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Feature Christmas 2019: Let it Be

Extraneous vowels and doctor productivity: an international comparison

BMJ 2019; 367 doi: (Published 17 December 2019) Cite this as: BMJ 2019;367:l6111
  1. Jennifer Kasten, assistant professor, pathology and cardiology
  1. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
  1. Correspondence to J Kasten jennifer.kasten{at}

George Bernard Shaw once quipped that the United States and the United Kingdom (and, by default, the Commonwealth) are “two nations, divided by a common language.”1 We assume he was referring to the United States’ system of spelling, which began to diverge from Britain’s in the 1830s under the influence of dictionarian Noah Webster.2

Based on 2005 estimates, the US has the highest worker productivity among English speaking nations: 67.32 as a ratio of gross domestic product to purchasing power.3 In contrast, Australian worker productivity is 55.87, followed by the UK at 51.38, Canada at 50.29, and New Zealand at 36.83. It is possible that, in the medical realm, time spent typing (or writing) the extraneous vowels in British English accounts for these differences. This becomes the proverbial albatross in inpatient and outpatient settings with heavy documentation burdens, reaching …

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