Vague unease

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EDITORIAL

Vague unease

Barbara
Fountain
2 minutes to Read
VAGUE Paper page idea 15.jpg
The editor envisages a new publication, but hardly a satisfying read

Barbara Fountain has been thinking about why we’re awash in a flood of opaque wordings

What is it with vagueness that it now seems to dog the COVID-19 response?

It seems only last month I was writing about how complicated it is to make things simple – and, actually, it was only last month.

Now I find myself mired in vagueness and ambiguity. Not of my own making, I might add.

Who would have thought that, hot on the heels of slightly confusing, though now possibly resolved, guidelines around care of COVID patients in the community, along would come vague law around medical exemptions for COVID vaccinations.

As I write, general practice awaits clarification of the vaccination order that allows a worker to be exempted from vaccination if a “suitably qualified health practitioner” finds it is inappropriate for them to be vaccinated for “particular physical or other needs”.

What were they thinking?

It certainly got me thinking. What is it with vagueness that it now seems to dog the COVID-19 response?

Part of the answer lies in the hard-to-fathom nature of viruses themselves, with their variants and changeable symptoms. But official declarations around vaccination should not lend themselves to vagueness.

So, with a vague sense of uncertainty, I set out to discover all I could about vagueness. I surveyed the territory between vague and ambiguous: vague means the information is lacking in detail; ambiguous means the content can have more than one meaning and the reader might have difficulty knowing exactly what is meant.

I imagined launching a magazine with the masthead VAGUE, featuring people in rooms, sitting around tables, looking at whiteboards, looking out the window, looking at their phone, looking at figures.

When I came across an academic paper in the European Journal of Pragmatism and American Philosophy (a merger, perhaps, of trans-Atlantic minds?) entitled “Vague certainty, violent derealisation, imaginative doubting”, I learned that vagueness has a huge academic following.

On the clinical front, ambiguity and vagueness in clinical practice guidelines reduces the likelihood of clinician adherence, according to a paper which, although published in 2005, resonates still.1 The authors propose a model – complete with flow chart – to eliminate unnecessary ambiguity and vagueness in practice guidance. They also warn of the danger of removing deliberate vagueness when seeking to “disambiguate” ambiguity.

Interestingly, it is noted that using vague terms in clinical guidelines is more likely when a recommendation presents an unusual financial burden. Useful tip.

Elsewhere, I noted the NHS has a Vague Symptoms Service.

There are online articles devoted to assisting with the use of vague language so the speaker remains vague without sounding vague.

Vagueness creates the tension of uncertain meaning, a vacuum which many listeners will fill with their own detail rather than exist with uncertainty.

One writer suggests using vagueness deliberately to promote conversation by ensuring the person to whom you are delivering vague pronouncements must ask for clarification.

Surely, health officials weren’t treating the vaccination order as a conversation starter – another one – between primary care and health-system hierarchy? If so, the vacuum has been filled with yet another chorus of disbelief.

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References

Codish S, Shiffman RN. A model of ambiguity and vagueness in clinical practice guideline recommendations. AMIA Annu Symp Proc 2005;2005:146–50.