonder if just leaving it and dealing with it on a rare case by case basis is better than formalising it at this stage.--Tom (LT) (talk) 09:12, 15 July 2020 (UTC)
Thanks, Tom. Flyer22 Frozen (talk) 02:27, 16 July 2020 (UTC)

Should we suggest "Pharmacodynamics", "Mechanism of action", or both?

At Wikipedia:Manual_of_Style/Medicine-related_articles#Drugs,_treatments,_and_devices we suggest titling a subsection on a treatment's mechanism of action as "Mechanism of action" or "Pharmacodynamics". I propose we drop the "Pharmacodynamics" suggestion. In an unscientific study I just asked a few non-clinicians around me, and no one had a good sense of what "Pharmacodynamics" means. They each reported being more likely to click on a "Mechanism of action" section. I'll leave you all to repeat the same study and see if you arrive at the same conclusion. These are just suggested section headings, so changing this wouldn't mandate any particular way. I'm just suggesting we no longer suggest "Pharmacodynamics". Thoughts? Ajpolino (talk) 23:52, 14 July 2020 (UTC)

  • I absolutely 100% agree. "Mechanism of action" is much clearer to lay readers. I personally think we should specifically note that the term is preferred to pharmacodynamics. I think it is very important that the information we write about can be understood. --Tom (LT) (talk) 00:23, 15 July 2020 (UTC)
  • I think it's more of a biochemist thing than a normal-person thing. It's going to be clinically important for some drugs (e.g., those with a narrow therapeutic index, or a half-life that's eitherr particularly long or short). I don't know if it's relevant to most. WhatamIdoing (talk) 06:19, 18 July 2020 (UTC)
@WhatamIdoing: I could be mistaken here, but I think we recommend a drug's half-life, distribution, et al. be covered in a subsection just after "Pharmacodynamics" titled "Pharmacokinetics". Ajpolino (talk) 18:07, 18 July 2020 (UTC)
It looks like that's meant to cover half-life but not therapeutic index?
Separately, I don't think that Pharmacodynamics and Mechanism of action are synonyms. WhatamIdoing (talk) 16:13, 19 July 2020 (UTC)

Chemical names aren't cultural

Paclitaxel#Society and culture has a ===Names=== section that I don't think should be under ==Society and culture== at all. I suspect that it was put there because of MEDMOS's suggested section order. WhatamIdoing (talk) 18:48, 6 August 2020 (UTC)

The "names" section also includes information about stereochemistry/structure, so per WP:PHARMOS, the logical place to put this information is under "chemistry". I was bold and moved it. Boghog (talk) 22:11, 6 August 2020 (UTC)
I prefer to have an "Etymology" or "Definitions" section separate from the "Society and culture" section, but it makes sense to me when one or both aspects are included in the "Society and culture" section. Flyer22 Frozen (talk) 04:35, 8 August 2020 (UTC)
In this case, though, the section was/is about the nomenclature. Flyer22 Frozen (talk) 04:39, 8 August 2020 (UTC)

"Impact" section

Hi WhatamIdoing, I saw your to-do list above and have been thinking about this as a section title to capsure the effects of a condition, test etc on a person. Perhaps we can insert this somewhere in the guideline as a section that can be included in articles if relevant, rather than approaching it from the perspective of each particular article type (eg disease, test, etc.). --Tom (LT) (talk) 04:21, 6 July 2020 (UTC)

Not sure what "impact" would cover that wouldn't already be covered in one of the other sections. For example, the "Society and culture" section. Flyer22 Frozen (talk) 05:45, 6 July 2020 (UTC)
The current set-up is comprehensive, I agree; I just propose this in response to WAID above and as I do think its prominence in some articles could increase. Society and culture seems to be and impact and interpretation of something at a group level; whereas "Impact" (or something similar) relates to an individual. I do think something could be said for increasing this from a subsection to a section title. As, after all, most encyclopedic articles represent actual topics that have the potential to be life altering or lifechanging and have large impacts on people. So it's weird that something so central to people's experience of the articles is hidden in a subsection. Such an approach would certainly be in line with the way medicine has been taught and recorded, but I don't think it necessarily means it's right for us. Happy to hear what others think though. --Tom (LT) (talk) 06:16, 6 July 2020 (UTC)
Tom (LT) (thanks for pinging me), I can see the value of this idea. Stevenfruitsmaak suggested something along those lines recently, and you can read the discussion in the archives here.
If you look at Diagnosis of HIV/AIDS, I'm not finding words (such as fear, anxiety, emotion) that suggest that the subject of the effect of this diagnosis on the actual person is mentioned anywhere in the article at all. Recommending a specific section might encourage inclusion of such information. I don't think that this information is about ==Society and culture==. That section is for stigma, or for culture-specific information. The fact that most people are frightened when you tell them they have life-threatening diseases is not about "society". Individual psychological reactions are about each individual separately.
I'm not sure whether we need a separate section, or if we need to produce a sort of parallel checklist for completeness ("If the article is about a substantially disabling pediatric condition, then you need to mention the rest of the family. If the article is about a life-threatening or disabling condition, then you need to mention psychological stuff. If the article is about a debilitating hereditary condition, then mention fertility choices. If the article..."). In edu-speak, that would be called an "infusion area", which means that you never teach a specific lesson about (e.g.,) women's careers, but you make sure that this information is "infused" throughout the curriculum. WhatamIdoing (talk) 23:41, 6 July 2020 (UTC)
Looking at the "Common sections" area ("WP:MEDSECTIONS), we have some of those referring to specific sections in general ("Society and culture", "etymology", "External links"). I recently edited Ostomy system, which has such a huge multidimensional impact on someone, and it was weird that didn't have a place do go. We could add a subsection to the "MEDSECTIONS" group called something like "Impact" with the text something like:

Impact Many articles within the scope of this guideline have a significant impact on a personal level, whether receiving a diagnosis, physically preparing for a test, recovering from surgery, or living with a chronic condition, or assisting as a carer. This information should be included within articles. This could be throughout the article, or if can be included with in a separate section called "Impact". When included, this information still requires reliable sources to be used.

