Our Identity Crisis

Mikkael Sekeres, MD, MS
Director of the Leukemia Program at the Cleveland Clinic in Cleveland, Ohio, and editor-in-chief of ASH Clinical News

I recently embarked on a quest to determine who we are and what we do as hematologists. I figured it couldn’t be that hard, getting to the nut of defining the term “hematology.”

The etymology of the word, according to the Oxford English Dictionary (OED), flows from the Greek haimo-, or “blood,” and the Latin logia, or “the study of.” We are described by this esteemed virtual text as “that branch of animal physiology which relates to the blood.” Simple enough. The noun hematology dates to 1811, in Quincy’s Lexicon-medicum, where it is defined as “the doctrine of the blood.” Doctrine itself can be defined as “a policy, principle, or even creed – a set of beliefs held by a church.”

Hematology as religion. I kinda like that.

The prefix haemato- dates to 1651 with its appearance in Mataeotechnica Medicinae Praxeos (which hasn’t yet come out with a podcast, in case you’re looking for it) in the phrase “These Haematognomists or diviners by the Phoenomena’s in the blood.”

Hematology as soothsayers pursuing the unknown. I kinda like that, too.

The OED’s definition seemed straightforward, but I wondered what somewhat less vaunted texts had to say about us.

Similar to the Merriam-Webster Dictionary, the American Heritage Medical Dictionary tells us that hematology is a medical science or branch of medicine “that deals with the diagnosis and treatment of diseases of the blood and bone marrow.”

I feel like we do more than that, though. Don’t we also manage normal blood and bone marrow? And what about that phrase “deals with?” Am I being overly sensitive in perhaps identifying a pejorative in saying we have to deal with pathophysiology that intrigues us?

Wikipedia focuses our efforts similarly on disease, as do Vocabulary.com and Thefreedictionary.com.

Mosby’s Medical Dictionary, now an Elsevier imprint but originating with the C.V. Mosby Publishing Company, incorporated in 1906, broadens our scope, defining hematology as “the scientific study of blood and blood forming tissues. Also spelled haematology.”

Thanks to the bloke who pointed out that last bit. How neglected the spleen and liver must feel, not to mention the lymph nodes and those ultimate slackers – the non–blood-forming bone marrow components – whose activities apparently fall out of our purview.

Stedman’s Medical Dictionary for the Dental Professions contains one of the more comprehensive definitions I came across, saying we are “the medical specialty that pertains to the anatomy, physiology, pathology, symptomatology, and therapeutics related to blood and blood forming tissue.”

This was a heck of a lot more inclusive than what I anticipated from a dental reference, which I thought would fall more along the lines of “the red stuff that gushes from the mouth after you stick sharp objects in it, but before you embark on your lecture on the virtues of obsessive flossing.”

Not that I’m an antidentite or anything.

Pulling these attempts at describing us together, I’d like to propose we take matters into our own hands with an all-encompassing definition:

hematologists \ hē-​mə-​ˈtä-​lə-​jists: those who explore with gusto the anatomy, histology, physiology, pathophysiology, signs and symptoms, therapies, and their complications of blood, bone marrow, blood-forming tissues, and organs that process blood and its components, not to mention the people harboring these substances who generously welcome us into their lives for brief periods so we can learn more, and hopefully help them feel better.

Put that in your pipe, Mr. Mosby, and smoke it.

Having resolved the challenge of describing who we are and what we do, how should we go about distinguishing between those hematologists among us who explore cancer from those who don’t?

The most common term I’ve heard bandied about for those with a cancer focus is “malignant hematology.” (Also spelled haematology.)

But what should we call blood and bone marrow specialists – hematologists (for complete definition, see above) – who don’t have such a focus?

“Non-malignant hematologist” has been introduced as a retronym. It does the job of drawing a line of distinction, but a wholly unsatisfactory one because, first, it necessitates separating cancer from non-cancer (e.g., bleeding diatheses, not cancer; myelodysplastic syndromes, probably cancer, but maybe not in its lowest-risk forms?) and, second, it involves defining a profession by what it isn’t, rather than by what it is and what it does. Not-for-profit agencies suffer from the same identity cataclysm.

“Benign hematologist” borrows from tumor nomenclature, making it relatable but a total misnomer for many diagnoses. I would be hard pressed to find anyone comfortable with calling thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, or lifelong severe factor deficiencies and their attendant morbidities and excess mortality benign conditions.

I suspect that patients with these conditions would readily agree.

“General hematologist” ignores those who specialize narrowly in, say, platelet disorders versus red cell disorders, and comes across as too militaristic, raising questions of who should be identified as Captain or Second Lieutenant hematologist, not to mention Private (practice) hematologist, and whether the last should represent the lowest or highest rank of service. I suspect highest.

My word, what a semantic twist I’ve gotten us into. Perhaps the most accurate and all-inclusive path forward is to avoid making such distinctions at all, and celebrate who we are collectively, rather than who we aren’t.

Hematologists.

Because the religion of hematology is open and affirming, and welcoming to new members, acolytes, diviners, and soothsayers alike.

SHARE