Answer: "Hospital" and "Surgery" in American/British English

[chomiji]

debirlfan asked us "What are the rules for American versus British usage for 'hospital' and 'surgery'?

It's true that British usage on these common medical terms differs from what's encountered in the United States. We'll take a closer look at how these words work.

Interestingly, the fathers of two of the core cast of the manga and anime Bleach are doctors. Protagonist Ichigo Kurosaki's father, Isshin Kurosaki, runs a small private clinic that bears the family name, but Uryū Ishida's father, Ryūken Ishida, runs the town's main medical facility, Karakura Hospital.

Bleach, translated by U.S. publisher Viz, uses U.S. English:

"Yasutora-kun asked me to call you," said Dr. Ishida. "Because he's in the hospital."

Dr. Kurosaki's office was officially open from 9 in the morning until 5 in the evening, but in fact, he saw people at all sorts of times for emergencies.

The usual way of expressing these ideas would be slightly different in British English:

"Yasutora-kun asked me to call you," said Dr. Ishida. "Because he's in hospital."

Dr. Kurosaki's surgery was officially open from 9 in the morning until 5 in the evening, but in fact, he saw people at all sorts of times for emergencies.

"In Hospital" vs. "In the Hospital"

Let's look at the usages for "hospital" first. The U.S. usage requires the use of the article "the," but the British usage doesn't. For those of us accustomed to the American usage, this may seem odd, but in fact, there are a number of U.S. terms that work in the same way. For example:

"Of course I didn't notice you weren't around the house today," snapped Karin. "I was in school!"

On the other hand:

Ichigo realized, to his horror, that a Hollow was manifesting in the hallway. He had never imagined something like that would actually happen in the school.

The way "school" is used in these examples parallels the British usage for "hospital." In the second example, in school could have been used, but then the implication would be slightly different: that would have meant that Ichigo was incredulous about the idea of a malicious spirit showing up at any school, anywhere. In the example as given, he's surprised that the malevolent being has show up at his school ("the school") in particular.

The British use of "in hospital" versus "in the hospital" has a shade of meaning that the U.S. usage doesn't have in that it refers to the subject's condition. "She's in hospital" means something like "She's ill enough that she's been hospitalized," whereas "I saw her in the hospital" could be because "She's visiting someone in the hospital" or "She works in the hospital."

If you usually use U.S. English and want to make sure your use of "hospital" conforms to British use, you can try substituting "school" for a moment, to check whether you've got the correct phrasing. Other examples of similar usage in the U.S. are "in prison" – "Kira couldn't have committed that crime: he's in prison" – and "in college" – "Dr. Kurosaki was still unused to the idea that he now had a kid in college." In both cases, the implication is a little more than that the person is in a particular location: it says something specifically about their status in the world as well, as a detained prisoner or as an enrolled college student. Similarly, the British use of "in hospital" means that the person in question needs a hospital's around-the-clock medical attentions.

Surgery or Doctor's Office?

In the United States, "surgery" usually refers to the work performed by the type of medical specialist known as a surgeon, who performs operations involving cutting and stitching the patient's body. "A surgery" would mean "a surgical operation," although the term is almost always used with an adjective specifying what type of operation:

Before Dr. Ishida became the director of Karakura Hospital and turned his talents to administration, he had performed hundreds of abdominal surgeries.

Still, "operation" would be a far more common term to use.

In the United Kingdom, on the other hand, a "surgery" is the facility in which a doctor performs medical procedures ranging from examinations to X-rays to minor surgical operations, such as stitching a small cut or burning off a wart. The equivalent to the U.S. "office hours" for a doctor can be "surgery hours" (but more often "consulting hours"), and in the United States, such a facility is usually called a "doctor's office":

"Kurosaki-kun," said Dr. Ishida, "I can spare you a surgery visit in about 15 minutes."

"Surgery!" Ichigo was startled. "No one said anything about an operation!"