What do you think? I remember SandyGeorgia mentioning this during a discussion about DLB as well (Apologies Sandy for multiple recent pings). --Tom (LT) (talk) 00:28, 7 July 2020 (UTC)
That description looks good. We should consider adding something about education and career effects. The "society" effect for a widespread disabling condition would be the loss of a zillion dollars to the global economy; the "individual" effect is that you lose your job.
Can we find a more specific term than "Impact"? ==Psychosocial effects==? ==Effects on life==? The loss of a zillion dollars to the global economy is also an "impact", and I'd prefer a suggested section heading that is clear that this is about the individual instead of the whole world. WhatamIdoing (talk) 15:20, 7 July 2020 (UTC)
You stated, "The fact that most people are frightened when you tell them they have life-threatening diseases is not about 'society'. Individual psychological reactions are about each individual separately." I disagree. As noted in the "Diseases or disorders or syndromes" section in MEDSECTIONS, "Society" in "Society and culture" is something that "might include social perceptions, cultural history, stigma, economics, religious aspects, awareness, legal issues, and notable cases." The word might indicates that "this is not all it can include." Something else it includes are individual experiences on the aforementioned matters or other matters...meaning how the disorder or disease, for example, affects people in some way and others in another. It's not like we typically cover how a medical issue or perceptions of anatomy affect one individual. The "Society and culture" section is going to include information about how people react (whether frightened or not) when they are told that they have a life-threatening disease. Some of these sections in our medical articles already do that, and that includes the Cancer article. I'd rather not start seeing "Impact" sections in articles when that impact material can go in the "Society and culture" section without incident. But regarding Tom's proposal, I think that the wording "This could be throughout the article, or it can be included within the 'Society or culture' section, or a separate section called 'Impact'." would be better. Still, something like "Psychosocial effects" or "Effects on life" could be a subsection of "Society and culture." It's what I would do, if I wanted such a specific heading.
I'll leave a post about this at WP:Med for wider input. Flyer22 Frozen (talk) 19:36, 7 July 2020 (UTC)
agree w/ comments above and posted below by Flyer22--Ozzie10aaaa (talk) 14:42, 14 August 2020 (UTC)
Cancer#Diagnosis says "Cancer diagnosis can cause psychological distress". Would you put that in ==Society and culture== instead? Cancer#Management mentions "emotional, spiritual and psycho-social distress" and says that some people "need help coping with their illness". Would you move that to a different section, or leave it where it is?
What is in Cancer#Society and culture section that sounds to you like it's really about the typical experiences of individual patients? The paragraphs there are about
  1. stigma (due to incurability),
  2. Western individualism vs the rest of the world (in the context of when, whether, and how the patient learns about the diagnosis),
  3. metaphors used to describe it (hmm, the UK metaphor of a journey seems to have disappeared),
  4. the positive-thinking nonsense from the 1970s, and
  5. a bit of philosophy. 
I don't think that any of that is about the effects of a condition, test, etc., on an individual patient. WhatamIdoing (talk) 19:44, 8 July 2020 (UTC)
I agree "Impact" doesn't necessarily convey that it's about an individual. "Individual impact?" "Experience?" --Tom (LT) (talk) 00:26, 9 July 2020 (UTC)
On talk pages, we sometimes talk about "patient experience", but MEDMOS rejects the "patient" language, and it's not appropriate in many circumstances anyway. WhatamIdoing (talk) 02:11, 9 July 2020 (UTC)
Whether to have something in the "Management" section as opposed to it being in the "Society and culture" section is a case-by-case basis thing. The takeaway is that the material will fit better in one of those sections. And so an "Impact" section, or rather an "Impact" heading, is not needed. The "Psychosocial effects" or "Effects on life" headings are better because they aren't as vague, and they could fit in either the "Management" or "Society and culture" section. You speak of "effects of a condition." That's vague. It could mean physical, psychological, or psychosocial effects. And physical effects aren't covered in our "Society and culture" sections. Stigma (due to incurability) can have a psychosocial effect. So if that is what is meant by "impact" in whatever case, then it fits in a "Psychosocial effects" or "Effects on life" section...wherever they are placed. Stigma is a society and culture thing that impacts people individually. Flyer22 Frozen (talk) 05:46, 9 July 2020 (UTC)
There is no content about individual psychological reactions to a cancer diagnosis in Cancer#Society and culture, and I'm having trouble imagining what would belong there. I have the same problem with heart disease, STIs, life-limiting genetic diseases, or all the other things that I think would cause some distress upon diagnosis. Could you make up an example sentence about someone's individual psychological response to a distressing diagnosis that you think belongs in the "society" section, so I can figure out why you think that would ever be the right place for it? WhatamIdoing (talk) 18:50, 9 July 2020 (UTC)
Hmm. Unless we are misunderstanding each other, this seems like it's a case where we simply disagree. WP:Med and WP:Anatomy editors haven't always agreed on what belongs in whatever section or how to set up an article. It's why WP:MEDSECTIONS states, "Changing an established article simply to fit these guidelines might not be welcomed by other editors. The given order of sections is also encouraged but may be varied, particularly if that helps your article progressively develop concepts and avoid repetition." It's why this discussion even exists. In this case, I don't understand how you are delineating things. And, no, I don't need more examples for your rationale. "Cancer#Society and culture" currently states, "People with a 'cancer personality'—depressed, repressed, self-loathing and afraid to express their emotions—were believed to have manifested cancer through subconscious desire. Some psychotherapists said that treatment to change the patient's outlook on life would cure the cancer. Among other effects, this belief allowed society to blame the victim for having caused the cancer (by 'wanting' it) or having prevented its cure (by not becoming a sufficiently happy, fearless and loving person). It also increased patients' anxiety, as they incorrectly believed that natural emotions of sadness, anger or fear shorten their lives." This is psychological/psychosocial material. And if this were still going on today, it would still fit in the "Society and culture" section. In fact, the section in question also states, "Although the original idea is now generally regarded as nonsense, the idea partly persists in a reduced form with a widespread, but incorrect, belief that deliberately cultivating a habit of positive thinking will increase survival. This notion is particularly strong in breast cancer culture." Another example of psychological/psychosocial material belonging in the "Society and culture" is what is currently here at the Vulva article. Labia stretching and how it affects women is a society and culture matter that includes psychological/psychosocial aspects. And, yes, I know that the Vulva article is an anatomy article. But above, I did state "It's not like we typically cover how a medical issue or perceptions of anatomy affect one individual." You stated, "someone's individual psychological response to a distressing diagnosis." For me, when discussing what we've been discussing in this section, it is not about someone's individual psychological response to a distressing diagnosis. It's about how the disorder or disease may affect people's lives, including socially. Naturally, the individual aspect will be covered by the fact that some people will go through it (the effect in question) while others won't. If we are talking about "psychosocial" -- the word that was suggested -- instead of "psychological", yes, that material may very well fit best in the "Society and culture" section. To me, what fits best in the Management (or Treatment) section, as opposed to the "Society and culture" section, really depends on the content (and personal opinion). Flyer22 Frozen (talk) 02:29, 10 July 2020 (UTC)
Telling people that they have a disease can increase their short-term risk of suicide. Where would you put that fact? WhatamIdoing (talk) 19:32, 10 July 2020 (UTC)
Not in the "Society and culture" section, obviously. Unless, of course, it had to do with mean-spirited or misinformed people spreading an unfounded claim that a certain disease can or will increase their short-term risk of suicide.
Again, "psychosocial" is one of the terms that was used in two of the proposed headings. Merriam-Webster defines psychosocial as "1: involving both psychological and social aspects // psychosocial adjustment in marriage [...] 2: relating social conditions to mental health". One example it includes is the following: "This arrangement requires students to balance their education and domestic realities, including psychosocial concerns like food and housing insecurity, violence, family illness and parents leaving home as essential workers." Another is the following: "Health workers and people in quarantine lacked psychosocial support and suffered from conditions such as post-traumatic stress disorder, PTSD." Yourdictionary defines psychosocial as "relating to the combination of psychological and social behavior. An example of psychosocial is the nature of a study that examines the relationship between a person's fears and how he relates to others in a social setting."
All of that (not just the bolded parts) is what I am talking about with regard to adding material to the Society and culture section. Social aspects are usually covered in the Society and culture section. Marriage stuff would normally fit best in the Society and culture section. Flyer22 Frozen (talk) 02:32, 11 July 2020 (UTC) Tweaked post. Flyer22 Frozen (talk) 02:44, 11 July 2020 (UTC)
So "Parents are distraught upon learning that their baby has leukemia" maybe gets filed under "Diagnosis – reaction to", but "Families go bankrupt from medical bills" or "Schools are notoriously bad at accommodating this disability" would go under ==Society and culture==. What about "Managing this condition requires so many hours per day that most parents are unable to remain employed"? WhatamIdoing (talk) 22:00, 14 July 2020 (UTC)
Given what I stated above, with emphasis on "case-by-case basis", I see no need to keep entertaining these alternatives or scenarios you are unnecessarily throwing out there. It's already clear we don't fully agree. Flyer22 Frozen (talk) 02:17, 15 July 2020 (UTC)
Because when I don't understand the metes and bounds of our (dis)agreement, then I'm more likely to come up with a bad suggestion for how to describe this in the guideline. WhatamIdoing (talk) 06:21, 18 July 2020 (UTC)
iPad/iPhone typing apology. At both Tourette syndrome and dementia with Lewy bodies, when we discussed this before, [6] I found that everything could be accommodated in the current suggested headings. I don’t think we need more Suggestions. But they are only suggestions. If something cannot be accommodated In this scheme, nothing stops you from adding a new section. I guess a broader question is whether there are problems with the current scheme. SandyGeorgia (Talk) 20:09, 7 July 2020 (UTC)
Yeah, the "If something cannot be accommodated In this scheme, nothing stops you from adding a new section." viewpoint is how I feel. Flyer22 Frozen (talk) 21:25, 7 July 2020 (UTC)
I agree that there is nothing critical about this proposal, and that really it is a matter of wording (I guess that's why we are discussing at this venue). I think the root problem that I refer to here is that the collective and individual impacts are described in the same section. We don't need to rigidly adhere to that rule, but I find it unusual that the impact on an individual is discussed in a subsection, whereas so much information is discussed with greater prominence. Although nothing stops an editor, I thought I would discuss it here because adherence to this guideline has been enforced somewhat concretely. If we are able to amend the guideline on the other hand, the likelihood of drive-by article reformatting is much lower, as would be the wasted time justifying the section to reverting editors.--Tom (LT) (talk) 00:26, 9 July 2020 (UTC)

