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practical in medicine, they should be as operational (usable as decision mak-
ing tools) and precise and usable in practice and research as possible. Other
deinitions are stipulative (coining new phenomena), lexical or reportive (how
the word is actually used), precising (eliminating vagueness), theoretical (for-
mulating an adequate characterization), motivational and persuasive (influenc-
ing attitudes in a rather metaphysical manner) or essentialist (specifying the
nature of the phenomenon to which the term refers). 26
For a health professional, entities are defined in the context of and in compar-
ison with other entities defined in a way to make them usable and useful if they
Discriminate and are clearly separated from other possibly competing
entities related to the problem
Represent a distinct substrate, different from others
Are, if possible and desired, measurable and otherwise subject to quan-
tification (counting)
Are subject to grading (degree, direction attributing)
Are categorizable within a classification in a specific context
Reflect and relate to a specific decision about an action to be taken
Have operational inclusion and exclusion criteria which distinguish such
an entity from others
Are mutually understood, hence warranting reproduction, repetition,
and reuse
Definitions themselves, regardless of how we deal with the problem of
interest, establish if our understanding and approach are good, bad, usable,
or meaningless.
For example, a definition of EBM as “the conscientious, explicit and judi-
cious use of current best evidence in making decisions about the care of
individual patients” 27 may be an excellent motivational definition, but if we
do not define “evidence” in context, as well as conscientious, explicit, judi-
cious use, and best evidence, can the reader say in operational terms who is
a practitioner of EBM and who is not, and ultimately, what is EBM and what
is not? We doubt it. 28
Elsewhere, for example, saying that “… our medicine is about … ” rather
than “is ” may be read by some as avoiding its definition itself.
In the new domain of knowledge translation, there are so many defini-
tions of it that they merit an online regroupment. 29
Definitions are a strategic resource for the arguer, ideally clear enough
to avoid common fallacies of meaning 18 like vagueness, equivocation (same
word having different meanings in the same argument), and others. 16
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