Dr. Ishida closed his eyes briefly and sighed. "What I meant, young man, was that I will be available to see you in 15 minutes in my office for an examination of those strange symptoms you mentioned!"

The reason to be concerned about these differences is that the wrong usage can throw your reader out of the story. If you have a British character, try to make sure her language sounds British when she discusses the medical situation, and do the equivalent for a scene set on the other side of the Atlantic with a U.S. character. And while we're at it, I may as well note also that when victims of a shooting or a road accident end up at the hospital via ambulance, they're taken to the "A&E" ("Accident and Emergency") or to "Casualty" in England but to the "Emergency Room" (or Suite or Department) in the United States.

Sources

• Week 3 Module 2 Lesson 2.4 National Identity: British and American English (Leeward Community College, University of Hawai'i)
• British and American terms (Oxford Dictionaries)
• ‘At hospital / In hospital / In the hospital (forums, WordReference.com)
• Come to set (Language Log, University of Pennsylvania)
• If a British Doctor Invites You to ‘Surgery,’ Should You Be Worried? (BBC America)
• Selected Vocabulary Differences Between British and American English (Boston University; sadly, this is an orphaned page, and its useful-looking linked siblings are gone)
• Surgery (Cambridge Dictionaries Online)

 

Comments

[debirlfan.livejournal.com]

"In hospital" seems to be becoming more common here in the US (at least in southern New England). I'm hearing it locally more and more often. I'm also hearing operations referred to as "surgeries" on a fairly regular basis. Maybe related to the popularity of British tv in the US these days?

[chomiji]

Yes, operations can be called "surgeries," but it's also a general category of procedure – he had plastic surgery or she's recovering from surgery. In the United States, it's not a place where medical procedures are performed.

There are still regional variations in U.S. speech, although they have become less distinct as more people watch the same TV shows and talk together online with others from different areas. Here in the Washington, DC area, I haven't heard "in hospital" myself outside of a British context, but the influence of popular TV shows and even books can turn up in all sorts of places.

[donutsweeper.livejournal.com]

Thanks for this, BrE vs AmE will always befuddle me.

[chomiji]

Certainly I don't always get right myself! But I know how jarring it can be to see errors the other way 'round – when an author from another country gets U.S. expressions wrong – so it's always a topic of interest to me.

[sosaith.livejournal.com]

Well done. I've never seen this explained quite so clearly before.

[chomiji]

I'm glad it worked for you!

[pepper-field.livejournal.com]

FWIW, in the UK, it tends to differ between hospitals vs. general practice (i.e. your local doctor, within the community - are they called GPs in the US?). If you work in a hospital and are trying to track down a consultant, you often get told "They're in clinic", or "They've got clinic on Mondays". This is the session when their patients come in to discuss their illness and the treatment options, some minor treatments are given, etc - basically, the thing that House is avoiding when he says "This is Vicodin. It's mine. You can't have any. And no, I do not have a pain management problem, I have a pain problem. But who knows? Maybe I'm wrong. Maybe I'm too stoned to tell. So, who wants me? [nobody moves] And who would rather wait for one of the other two guys? [Everybody raises their hands] Okay. Well, I'll be in Exam Room One if you change your mind."

We wouldn't call that a "surgery", probably because, in hospital, actual surgery is a distinct possibility and so the likelihood of confusion is greater. If I was trying to find a consultant and was told "They're in surgery", it would be because they were a surgeon and were currently cutting someone open.

I think "clinic" has the same useage in the US, but I could be wrong...?

Whereas everyone refers to "GP surgeries" for the same thing but in the community. "Surgery" in this case refers to both the place ("My GP surgery address is...") and to the session ("My GP holds surgeries at 8am").

Just to add a further level of confusion. ;)

(Knowledge from: I work in a hospital in the UK and a lot of my day is spent trying to track down consultants, only to be told they're in clinic.)