Experienced editors know they can create a new (sub)section, and they know they can discuss psychosocial effects in the Society and culture section. But what about less experienced editors? One of the primary purposes of a guideline is to educate less experienced editors. We should therefore highlight the importance of discussing the psychosocial effects of disease. ¶ There is another—perhaps even more important—reason to emphasize a malady's mental and emotional impact: Wikipedia's guidelines, policies, and procedures communicate our ethos.[1] The minimal attention we currently pay to the mental and emotional impact of illness suggests an apathetic, insensitive attitude toward human suffering.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 08:42, 18 July 2020 (UTC)

References

  1. ^ Webster's Third New International Dictionary of the English Language, Unabridged, ed. Philip B. Gove (Springfield, MA: G. & C. Merriam, 1961, rev. 2016 [Merriam-Webster, Inc.], periodically updated as Merriam-Webster Unabridged, https://unabridged.merriam-webster.com/unabridged/ethos ("ethos noun 1 : character, sentiment, or moral nature: a : the guiding beliefs, standards, or ideals that characterize or pervade a group, a community, a people, or an ideology : the spirit that motivates the ideas, customs, or practices of a people, an epoch, or a region; b : the complex of fundamental values that underlies, permeates, or actuates major patterns of thought and behavior in any particular culture, society, or institution").


===Mental and emotional aspects=== might be a good heading for some articles (the "scary disease in adults" category). I think you wouldn't need/want it for Common cold, and we might want something separate for caregiving content. WhatamIdoing (talk) 16:18, 19 July 2020 (UTC)
Good ideas. :0)   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 00:15, 24 July 2020 (UTC)

Proposal to include ethnicity and geographic distribution

In keeping with the global spirit of WP:WORLDVIEW, I propose specifically mentioning "ethnicity" and "geographic distribution" among the items listed beside Epidemiology under
== Diseases or disorders or syndromes ==

FROM:

TO:

86.186.155.159 (talk) 12:37, 24 July 2020 (UTC)

