The “Theys” Have It – Or Does He or She?

Mikkael Sekeres, MD, MS
Director of the Leukemia Program at the Cleveland Clinic in Cleveland, Ohio

Recently, in a decision that was heralded by some as transformative, by others as a “win for gender neutrality,” and by presumably the majority of the U.S. population as entirely irrelevant, the American Dialect Society (come on, you know you’re a member) identified the word “they” as its 2015 Word of the Year, and in so doing gave the pronoun its official – and wide-reaching – approval to be used in the singular form.


Let’s put this recommendation in context.

Previously, when reporting my extracurricular activities and wanting to protect the identity of my companion, I might have uttered the following sentence:

“I went with a friend to an all-night rave and he or she ended the night face-planted on my spare couch.”

Now, according to the American Dialect Society, I can safely say, without retribution from the Grammar Police:

“I went with a friend to an all-night rave, and they ended the night face-planted on my spare couch.”

If you’re scandalized, by the way, “rave” is my code word for “study session at the science library.”

Why is this relevant to us as health-care providers, though?

Certainly, we have all been in the position of discussing a patient, wanting to protect that patient’s HIPPA rights, and struggling with ways to avoid identifying that patient’s sex or gender. The word “they” makes that less cumbersome than the loquacious phrase “he or she,” and renders us less likely to slip.

Nota bene: “Sex” refers to a person’s biology, while “gender” reflects one’s self-image as relating to sexual nature. Whereas in the past ASH Clinical News has used the term “gender” in our reporting to avoid the appearance of being too racy, henceforth we will use “sex” as it relates to the biology of subjects in studies.

The Washington Post, in an opinion piece published December 4, 2015, also declared its intention of using the singular “they,” in part because of the increasing visibility of gender-neutral people.

Seems like a win all-around, right? Easy and politically correct.

Not so fast.

I may be in the minority, but – though I have many patients who identify as gay, lesbian, transgender, bisexual, and by a variety of other gender- and non–gender-specific terms – I have yet to treat someone who identifies as gender-neutral. I’m sure I will one day, and will be sensitive to refer to that person in whatever way is preferred.

Notice how, in the previous statement, I easily avoided using the singular “they.”

The majority of my patients, regardless of their gender identity or sexual orientation, actually prefer that I be gender-specific, rather than being neutral and, as a result, indistinct.

They even expect that, as a doctor, I will be accurate in identifying their gender or sex.

Which makes me wonder, are we using the limited gender-neutral advantages of the singular “they” as a cloak for being lazy about language? Don’t we value accuracy and specificity in medicine, and trust ourselves to be flexible about our language if an individual patient prefers nomenclature that differs?

I asked the editors-in-chief of other ASH publications their thoughts on this issue.

Bob Löwenberg, MD, PhD, editor-in-chief of Blood, commented, tongue-in-cheek: “This has not yet been one of the major issues for us at Blood. While the use of ‘they’ instead of the singular ‘he or she’ has the purpose of introducing a neutral term, it actually amplifies the impact of a particular phrase. The traditional name of our journal has also been singular until today. We now plan to change the name of the Journal to: Blood x 2, The Journals of the American Societies of Hematology.”

Jason Gotlib, MD, MS, editor-in-chief of The Hematologist, countered: “I am generally supportive of the use of the gender-neutral term ‘they’ when used to replace the awkwardness (albeit inclusiveness) of the term ‘he or she.’ However, we have no plan to change our publication to The Hematologists. I am looking forward to a modern-day reboot of Abbott & Costello’s ‘Who’s on First?’ to see how these dialect changes would play on the baseball diamond.”

So, dear readers, please be advised that, for the foreseeable future, and outside of direct quotes in interviews, ASH Clinical News will continue to avoid the singular “they” in its pages, as I suspect will Blood and The Hematologist.

What other grammatical decisions have we made?

With the now standard caveat of “outside of direct quotes,” you won’t see us using “utilize.” The word “utilize” is defined by Fowler’s Modern English Usage as being essentially a pretentious form of the word “use.” It’s what I call an intellectual muscle car – we deploy it to overcompensate when we want to sound smarter than we feel, or hope to inject authority where it may be lacking. In sum, you users should use “use” and hew the use of – ew – “utilize,” which we rue.

“Currently” or “at the present time” are terms that have been stricken from our sentences, and even direct quotes. I always have to ask, what do either of these phrases add to a sentence written in the present tense? By definition, a trial enrolling patients must be doing it currently, or at the present time, or it would have enrolled patients. I suppose these words are meant to indicate how up-to-date the findings of a study are, when instead they emphasize that reported results may only be, in fact, interim, which may disqualify an abstract from being submitted to the ASH annual meeting. Currently.

And, finally, we have removed modifiers from the word “unique.” Why? Because, by definition, “unique” means one of a kind, and if you’re already one of a kind, you can’t be an extreme form of one of a kind, like half of a kind, or a quarter of a kind.

If there are other grammar gotchas we haven’t noticed, please let us know, by emailing us at We want to make ASH Clinical News the most unique magazine they utilize. At the present time.

The content of the Editor’s Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.

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