[chomiji]

All this terminology is constantly evolving.   :-)

In the U.S., a "clinic" is a much smaller sort of business than a hospital. It may be a regular, free-standing operation. For example, the "Health Unit" at my workplace could be called a "clinic": it provides 'flu shots, allergy shots, dietary counseling, weigh-ins for those trying to lose weight, and even has an actual doctor a couple of afternoons a week; otherwise, the services are provided by Registered Nurses.

A "clinic" can also be a one-time or periodic temporary event: "The Health Unit will be holding a Glaucoma Screening Clinic next week," for example.

I see that you use "clinic" the way that I expect a person from the U.K. to use "hospital." In the U.S., I'd expect "a clinic" or "the clinic": "That's a nasty cough. Better run down to the clinic and see whether they'll prescribe something."

Although it's certainly possible that some U.S. hospitals refer to the time when the doctors will see walk-in patients as "clinic," I'm much more accustomed to hearing that as "office hours," as opposed to being "on call" at home, for emergencies, or "on shift" or "in surgery" at a hospital: "Dr. Slater will be in surgery Tuesday and Thursday afternoons; her office hours are Monday, Wednesday, and Friday, nine to four-thirty. She is on call, for emergencies only, after hours and on the weekends."

I have heard of a doctor in a larger U.K. facility (a high-quality nursing home, in this case) referring to a medical exam as a "surgery visit," meaning that the patient would visit the doctor's examining room for a full physical workup.

Most of my U.S. hospital knowledge is from being a member of a family with multiple serious health issues, requiring that I spend a lot of time in a variety of hospitals, either as next of kin or a patient myself. Actually, nowadays, a lot of the less invasive procedures are performed in "outpatient surgery centers" or other clinical settings, especially in high-population areas like mine. You have your op or other under-anesthesia procedure (e.g., colonoscopy) and are sent home for recovery.

[azure-chaos.livejournal.com]

With regards: I see that you use "clinic" the way that I expect a person from the U.K. to use "hospital."

Clinics are held in a hospital by specialist departments (they're never walk-ins always by appointment/referral only - the only exception to this is the audiologist who will take walk-ins for people needing batteries changed in hearing aids lol).

Example:
"I've got a hospital appointment," John told Sherlock.

"Oh really? Who with?" Sherlock asked, trying to sound like he was interested.

"The eye clinic."

You'd never say "I have a clinic appointment," but you might say "I have an appointment for the eye clinic at the hospital," and you could also say "I have an appointment for Mr Ball's clinic," when booking in at the hospital (or simply, "an appointment with Mr Ball" but often you don't get to see that consultant but one of their team that works in their clinic). Note: He's "Mr" Ball because he's a consultant (though some consultants still like to be called Dr, they just all like confusing us, I think).

It's not always that simple though, sometimes the 'clinic' is dropped/implied.

"I've got a hospital appointment," John told Sherlock.

"Oh, really? Who with?" Sherlock asked, trying to sound like he was interested.

"It's with ENT." [Ear, Nose & Throat]

That's on top of the example pepper_field gave.

"Where's Mr Ball," Sherlock demanded impatiently as he glared at the man's secretary.

"He's in clinic until 2. And he won't see you without an appointment."

And to add further confusion about the use of 'surgery', when Members of Parliament hold consultations in their local areas (constituency) they call it a 'surgery' too. So "John Doe MP holds a surgery on the first Monday of every month."


I have a feeling that I may have just made things even more confusing. lol.

[chomiji]

:D

I expect that there are lots of specialty uses like that. In the U.S., the sub-unit of a hospital that specializes is almost always called the [Specialty] Department (for example, the Radiology Department) or, if it involves inpatients, the [Specialty] Unit (foe example, the Cardiology Unit ... I guess that would be the Cardiology Ward on your side of the pond?). And as you said for the U.K., it can also just be called by the name of the specialty: "You'll find her up in Oncology."