  • Support - sounds like a sensible addition. --Tom (LT) (talk) 12:56, 24 July 2020 (UTC)
  • Support, but ... - it does sound sensible. At the same time, there's always the possibility of "unintended consequences" or "unforeseen complications" when making significant changes. Perhaps add such (sub)sections to a few of articles to serve as exemplars and as a way to (maybe) identify unforeseen complications. If the consensus is to support without such "tests" (for lack of a better term), then I will also support the proposal.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 17:05, 25 July 2020 (UTC)
    I appreciate your thoughtfulness Mark, and I absolutely agree about the "unintended consequences" part at least (epidemiology does tend to be somewhat complicated and nuanced, and – like other medical content – calls for careful wording). Part of my thinking is that "geographic distribution" is so key to epidemiology that it really needs to be elicited alongside age, sex, etc. And that "ethnicity" also needs to be there, and is another key factor that often needs to be covered. 86.191.67.230 (talk) 18:39, 25 July 2020 (UTC) [OP]
    I'm not an epidemiologist, but I'd say ethnicity is almost never a factor in disease, never mind a key factor. I'm willing to be educated, though, if anyone can provide enough examples where it is actually a key factor. Boing! said Zebedee (talk) 17:24, 26 July 2020 (UTC)
    (@Boing! said Zebedee: I have no wish to be drawn on this extensive invitation, but just one aspect here: PMID 30978304 ) 86.191.67.230 (talk) 18:25, 26 July 2020 (UTC)
    Thanks, I'll check that out. But I must reflect what RexxS points out below, that (though there can be overlap) genetics is not ethnicity, and those links are not about ethnicity. For example, I have a genetic aspect to an illnes, but it's not ethnic. Boing! said Zebedee (talk) 18:30, 26 July 2020 (UTC)
    Thanks for that, @Boing! said Zebedee: Obviously they're not the same thing, but they can sometimes be linked. Just by way of an example, if you look at the abstract of PMID 30978304 I think you'll see the problem of how focusing on a single ethnicity (in this case, a supergroup of "populations of European descent") can potentially skew our scientific understanding of genetic risk factors. Well, that's a general methodological concern, I hear you say... For an all too immediate example of how an ethnically-related risk factor can impact on *multiple* diseases, you might look at betel (a page I've tried to improve from a health perspective, despite pov pushers). A couple of years after discussing this "neglected global public health emergency" with Johnbod over a convivial pizza after meeting up at Cancer Research UK, one of my closest friends sadly fell ill with esophageal cancer of the squamous-cell type, for which betel nut chewing is a major risk factor ([7][8]).[1] She was British-born (of mixed European heritage), but had spent part of her life in countries (and among ethnicities) where betel nut chewing was somewhat analogous to tobacco smoking in Europe. I feel this personal memory provides a tangible example of how risk factors related to ethnicity can be both very real and, at the same time, not altogether straightforward. And, in fact, epidemiology - which looks at variations in morbidity and mortality among different groups/populations of people (including different ethnicities) - is intriguingly complex. But, as you may rightly say, that's not what we're talking about here under the Disease section heading of == Epidemiology == . And I'll agree with you. But, if we reflect about how COVID-19 in Britain, the US, and elsewhere, has disproportionately affected minority ethnic groups – obviously something that requires explanation – then I think you can see how pertinent it can be to cover variations among ethnic groups (which clearly isn't the same thing as claiming that ethnicity causes disease [I know you didn't say that :-]). Though, as I've tried to make clear below, my intention here, as OP, was basically to encourage more truly global coverage, without fixating on any particular *word*. 86.191.67.230 (talk) 20:43, 26 July 2020 (UTC)
    I certainly agree with the desire "encourage more truly global coverage, without fixating on any particular *word*", but when the word is "ethnicity" then it could be opening a door to problems. The betel story is interesting (my mother-in-law chews the stuff), but I'd use the word "cultural" for that factor rather than ethnicity. If we drew a Venn diagram of genetic/ethnic/cultural factors there'd be certainly be some overlap, but I'm really not sure how much (and I think at least some of the factors would be controversial). Then again, ethnicity is surely based on cultural distinctions at one end of the spectrum and genetic distinctions at the other end. And, as far as science/medicine goes, there isn't really any such thing as ethnicity at all. I think we could benefit from considering all these factors, but I disagree with the idea of lumping them all under ethnicity. Perhaps we should go with "geographic, genetic, cultural and social factors"? But might that be getting a bit too wordy? Boing! said Zebedee (talk) 07:24, 27 July 2020 (UTC)
    I'll also add that yes, I do think the fact that minority ethnic groups appear to be more seriously affected by Covid-19 in the UK and US is important. But the effect is on multiple different ethic groups, which suggests it's not actually an ethnic effect. And I think seeing it as an ethnic effect can keep us away from considering the underlying reason. Is it social (eg relative deprivation, as some suggest)? Is it simply wealth, where wealthier people generally live in situations of more effective social distancing? There's a whole bunch of possible factors, and I'm sure it's being covered in our articles without the MOS having to say "ethnic" specifically. Boing! said Zebedee (talk) 07:32, 27 July 2020 (UTC)
  • Oppose including ethnicity as a determining factor in epidemiology. Ethnicity is a social construct, as much as race is. Without a definitive means of establishing ethnicity, figures linking linking ethnicity to a particular disorder are at best speculative, and at worst misleading because of the presence of confounding co-factors. --RexxS (talk) 19:11, 25 July 2020 (UTC)
  • Oppose including ethnicity, unless there is clear MEDRS research showing different prevalence among ethnic groups, typically in settings involving immigration at some point. Sickle cell disease would be one example. Apart from Rexx's point just above (though epidemiologists do seem to believe ethnicity exists, unlike sociologists) the ethnic makeup of those affected will largely follow geography for diseases. Johnbod (talk) 20:08, 25 July 2020 (UTC)
  • I Oppose including ethnicity too. I think RexxS and Johnbod have explained the reasons well. Boing! said Zebedee (talk) 11:49, 26 July 2020 (UTC)
    • @RexxS and Johnbod: Are you opposing "ethnicity" alone (rather than the spirit of the proposal to encourage greater WP:WORLDVIEW in our descriptive coverage of the occurrence and distribution of diseases/disorders/syndromes under == Epidemiology ==)? 86.191.67.230 (talk) 09:24, 26 July 2020 (UTC)
      • I think I was clear that I support including "geographic distribution", and perhaps less so that I support including ethnicity where there is good research supprting this. So Sickle cell disease yes, but not probably African trypanosomiasis. I must say that most of the disease pages I look at seem to have geography/ethnicity covered in a reasonably appropriate way already, but no doubt there are many where just the US (perhaps and the UK) is covered, and any ethnic element is restricted to prevalence among African-Americans. COVID 19 is an example where the extensive early reseach on ethnicity should be mentioned, but extremely tentatively, given it seems clear that socio-economic factors have large confounding effects. The paper you link to just below sums up the issues well, I think. The author does not seem to agree with RexxS that "Ethnicity is a social construct, as much as race is", but seems to admit the difference between the two is often in the eye of the beholder. Johnbod (talk) 14:46, 26 July 2020 (UTC)
        • Indeed. Where there is a clear and well-documented relationship with ethnicity (and I think "ethnicity" spans a spectrum from genetics to social construct), it can be included. But adding it to the MOS as something that should be included will surely encourage people to add it where it isn't scientifically validated. Boing! said Zebedee (talk) 14:54, 26 July 2020 (UTC)
          • To be clear: I support the use of geographic distribution as that is a clearly defined criterion. I have a problem with treating ethnicity in the same way. Firstly, because ethnicity is either going to be self-reported or assumed by the the data collectors. That leaves considerable margin for error or misinterpretation. Secondly, because I don't believe a mechanism exists for connecting ethnicity with disease transmission. Does anybody seriously propose that being Jewish or African-American or Basque makes you more or less susceptible to a disease or to transmitting it? The social factors governing those are far more important: relative poverty and cultural-specific behaviours can be seen to play a far greater part. Finally, it is a mistake to confuse ethnicity with genetics. You only need examine studies like "Genetic diversity and the emergence of ethnic groups in Central Asia" to see evidence that ethic groups are far from genetically homogeneous, and that there is often more variably in genetics within a group than between groups. --RexxS (talk) 15:23, 26 July 2020 (UTC)
            • Re:"it is a mistake to confuse ethnicity with genetics". Yes, that's a good point, but then there are groups widely considered ethnic groups who share a crucial bit of genetics. The example of our Sickle cell disease article does make mention of "ethnic group"s and "ethnic origin", and I don't see anything wrong with the way it does it. Sickle cell disease transmission really has got nothing to do with social factors, but is down to genetic characteristics shared by some ethnic groups. Anyway, this is essentially why I think any relevant ethnic characteristics can be covered without the MOS saying so - after all, the vast majority of diseases really have no ethnic connections at all. Boing! said Zebedee (talk) 15:48, 26 July 2020 (UTC)
            • (edit conflict)To be clear: per my cmt below, I wasn't really expecting the "ethnicity" suggestion to be discussed here as a *determinant* (cause, risk factor, etc) of disease, but, primarily at least, as a *descriptor* (similarly to "geographic distribution"), per my understanding of how == Epidemiology == as a page *section* (as distinct from the field) fits into MEDMOS likes to structure the diseases/disorders/syndromes group of MED pages (although understanding of causality/etiology often emerges, eventually, following observations of particular *variations* in distribution). And given that there seems to be some consensus here on the descriptive aspect, I'm really, really happy to step back for the time being from debating the precise wording. As you (both :) point out, the idea is simply to help stimulate appropriate breadth of descriptive coverage to fit current knowledge on the topic of each page, while avoiding unintended consequences. (And, of course, I fully recognize the work-in-progress aspects here and elsewhere on Wikipedia.) 86.191.67.230 (talk) 16:18, 26 July 2020 (UTC)
I support including this, both geography and ethnicity. Think about subjects such as Medical genetics of Jews, the Finnish heritage diseases, Health among the Amish, and others. If you're writing about any of the uncommon diseases that would get mentioned in those articles, then it is DUE to mention it in the article, and the ==Epidemiology== section is usually going to be the correct place. WhatamIdoing (talk) 20:46, 14 August 2020 (UTC)

