Words have meaning. Books are published by various learned people in order to solidify the meaning and spelling of words and establish general agreement among our countrymen. These dictionaries are important because without them people or governments may try to arbitrarily change the meaning of words for their own advantage. A common language with general agreement about the meaning of words is one of the pillars of civilized society.

Aside from the wide-ranging cultural and societal implications of precise common language, there is a certain practicality to a uniform understanding of what words mean.

If for some strange reason the government decides to make the words trousers and eyeglasses synonymous, the request for patients to remove their eyeglasses and read the top line of the eye chart suddenly becomes problematic.

This, of course, is an absurd example. It seems less absurd, however, when one considers the recent actions of CMS to require precise government-approved language in order to be paid for reading a radiograph. It seems that the bureaucratic geniuses in our nation’s capital have deemed that the word reviewed no longer means what all the dictionaries say it means. If one enters into the medical record, “I have reviewed PA and lateral radiographs of the chest and find a normal cardiac silhouette and no infiltrates”, no payment will be forthcoming. If, however, reviewed is substituted with interpreted, payment will flow, much to the consternation of your local radiology group.

While these two words are not synonymous, reviewed, by definition, is actually closer to what we do than interpret. Review means to make a general survey or a critical evaluation. Interpret means to explain or tell the meaning of something. So, why is our government splitting semantic hairs? Always follow the money when things don’t make sense. They don’t really care what word is used. They care that emergency physicians usually say reviewed, and if they deem that word to be unacceptable, payment can be withheld.

This behavior is troublesome for two reasons. First, withholding payment over the choice of two generally acceptable terms is disingenuous and makes me feel even more cynical (I did not believe that was possible) about our federal government. Second, manipulation of our language is a particularly Orwellian act and should make every citizen open their eyes to the truly objectionable actions of our government.

Government manipulation of words is not new and has been used to advantage by both Republicans and Democrats. The Democrats do seem to have more of a knack for it, however. In Washington, a cut is not really a cut. It is a reduction in the rate of growth. The president has not proposed a tax but a revenue enhancement. The service members initially sent to Viet Nam were only advisers. Before a grand jury, Bill Clinton said that to answer a question it would depend on what the meaning of is is. In Korea there was no war, just a conflict. More recently in Egypt, a coup is not really a coup if our government wants to continue sending aid to a country without tossing federal law out with the cat litter.