Effective communication is the key to success in almost all endeavors. This is particularly important in medical practice, where poor communication fosters poor patient care, sometimes with fatal outcomes. In that light, many medical manuscripts that routinely cross my desk have conspicuous grammatical mistakes, punctuation errors, and confusing sentence structure. But in all fairness, proper use of the English language is not easy and can itself be confusing.

There are words, for example, that look wrong to your eye but sound right to your ear. Such incongruity is typical of misused homophones—words that sound alike but differ fundamentally in meaning, origin, and spelling.1  “The heroine used a vile vial of heroin.”

Some words look alike and are spelled alike but are pronounced differently and have different origins and meanings. They are called homographs 2 : “He stood on the bow of the ship and played the violin with a bow. The invalid had an invalid driver's license.”

Still other words have oxymoronic features. For instance, there is no egg in eggplant, no ham in hamburger, and no pine or apple in pineapple.3  Moreover, paradoxes abound: quicksand works slowly, boxing rings are square, and a guinea pig doesn't come from Guinea, nor is it a pig.3 

For readers who appreciate remarks of this sort and who welcome mental challenges, I offer my paraphrased version of an intriguing commentary on the word “up.” 4 

Up means toward the sky or at the top of the list. Yet, it is correct to say that we wake up and speak up, that topics come up for discussion, that officers are up for election, and that it is up to the secretary to type up a report. We also call up our friends, brighten up a room, polish up the silver, warm up the leftovers, clean up the kitchen, lock up the house, fix up the car, stir up trouble, line up for tickets, work up an appetite, think up excuses, dress up for special occasions, open up a stopped-up drain, and close up a store at night and open it up in the morning.

When rain threatens, we say that it's clouding up. And when the sun comes out, we say it's clearing up. Rain can mess things up, but without it, things can dry up.

To prevent any mix-up about the use of Up, we can look up Up in the dictionary, where it takes up lots of space and adds up to a slew of definitions. But if you're up to it and don't give up, you can build up many more ways to use Up, winding up with several hundred or more.

As a follow-up, I decided to dig up, pull up, turn up, and put up as many words as I could find to use with Up (Table I). I know up front that my list is incomplete and that some readers will be up in arms. They, in turn, will no doubt rise up to upstage me and will up my totals. At any rate, Up seems to have more meanings than any other 2-letter word in our lexicon.

Table I.

Words Used with Up to Create Different Meanings*

Words Used with Up to Create Different Meanings*
Words Used with Up to Create Different Meanings*

Now my time is up. So I'll wrap things up and respectfully shut up!


Homophones: sound-alike impediments to effective communication
Tex Heart Inst J
Medical English usage and abusage
The Oryx Press
Let's face it: English is a crazy language [Internet]
. .
Available from: http://gpsinformation.info/main/UP.txt [cited 2015 Mar 26]

Author notes

†Dr. Fred died 30 December 2018. This is one of his final papers.