References

  1. ^ Akhtar S (February 2013). "Areca nut chewing and esophageal squamous-cell carcinoma risk in Asians: a meta-analysis of case-control studies". Cancer Causes Control. 24 (2): 257–65. doi:10.1007/s10552-012-0113-9. PMID 23224324. ...efforts aimed at curtailing the addiction to areca nut chewing may contribute to lower the incidence of esophageal squamous-cell carcinoma and related mortality in Asians.

(sub-) proposal to include geographic distribution

In view of the expressions of concern above regarding the relevance of ethnicity to epidemiology in general [9] (which, frankly, I hadn't altogether foreseen - and I think entering into discussion on some of the points and claims raised might not be helpful here), I feel it may be better to confine this proposal to "geographic distribution" (or something similar - e.g. perhaps "...across different populations" [?]). In practice, I feel mention of this key element should encourage broader *descriptive* coverage (per the MEDMOS listing, I understood "determinants" primarily fit under == Causes == [ Causes: Includes risk factors... ]). And it clearly doesn't exclude appropriate, reliably-sourced, coverage of other pertinent epidemiological descriptors.

FROM:

TO:

Actively consider the possible role of sociodemographic, cultural, geographic, racial/ethnic, and sex/gender variables

First a little comprehension check for yours truly. If I understand correctly, we are discussing the Manual of Style for Medicine-related articles, specifically with regard to the Diseases or disorders or syndromes section of an article, under which are suggested headings, one of which is epidemiology, and we are further discussing how to best describe (prescribe?) the content of epidemiology sections. Is that correct?

Assuming I'm oriented x 4, allow me to proceed to my main point.

I am not sure the best way to accomplish this goal, but I am sure that our objective should be to encourage editors to consider the potential role that sociodemographic, cultural, geographic/environmental, racial/ethnic, and sex/gender variables might play in the cause(s), exacerbations, diagnostic challenges, and epidemiology of a disease, disorder, or symptom.

By "consider" I mean, in part, to look for such factors when searching the literature. If we don't look for them, we will assume they don't exist. These sociodemographic, cultural, geographic/environmental, racial/ethnic, sex/gender, and other variables might fall under Epidemiology or they might merit discussion under the Society and culture section, or they might not be relevant at all.

Headings are simply a classification scheme. Consequently, we will often need to describe factors that do not fit neatly under one or another heading. The most important thing is that we remain awake and thoughtful about the possibility that sociodemographic, cultural, geographic/environmental, racial/ethnic, sex/gender, and other variables might play an important role in the development or maintenance of a disease/disorder/syndrome.

As a side note, here are some Wikipedia articles I stumbled across that offer food for thought: Race and health, Hispanic paradox, Mexican paradox, French paradox.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 08:18, 27 July 2020 (UTC)

@Markworthen Yes indeed, that was the intention, and I agree with pretty much everything you say here (including "I am not sure the best way to accomplish this goal." :-) Leaving aside the evident misconstruals contained in this thread, I acknowledge a general lack of appetite here for these particular MEDMOS proposals, and fully accept the potential for unintended consequences. This does not alter my longstanding belief in the relevance of not overlooking such factors, including socioeconomic / occupational ones. I believe the present juncture – in which current events have brought such factors to wider public attention – could be a good time for MED contributors to consider them, somehow, in a rational and informed way. Imo, we would do well to acknowledge the potential relevance (e.g., see PMID 23224324 / above) of systemic bias here, especially considering the global reach of the English-language Wikipedia as a freely available source of reliable health information. 86.191.205.25 (talk) 14:46, 30 July 2020 (UTC) [OP]

Wrt this and the above discussion, I think we should be careful not to allow the "suggested sections" of this MOS to so dominate our thinking about how to write and structure an article. It is just a list of suggestions. The basic policy here is WP:WEIGHT: what does the body of high quality literature say about aspects of this subject? What proportion and prominence do they give to these aspects? There is a danger that we have a heading and editors go looking for material to fill that heading and end up finding on PubMed or GoogleBooks material that is biased or horribly out-of-date or mere brief mention, and include it for the sake of saying something. This isn't speculation: such editing occurs. Instead, I would encourage editors to first find the most recent and comprehensive sources on the topic (academic/professional textbooks, chapters in such, expert clinical guidelines, reviews) and look at the section headings and aspects the sources consider important. I agree of course it is useful to have a check-list of possible sub topics to consider for inclusion and not to overlook something, but don't treat it rigidly and be aware that there may be good reason why many sources don't cover that aspect (at all, or in any detail). Of course, not every source is comprehensive: a review by a neurologist may be lacking in coverage of social, carer, nursing or economic aspects of a disease, say. -- Colin°Talk 09:26, 27 July 2020 (UTC)

What Colin said. Please stop the CREEP here— the section is just a suggested list, and it is not possible to encompass everything, nor will every topic be the same. And the entire page needs to be rewritten, to get back to how a guideline should operate. Colin, wish you would do that :) SandyGeorgia (Talk) 12:36, 27 July 2020 (UTC)
  • Yes, I much prefer this approach, especially the way Colin puts it. A check-list of possible sub topics to consider for inclusion is clearly a useful thing to have, but if we over-stress it we could be making a tool for literalists to beat us with (and we have far too many literalists here as it is). Boing! said Zebedee (talk) 12:50, 27 July 2020 (UTC)
Yes. I wonder whether it would be helpful to turn this list into a table, so that we could have "Suggested heading(s)" in one column, and "Suggested content" in another. Please have a look at voy:STICK for one idea about how to organize a list like this. (They do theirs the other way around, with "Content" in the first column and "Heading" in the second.) WhatamIdoing (talk) 20:49, 14 August 2020 (UTC)

The copyright section contains some medical specific advice about DSM, questionnaires. We recently got stung with ICD-10 copyright issues. But some of the section contains general advice:

Write in your own words whenever possible, and ask for help about the fair use of images and text when you need it.
Attribution is required for copying content in the public domain and under various licenses. See WP:Compatible license, WP:COPYPASTE, WP:PLAGIARISM, WP:FREECOPYING, Template:PD-notice, and Template:CC-notice. Copying content under a compatible license requires a template under the correct license. Removing it for copied content under a compatible license will result in a copyright violation.