In the U.S., the term "clinic" now sometimes extends to other opportunities to consult with experts and maybe get things repaired: a "sewing machine clinic," for example, or a "computer clinic."

[azure-chaos.livejournal.com]

Yeah, Radiology is usually 'department'. Unit vs Ward, there seems to have been a shift in recent years to unit for some things. Like you'll have Surgical Ward but High Dependency Unit, Cardiology seems to be one of those that's shifting to unit, at least in my observations, actually I think the one near me goes by "Cardiac" unit. Intensive Care in some places has become ITU (intensive therapy unit). And, as you say, there's always the fact that sometimes we're too lazy to say even department/unit/ward and it just becomes the name of the specialty, "Mr Jones is in Cardiology" vs "Mr Jones is on the cardiology ward/unit" (oddly I've not see that used where it's 'cardiac' so I would wonder if it's mostly an '-ology' thing). And of course, it's not always 'pathology' but sometimes the 'path-lab' where we go to get our blood tests done. lol.

I've seen that use of clinic here too, for computers at least.

[sg-wonderland.livejournal.com]

For one American view of the 'clinic', I tend to think of that more as a place where one would see any one of a number of doctors or maybe just a nurse. Most clinics come with a rotating staff of doctors, especially rural clinics. You might also see a nurse who can administer some shots, but could not write a prescription for, say, antibiotics; that would have to entail a doctor's examination.

My personal doctor has a physician's assistant who works in his office. She can do exams and write prescriptions. (Although technically, they are done on computer and whisked virtually to the drugstore/pharmacy. We don't have chemist's here in the States.)

A specialist (cardiologist, gynecologist, etc.) might be at the clinic one day every week or two weeks depending on the need. But I doubt if you would actually see a surgeon there; most of those visits would be in the surgeon's office or, more likely, in a hospital setting. My personal physician is on staff at a local hospital so if I were ill enough to require hospitalization, he would send me to this hospital because he would be in charge of my care.

[chomiji]

Yes, that's the usual U.S. definition of a clinic; see my response to pepper_field.

From the U.S viewpoint, the U.K. use of "surgery" to mean the facility in which a doctor provides an examination is distinctive and can be startling.

Doctors in the U.S. who perform operations of some sort typically have an office facility in which they provide examinations and perhaps a few other services, as well as "hospital privileges" at one or more hospitals or other larger medical facilities. An obvious example is the usual obstetrics/gynecology set up: you see the doctor(s) for your checkups in the office, but when you deliver the baby or need a D&C, you need to go to a larger facility such as a hospital, although you will be attended primarily by your own doctor(s) – the same one(s) who examined you in the office – while you are there.

The plurals in the preceding paragraph are because in more populous U.S. cities, group practices are very common.

[sg-wonderland.livejournal.com]

Group practices are rare in my rural area; I'm guessing that's basically a city/country type of thing.

I really love it when folks offer this kind of advice for non-American writers trying to write American characters. For me, nothing takes me out of a story faster than hearing an American character using a British-ism or vice versa.

I spent a ton of time the other day (Downton Abbey fic) trying to discover if Carson would carry in the tea tray or if that would be some other servant. I still don't know definitively. I suppose I will actually have to watch an episode to find out. What a sacrifice!

[chomiji]

I think the group practice idea is definitely driven by population. When you have more people, they need more doctors, and when you have a certain number of doctors in similar areas of practice in close geographic proximity, it makes sense to practice as a group: you can split overhead costs (such as running the waiting room and ordering supplies) and back each other up, so no one has to be on call every weekend or evening.

>> What a sacrifice! <<

XD

There's also a marvelous book called Ager's Way to Easy Elegance (1980), written by an old-school butler, that covers a lot of the details of who used to do what. The book is aimed at encouraging modern folks without servants to take proper care of their clothes etc., but a lot of the author's actual experiences come out in his discussion of the various topics. (You would likely have to buy a used copy.)

