Correspondence

Here’s a dermatology riddle: You can describe me, you can measure me, you can experience me. I’m very common and important. But I don’t have a name. What am I? The answer is “quality of life impairment” (1).

The main purpose of proposing the new word “quimp” to mean “quality of life impairment” is to facilitate the integration of thinking about quality of life (QoL) into routine clinical practice (2). Having a single word might also accord the subject more importance. Attention to ideas may be held back by only being able to express a concept in a clumsy way, using several words. If you had to say “the feeling that makes you want to scratch” instead of “itch” or “the feeling that makes you cry” instead of “pain” then less attention may have been paid to these issues. A single word may help communication and give a “personality” to an idea: it is more awkward to describe your daughter as “our new little girl, we’re still trying to agree a name” than to call her, say, Mary.

The origin of quimp is obvious: “QUality of life IMPairment”. The word appropriately rhymes with and sounds like “limp”, that quintessentially describes a physical impairment. Words describing the most important things are usually single syllables: love, war, peace, food, sex, sun, rain. Key words in dermatology are also often single syllable: itch, pain, scale, red, rash, scratch, spot. Quimp is one syllable instead of the eight of “quality of life impairment” and is easy to remember and pronounce (“kw?mp”, to rhyme with “limp”). Communication is aided by using simple unambiguous words, rather than long descriptive phrases.

Some examples of the possible uses of quimp are: “How severe is that patient’s quimp?”, “Did you measure his quimp?”, “How can we improve her quimp?”, “That child’s eczema is quiescent, it’s hardly causing any quimp”, “His quimp should improve quickly once he starts the biologic.”  “Quimpic” is the derived adjective, meaning “having or resulting in quality of life impairment”. Examples of its use might be “It’s on her face so it’s a very quimpic hemangioma”, “He’s keen on swimming so the psoriasis could be quimpic for him.”

Some song phrases “earworm” their way into our subconscious (3): perhaps single words can have the same effect. If quimp became embedded in our minds and our vocabularies it might subconsciously trigger our thinking about QoL impairment. Perhaps it could influence thinking and attitudes about the attention we should give to this aspect of patient experience and care.

New words are always being created. Dermatologists have constantly been inventing new words, mainly to describe diseases or symptoms. There was a flurry of such activity in the early 19^th century as the battle raged between the Willan (4) and Alibert classifications: the process continues whenever new diseases or concepts arise that need to be defined and communicated. There are at least 12 types of new word formation (5). Quimp is an example of a “portmanteau” word developed by “blending”.  Although their origins go back to Latin and earlier, the words “quality” (qualité) and “impairment” (empeirer) come via Old French (6) from the 13^th to 14^th centuries: at that time the rulers in England still spoke Anglo-Norman French. So the “new” word quimp has a long historic pedigree.

As with many words, “quimp” has several meanings. It is defined (7) as “a graphic element, used within maledicta balloons in comics to represent obscenities, curses and swearing, resembling the planet Saturn.” Written as “QuimP,” it is the name of software used to quantify spatio-temporal patterns of fluorescently labelled proteins in the cortex of moving cells (8). Neither use is likely to cause any confusion in this totally different context. And it is nothing to do with the Brittany town Quimper.

There are several limitations to the quimp proposal.
Although suggested in the context of health related QoL, the word quimp seems to make no distinction between health related QoL and the more general concept of QoL. Quimp could be used in any of these contexts to mean “quality of life impairment”: it is a generic word that could be used in any area of medicine or beyond. It is virtually impossible to conduct a meaningful prospective trial concerning a new word proposal: however the prospect remains of tracking the use of quimp in future publications. No Delphi process or discussion groups were involved in developing this proposed new word: the idea will either sink or swim. Quimp encompasses the pronunciation of the pejorative term “wimp” and the archaic vulgarism “quim” as well as the mischievous “imp”. However in English, words commonly closely resemble others while maintaining clear separate meanings and not being perceived as associated, such as “quilt, wilt” and “quit, wit.”

It could be said that there is no need for a new word when existing words such as “affliction” or simply “impairment” could be used. These words would also make sense in the examples given above. However they are too general descriptors and miss the point that we need a specific word around which to focus attention. Of course not every concept needs a specific word: the English language does work well with descriptive phrases. However there is a “political” motivation to this proposal in promoting attention to QoL issues in dermatology.

So the answer to the riddle was “quality of life impairment”. But the solution to the problem that the riddle revealed could be “quimp”.

AYF is copyright owner of several quality of life indices.