The second paragraph was added here. I propose the above text be deleted as non-medical-article advice that belongs elsewhere. -- Colin°Talk 16:20, 13 August 2020 (UTC)

It is also incorrect; a template is not the only way to do it. Scroll down in this diff to see the technique I learned from Diannaa, a copyright admin. I think that people were trying to make this page cover all bases, and by doing so, creating unnecessary forks and instruction creep; we are generally always better referring people back to the main guidelines, and students will not read stuff anyway. SandyGeorgia (Talk) 16:51, 13 August 2020 (UTC)
Agree I think there has been an attempt to make this a one-stop-shop for all the problems student editors typically introduce. And yes, they don't read the manual anyway. -- Colin°Talk 17:09, 13 August 2020 (UTC)
Huh? Student editors and editors who write poor content often don't read WP:NOR too, so we might as well delete it then? I'm not seeing why "they don't read the instructions" is a valid reason to remove instructions. They can be pointed to instructions after the bad edits anyway. Crossroads -talk- 03:44, 14 August 2020 (UTC)
NOR is a Wikipedia-wide policy page. The concern here is that we fork information to a local page, trying to be one-stop shopping, while providing information that is often at odds with Wikipedia-wide pages. Certainly we can and should point them to the accurate, Wikipedia-wide, consensus pages, like NOR ... even if they don’t read them. SandyGeorgia (Talk) 04:21, 14 August 2020 (UTC)
I am in partial agreement. I think this small section is mostly easy to read and, at least in my small corner, highly relevant. I think there needs to be a general reference to the idea of copyright problems to highlight we operate under a more broad manual of style, and there also needs to be some specifics highlighted, particularly PD and attribution as mentioned.
I do agree this sentence is completely unhelpful: See WP:Compatible license, WP:COPYPASTE, WP:PLAGIARISM, WP:FREECOPYING, Template:PD-notice, and Template:CC-notice, and this kind of link farming would be better if replaced by a single reference to WP:COPYRIGHT (or if there's a better link, the top-most article about this topic).
To be clear, I think with exception of that sentence I feel the rest of the content is quite useful to our guideline and should be preserved.--Tom (LT) (talk) 08:35, 14 August 2020 (UTC)
I've trimmed it back to the previous text, which mentioned DSM and questionnaires. Whether the other text was "quite useful" is completely irrelevant if it merely duplicates guideline and policy elsewhere. Arguments to keep or add content to this page need to be firmly grounded in why medical articles are different or why writing them is different. -- Colin°Talk 14:04, 14 August 2020 (UTC)
I think it's a good idea to (continue to) document the DSM situation, and questionnaires/screening instruments/rating scales are another area where a desire for accuracy and precision can accidentally lead editors into copyvio problems. As for the rest – there is much to be said in favor of one-stop shopping, but the risk of de-synchronization is significant here. Copyright is a specialty area, and we're better off pointing editors to the specialists. WhatamIdoing (talk) 20:26, 14 August 2020 (UTC)
Also, given how much time we spend complaining about people (e.g., students) who don't "write in your own words", maybe we'd like to keep that. WhatamIdoing (talk) 21:16, 14 August 2020 (UTC)

Discussing before making significant changes

We can move on.
The following discussion has been closed. Please do not modify it.

Yes, WP:BOLD is a thing. But we all know that this guideline is subject to much debate (including disagreement). That is clear by even the recent RfC: Wikipedia:Manual of Style/Medicine-related articles/RFC on lead guideline for medicine-related articles. So can we discuss significant changes, ideally ensuring that consensus has been achieved, before implementing those changes? Flyer22 Frozen (talk) 02:15, 14 August 2020 (UTC)

I think discussion would be much easier and more productive if we avoided mucking up this talk page with multiple sections and excess markup. It would also be very helpful for you to read this, and the entire page again. We cannot again come up with a local consensus guideline for lead that is in conflict with the broader consensus at WP:LEAD. I am curious as to why you thought this new section was needed; could you please enlighten me? SandyGeorgia (Talk) 02:54, 14 August 2020 (UTC)
You keep changing the topic (in this case acting as though occasionally bolding one's commentary is more of an issue than adhering to the WP:Consensus policy), and being passive-aggressive. I wonder why. To repeat what I stated above, "I am very aware of the WP:LOCALCONSENSUS policy and have cited it times before. As made clear by various editors, including those in the aforementioned RfC, this lead guideline does not conflict with WP:Lead. Even you and Colin argue that it offers nothing new." Flyer22 Frozen (talk) 03:22, 14 August 2020 (UTC)
Much better, thanks: no excess markup, much easier to read. Eliminating the “I repeat” will also help keep discussion moving forward. The aforementioned RFC has no bearing on this discussion; it reached no consensus (hence is meaningless) because I mangled the format and several editors disrupted. (Although if you read it in its entirety, you will see that very good progress was made in people adjusting their initial opinions via discussion.) There are differences of opinion regarding what you call the page “Status quo”. Let’s not repeat the past— meaning, pinging people to a mangled talk page, that is made difficult to read, is likely to lead to !voting rather than productive discussion. I am ignoring the rest of the personalization, and hope we can move forward without it. The lead content you propose is out of sync with WP:LEAD, but that discussion is above. SandyGeorgia (Talk) 04:39, 14 August 2020 (UTC)
Uh-huh. More condescension. Got ya. Unless actually disruptive, I will talk how I want to talk, like many others on this site (including admins at WP:ANI) who occasionally use bold and italics in their posts. Hardly anyone complains about that stuff, and it's not banned anywhere at WP:TALK. Not that it could be banned there since that is a guideline, not a policy. But, hey, you can go and make a proposal at Wikipedia talk:Talk page guidelines about this. We'll see if editors there take that proposal as seriously as they took the far more important "breaking up people's comments" thing that I took care of in 2017. Either way, we both know your complaint is about being frustrated with the fact that I disagree with you on the lead matter. You speak of personalization...and yet you have personalized this. If this went to ANI, you better believe that more than one editor would point this out.
I stand by everything I stated above, including the very reasonable request to discuss before making significant changes to this guideline. Those comments that you call votes are more than just votes. There is also nothing wrong with RfC discussions or RfC-style discussions. That is one way we achieve consensus on this site. And when we have one or more editors enforcing a big change after a recent RfC very clearly stated "no consensus", that is an issue. It is an issue that might require another RfC. RfCs are supposed to judge the weight of arguments. No one is going to just go by an editor brow-beating others into compliance. No, they are going to want to know what a variety of other editors, especially those within their field of expertise, think and gauge consensus or lack thereof. You state that "the lead [I] propose is out of sync with WP:LEAD, but that discussion is above." I didn't propose a thing. And even if I had proposed the lead setup that I mentioned that I favor (a setup that is already in place and doing wonderfully at various medical articles), it would not be out of step with WP:LEAD, any more than WP:FILMLEAD is out of step with WP:LEAD. I already stated that different topics might require that leads are handled in ways specific to those topics. It doesn't mean that the guidance conflicts with WP:Lead, any more than WP:MEDRS conflicts with WP:Reliable sources or WP:Verifiability.
You can keep debating. Obviously. But I'm not going to keep debating you on these things. There is no point. You have made yourself clear. I have made myself clear. And I don't tolerate being condescended to. If I were a newbie, maybe. But I am a very experienced Wikipedia editor, and I don't need lessons from you. Flyer22 Frozen (talk) 05:16, 14 August 2020 (UTC)
Holy wall of text! SandyGeorgia (Talk) 05:27, 14 August 2020 (UTC)
Sigh. As if you don't often make long posts. Next time just stay on topic instead of trying to distract with condescension. If there is no "your markup is so bad" and "you need teaching to, young lady", things should be fine. Flyer22 Frozen (talk) 05:35, 14 August 2020 (UTC)
A request to follow talk page guidelines need not be met with walls of hostility. Good practices for talk pages about bolding and italics is found at WP:SHOUT. SandyGeorgia (Talk) 07:45, 14 August 2020 (UTC)
More of the same. Wow. You start with the hostile nonsense and then say I'm being hostile. So ridiculous. This is ridiculous. Since you want to point to WP:SHOUT, as if I am not aware of that section, then I will quote the following from it: "Bolding may be used to highlight key words or phrases but should be used judiciously. Italics are often used for emphasis or clarity but should be avoided for long passages." So is the use of bolding or italics banned? No, just like I stated. Do I use both occasionally? Yes. And, yes, I used italics in two three quotes, which you would probably classify as long passages. So have many others. So do many others at ANI every day. Either go report me there or move on. Flyer22 Frozen (talk) 08:19, 14 August 2020 (UTC)
I also see the use of italics after the use of italics for quotes in the #Technical language section above. Sighs again. Flyer22 Frozen (talk) 08:27, 14 August 2020 (UTC)

