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Dr. Brian Deady is compelled to correct one of medicine's most commonly misspelled words

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I still enjoy working with medical students, after more than two decades in emergency medicine. They are usually wide-eyed and eager, and their enthusiasm is infectious.

After all this time, our routine is well established: We meet in the turmoil of the ER and, just before the shift starts, we steal away to get a coffee at the Tim Hortons in the hospital. The medical students seem to appreciate the gesture – the caffeine imbibers, I mean.

Thereafter, the day proceeds in the usual fashion: I do my work and oversee theirs. We meet between patient interactions and they recount the histories they have gathered, the handwritten record lying on the countertop between us. I listen, at least I try to, but emptying my head of the surrounding distractions often proves difficult. It helps, I've found, if I can follow the words written, or more and more often now, printed, on the patient's chart.

Today, I am paired with a young man who seems bright and keen to learn. He has just done a history and physical examination, his first of the day. I hear his presentation, "Alexa P. is a three-year-old girl, brought by her mother with a one-day history of vomiting and diarrhea." But what I read on the chart is the word written with a double "t" before the "ing": vomitting.

I simply cannot recall, I think to myself, how many times I have seen this word spelled incorrectly during my career. Not just the medical learners but even some of my fellow physicians, paramedics and nurses spell it with a double "t." I understand that. I do, really. I'm partial to double-doubles myself, but then again, that's a Canadian cliché. And anyway, that's coffee, not tea, er, I mean, "t."

How could this be, though?

I think it through to reassure myself that the vast majority of students who add an extra "t" to the gerund form of the verb to vomit are anglophones; the English-as-a-second-language students, on the other hand, mostly seem to get it right. In fact, I blame one of my former colleagues, a French-Canadian, for opening my eyes to this error years ago, when I first started working in our department.

"If there is one word you English can't spell, it is vomiting," François said, unleashing what would turn out to be decades of torment upon my inner grammar-geek.

But in the moment, while listening to the history of a three-year-old's vomit(t)ing and diarrhea, I can't stop myself from trying to recall the rule about adding "ing" to a verb. Let's see, does one add an extra consonant, always, sometimes or does it depend on whether you prefer American or British orthography?

I remember reading in Lynne Truss's book Eats, Shoots & Leaves that for the past several decades in the majority of schools in the English-speaking world, students have not been taught grammar and punctuation. Perhaps in today's world of electronic autocorrect, spelling has been de-emphasized, too? I'm not sure, but what I do know is that "vomitting" gets my vote for the most common spelling error on medical charts.

Emergency medicine's knowledge base is vast. The latest two-volume, synapse-snapping, bicep-building version of the discipline's most commonly studied textbook, Rosen's Emergency Medicine, runs to over 2,800 pages. My choice of what to teach any student is limited only by my own experiences and familiarity. I ask myself if correction of a spelling mistake, even a very common one, is a legitimate teaching mission for a clinical educator? Or have I crossed the line to become a pedantic prick with a pet peeve? Hmm, I have to wonder.

The student's narrative history of Alexa P. draws to a finish. He waits for me to comment or ask questions. There is a brief moment where the silence between us becomes slightly uncomfortable. I jump to it and decide.

"Okay, good history. I get a pretty fair idea of the patient and the presenting complaint. You didn't discuss management of the problem but we can work on that after we see her together. So, let's go."

Then just as I turn to walk to the toddler, I stop and throw this in, "Oh. By the way, almost forgot, you misspelled a word there, in the written record, you know."

"Oh, really? Which one?"

He seems embarrassed by this, as students so often are. I try to lighten the mood as I explain the problem.

"Don't worry about it. You're not the first and surely not the last, either. I'm thinking of having a sweatshirt made that says, 'Vomitting: It's not a T-Party!' Except, I doubt my humour would amuse anyone but me."

The student gives a polite but forced chuckle, which serves to reinforce the thought that I should keep spelling-bees in my bonnet and lame jokes to myself. We walk to his young patient and the double-t time is forgotten.

Finally, here is the rule: Double the last consonant when adding a vowel suffix to words ending in one vowel followed by one consonant, only if the syllable before the suffix is accented. This is always true for one-syllable words.

There, you see? English spelling rules are arcane and often difficult to remember. Regulations be damned, the written form of some words simply must be memorized. Vomiting is one of them.

Dr. Brian Deady lives in Coquitlam, B.C.