[azure-chaos.livejournal.com]

From the pov of England (and I say that because I don't know if it differs in Scotland).

Ah see there's another difference there. Now, being male I'm no expert on women's things but in general, you'd only see a obstetrics/Gynae if there was a problem otherwise you would be under your general practitioner (the GP that you see at the 'surgery' (or what the US apparently call a clinic), the woman would go to the hospital ante-natal clinic/maternity unit for scans and if there was a problem would see an obstetrician there, this would not be the doctor who sees them at the GP surgery. And often it'd be a community midwife that you plots your progress while pregnant at the GP surgery and not a GP (though I dunno if the GP is seen at certain milestones or only if there's a problem).

In my experience you only see a specialist (whether that's obstetrics, orthopaedics, surgeons, rheumatologists or oncologists) at a hospital and in order to see them your GP will have to refer you to them (and unless there's something urgent flagged then you'll usually have to wait at least a few weeks to get an appointment, though there is now a fast-track system in place for if it's suspected that you have cancer, though even that can still take a week) in my experience eye clinics are an exception, as you might be sent straight there by a GP or even an opthamologist after a standard eye test (they'd give you a letter and tell you to go straight there if there's something that requires immediate care).

Specialist doctors do have an office but they wouldn't usually see a patient there (it's more where they keep their stuff and go when they're not seeing patients, it might also be where their secretary is), patients are seen in clinics which are held in a group of consulting rooms in part of the hospital. Depending on the size of the hospital they may have a specific area dedicated to each specialty or they might have just one or two areas that will see a different specialist clinic using them on different days, eg. On Mondays and Fridays the consulting rooms were home to the Rheumatology clinic, Tuesdays and Thursdays were Orthopeadics and Wednesdays it was the neurology clinic.

[chomiji]

I'm learning some fascinating details here!

In the U.S., re women and OB/GYNs, the opposite is often true: their OB/GYN often acts as the GP, and the usual yearly checks (blood pressure and so on) are done when their yearly GYN exams are performed. In a subscription health maintenance organization (HMO) like Kaiser Permanente (one of the larger such options in our part of the country), a man's default doctor will typically be a GP, but a woman's will be an OB/GYN. (And a child's will be a pediatrician.)

Of course, there is no national health service (yet, anyway) in the United States. If you belong to an HMO, the same specialty referral practice you describe is followed: your "primary care physician" must write a referral (and it will usually be to another doctor in the HMO system, unless you have a very exotic problem). If you have "traditional" health insurance (sometimes referred to as "pay as you go"), you can freelance this, if you're willing to pay "out-of-pocket" to at least some extent. If you don't want to go back to your usual doctor for a referral, you can in theory call any doctor you wish. If the doctor is on your insurance plan, you pay a small flat fee (after your yearly "deductible"). Otherwise, you pay out of pocket and file with your plan for a refund. Most plans have a set rate at which they will reimburse you for these "out-of-network" services.

Most specialists here who are not part of HMOs (which have their own health service facilities, rather like small hospitals but without emergency rooms or major surgery suites) rent office space. Sometimes the entire building is devoted to medical services, but often, at least in major urban areas, the doctors will be in a building that also houses other professionals who need office space, including lawyers, real estate title services, and so on.

[azure-chaos.livejournal.com]

I'm learning something too. :)

Yup, everyone here just goes to a GP, men, women & children as a first point of contact for everything. Often surgeries will also run things like an 'asthma clinic', which are often run by the practice/surgery's nurse. And, apparently it's usually a nurse at the GP's surgery who will do the women's smear tests once every 3 years (unless you're high risk); my sis-outlaw said it's rare that a GP will get involved in doing those but anything that's not routine is likely to go through the GP then referred to a specialist.

It would be wonderful to be able to choose which doctor's services you want to buy. In theory we were supposed to be getting this choice, but it's not happened as far as my experience. Of course, we do have the option of private health insurance, but that's another issue altogether lol.