Way too much text. In short. This is a wiki. If you look at the history, the contentious parts of this guideline were added completely without discussion. We, as a project, have got way too stuck in this asymmetric rut that to impose something on the project requires only a simple edit, but to argue against that requires thousands of words of argument and RFCs and arbcoms. This guideline should say less than it does. If something is contentious it should be removed. If something is against wider community guideline and policy then it should be removed without fuss. And yet, here we are with thousands of words and fuss. -- Colin°Talk 09:23, 14 August 2020 (UTC)

For clarity: This is a community-wide guideline. Unlike with a WikiProject advice page (e.g., WP:PHARMMOS), what "we, as WikiProject Medicine" do or think is irrelevant. What matters is what "we, as the English Wikipedia" do. The 'rules' and processes for changing this page are the same ones that get used at the main Wikipedia:Manual of Style page. I say this because I think it's important for all editors, not just long-time WPMED folks, to know that they are welcome to participate in improving this page. WhatamIdoing (talk) 20:21, 14 August 2020 (UTC)
Colin, you've contributed much to the "wall of text" on this talk page, and you often do type a long post. You type long posts more often than I do. If you are stating that you are going to make contentious edits to this guideline without discussion, such as first proposing the change, then you should prepare to be reverted more often than not. You should be prepared to debate and realize that not everyone is just going to go along with your edits. And, for me, it matters not how much hostility I am subjected to for simply disagreeing. If I disagree, I disagree. Being condescended to won't change my mind. It's not a smart tactic to get one to agree with another. It's also nothing compared to the harassment I face daily from socks and/or trolls. Like WhatamIdoing just stated, this is a community-wide guideline. A lot of things in this guideline have been subject to discussion. I should know; I've been here helping to craft it while you've been away, though you've occasionally popped up at WP:Med to complain about WP:MEDRS and about how some supposed gold standard version of WP:MEDMOS existed a few years back is gone. I'm going to state again that this guideline has been worked on by various editors since then. Their opinions, those collaborations, don't just go out the window because one or two editors disagree with the results five years later. And at this point in time, you have no consensus whatsoever for removing the lead section of this guideline. Flyer22 Frozen (talk) 00:17, 15 August 2020 (UTC) Tweaked post. Flyer22 Frozen (talk) 00:27, 15 August 2020 (UTC)
Flyer22 Frozen, please don't make personal attacks. -- Colin°Talk 10:11, 15 August 2020 (UTC)
I made no personal attacks against you. Perhaps you want to visit WP:ANI and see what they rule and don't rule as personal attacks time and time again. And perhaps you'd want to state the same to your editing partner. Flyer22 Frozen (talk) 00:10, 16 August 2020 (UTC)
Flyer22, please stop attacking other editors and personalizing discussion; it is inappropriate here as anywhere. Wikipedia is not a battleground, and we need to resolve the guideline disputes. SandyGeorgia (Talk) 23:10, 16 August 2020 (UTC)
SandyGeorgia, will you stop attacking other editors and personalizing discussion, treating it as a battleground, and then saying that others are doing it? You attacked me/personalized this discussion in the #Removing guidance about the lead, and adding a bit about terminology and technical language section above, and that includes a silly threat. You then did the same thing in this section (but without a silly threat). It led to an atmosphere that has made editors opt out of contributing to the latest discussions on this talk page (although, besides Seppi333, one editor did clarify that the reason she isn't participating is solely due to lack of time). I find it astounding when editors engage in repeated hypocrisy and show such a lack of self-awareness. After reading your "tsk tsk post (add-on here), no one is going to buy your "It's Flyer22 who started all of this hostility/is the one attacking other editors and personalizing discussion" argument. It's that post of yours that others have pointed to as one reason for not getting involving in these latest discussions. They do not want to be similarly attacked (including being condescended to) for disagreeing with you or Colin. Flyer22 Frozen (talk) 02:21, 17 August 2020 (UTC) Tweaked post. Flyer22 Frozen (talk) 08:19, 17 August 2020 (UTC)
You have pointed to a section that you claim includes an attack. If you provide a diff that shows an attack, I will gladly apologize and strike. I recognize that I may have offended you by asking you to stop using excess markup, which makes the page very difficult to read— for me, at least, and apparently for others as well, which is why the talk page guidelines advise against it (and I do appreciate that you have ceased the italics, bolding, etc.). And a page that is difficult to read means that interested editors will respond that they don't have time to engage, creating a self-fulfilling prophecy. I am sorry I did not make the request about excess markup on your talk page, if that is what so inflamed the discussion here.
As to the post on your talk, and your references to your email, I assume everyone who works on medical content is familiar with ascertainment bias; perhaps I assume too much? You might not like to hear what is in my email; I personally prefer openly stated opinions to email; you may find this one helpful.
Now, can we focus on policy-based discussion moving forward, and stop repeating the claim that "a couple" of editors hold certain opinions, which is a false statement? The "consensus" you mention has never existed for this content, and the forced order you like is not best practice, it is a fait accompli; you can see how the arbs ruled on such. WP:P&G gives clear guidance on how we should focus this discussion, and the acrinomy is not helpful. Best regards, SandyGeorgia (Talk) 14:04, 17 August 2020 (UTC)
Since you apparently needed this to be cleared up for you, I am grateful that Crossroads cleared up the matter below. The "excess markup" thing (occasional bolding and italics), which many others do and is done in the #Technical language section (when it comes to italics) by others (Colin included), was just more unnecessary distraction. You'd already brought up your issue with "excess markup" in the #Removing guidance about the lead, and adding a bit about terminology and technical language section above, although that issue only seems to be with me doing it. But you decided to bring it up in this section where I made a reasonable request, and then this section became an area of bickering. With regard to how you talk to me, I was clear what my issue was/is, and Crossroads touched on it below. Do not condescend to me. Do not make comments that essentially amount to "You're going to get sanctioned like Doc James. Watch out." As for "a couple" of editors hold certain opinions? Not a personal attack. And not at all false. You and Colin hold opinions that a number of editors disagree with. And as for those who agree with you, not all of them fully agree with you. There is nothing at all wrong with me stating that a lot of things in this guideline have been subject to discussion/that this guideline has been worked on by various editors since some 2015 version that you and Colin prefer. There is nothing at all wrong with me stating that those editors' opinions, those collaborations, don't just go out the window because one or two editors disagree with the results five years later. Consensus for the lead section of this guideline has existed per what Crossroads and/or I have argued in the #Removing guidance about the lead, and adding a bit about terminology and technical language and #Lead sections, and what I have argued in this one. More below. Flyer22 Frozen (talk) 03:19, 18 August 2020 (UTC) Tweaked post. Flyer22 Frozen (talk) 03:26, 18 August 2020 (UTC)
Your tsk tsk post states, You are heading right down the path that the arbs cautioned against. This very much reads like intimidation - 'agree with me or else you will end up sanctioned'. You also claimed she was pinging select editors, without proof, even though she pinged without discrimination as allowed by WP:APPNOTE. It's also odd to see you complain about not read, sheesh! and Holy wall of text!, and about excess markup in talk discussions, but later post this. (Personally, I see nothing wrong with posts that are long when needed, or with any amount of formatting.) As for fait accompli, the arbs did not say that is the case with this page and never said a faction can therefore make whatever changes they want. Crossroads -talk- 16:24, 17 August 2020 (UTC)
Thanks for giving me something concrete to respond to. 1) I don't attempt intimidation; not my style (unlike the "take it to ANI" we see from others, which is certainly an attempt to intimidate). If you read that into my post, you don't know me. That was a reminder that what didn't work before is unlikely to work now, was not helpful, and we should move forward with something more likely to achieve consensus. 2) Pinging select editors: Flyer pinged editors who have never before posted to this page, while not pinging many who have, many times over many years. Choosing to ping editors from an obviously flawed RFC, that achieved no consensus, is odd and unconstructive. 3) The "Back to policy" post I made was not an italicized, bolded, "I repeat" post made that does nothing but personalize and attack others; it is intended to be informative and helpful and offer a new way to view these discussions. YMMV; you are welcome to view it differently, but I suggest that responses to policy are more likely to be a way forward here. I have responded to your post, and my offer to strike any attacks pointed out by Flyer stand, but I will not continue responding after that to posts here which are doing nothing to achieve consensus and end disputes. If you have further personalizing remarks, they are welcome on my talk page. SandyGeorgia (Talk) 16:51, 17 August 2020 (UTC)
Oops, I failed to respond to the fourth point about fait accompli. 4) There were five areas of fait accompli; the arbs ruled on fait accompli. We should pay attention to them. SandyGeorgia (Talk) 19:35, 17 August 2020 (UTC)
"You are heading right down the path that the arbs cautioned against" is not intimidation, but "Take it to ANI" is intimidation? I don't think so. That's just her telling you to stop accusing her of attacks on this talk page where it disrupts consensus building. And, indeed, she hasn't attacked you. Crossroads -talk- 19:28, 17 August 2020 (UTC)
Those "five areas" are your comments; happening to be on an ArbCom evidence page lends them no extra authority. They didn't say they were endorsing each and every one of your specific claims. Indeed, ArbCom specifically talks about "large numbers of similar edits", which obviously doesn't make sense when talking about the wording of a single guideline page. They never said anything about this page, nor did they say that our medical guidelines need review, which they could have done like they did with Gamergate pages at Wikipedia:Arbitration/Requests/Case/GamerGate#Review of articles urged. I nonetheless think this part of Wikipedia:Arbitration/Requests/Case/Medicine#Fait accompli is relevant regarding trying to change the guideline now: It is inappropriate to use repetition or volume...to exhaust their ability to contest the change. Let's work on finding areas of agreement. Crossroads -talk- 19:51, 17 August 2020 (UTC)
Would anyone mind if we just boxed up this section, or even archived it (the page is getting long again)? I don't think there's an actionable request for a change to the guideline anywhere here, and I suspect that anyone who's willing to take advice about their behavior already has done so. WhatamIdoing (talk) 22:11, 17 August 2020 (UTC)
Perfect ... Flyer is welcome to my talk page to sort any remainders, SandyGeorgia (Talk) 22:36, 17 August 2020 (UTC)
I replied above. But a bit more: You stated, "Flyer pinged editors who have never before posted to this page, while not pinging many who have, many times over many years." That is not true! I already told you, in the #Removing guidance about the lead, and adding a bit about terminology and technical language section above, "I pinged medical editors who have been involved with crafting information on lead material in this guideline (and that includes whether or not the lead should have citations) within the last five years to see what their thoughts are on retaining or removing the section in this guideline." They are in the archives! One can find them via the "Find edits by user" feature in the edit history. They can be found in the discussions such as those listed at Wikipedia talk:Manual of Style/Medicine-related articles/Archive 10#LEAD redux. And I also noted that I pinged all of the editors who commented in the "Survey" section of the aforementioned RfC. And in the case of the RfC, that is significantly fewer editors who were pinged, and a couple or few of them are medical editors who have commented on this talk page. So I mainly pinged editors who have been involved with WP:MEDMOS. And, no, pinging editors from a heavily advertised RfC about this very guideline is not odd and unconstructive in any way.
Anyway, thank you, Crossroads. Yes, I don't see that what I've stated to Sandy or Colin is any more of a personal attack than what they've stated here. We can move on. No, I don't want to continue any of the above on my talk page or on anyone else's. Flyer22 Frozen (talk) 03:19, 18 August 2020 (UTC)
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