The issue is the use of commas with subordinate clauses, especially those
that begin with "which."
Comma usage in subordinate clauses is probably the most difficult aspect of
comma use. The bad news is that it IS difficult; the good news is that almost
everybody has the same problems with them, with the result that there is a lot
of leeway in how you use them.
You know what a subordinate clause is, I am assuming. Clauses - among other
things - are either restrictive or nonrestrictive. If they are nonrestrictive,
they require the comma. If they are
restrictive, the comma does not need to be there. The same rules apply to some
phrases as well as clauses. The essential question is whether or not the
sentence communicates what is intended (the main message) if the clause is not
there. Look at the following examples:
Give me the book which is on the hall table.
The book, which is one I have read many times, is on the hall table.
The first sentence is restrictive. Without the information in the clause there
is no way for the
listener to know what book - out of all the books in the world - is the one I
want.
The second sentence is nonrestrictive. While the fact that I have read the book
many times is
interesting perhaps, it is not essential to the meaning of the sentence.
The MS Word grammar check offers the following test: If you can substitute a
"that" for the "which," the clause is restrictive. The rule is of limited
usefulness in medical transcription because "which" is so commonly used, but you
can apply it to the sentences above and see how it works for you.
More examples:
My brother, who is 72 years old, runs the gaming operations on a casino ship out
of Cape Canaveral.
With the commas, the clause is nonrestrictive, and the meaning is that my
brother runs the gaming operations; his age is really irrelevant to the point I
am making.
My brother who is 72 years old runs the gaming operations on a casino ship out
of Cape Canaveral.
This time the clause is restrictive, and it means that my 72-year-old brother,
not my 67-year-old brother, runs the gaming operation. That is, his age is given
to distinguish him from any and all of my other brothers and is required to
properly identify him.
Let's look at some medical examples:
He had a CT scan, which showed no significant abnormality.
He had a CT scan which showed no significant abnormality.
It seems to me that the comma is optional in a sentence like this, although
there is a very subtle
difference in meaning if the comma is not there, the implication being that he
has had CT scans
before that DID show an abnormality. This is the kind of sentence that you could
argue for either way, on the very remote chance that your QA person would ever
even mention it to you.
He was started on an aggressive physical therapy regimen, which showed almost
immediate beneficial effects.
We gave him the antibiotic which historically he had responded to the best.
He was taken to the operating room, at which time he received a general
anesthetic.
The anesthetic, which had never bothered him before, caused severe itching of
his face and
extremities.
The patient, who has been seen in this facility frequently, was brought in with
an acute COPD
exacerbation.
Patient has had severe reflux esophagitis which has failed treatment with
cimetidine and ranitidine.
She has occasional crackles which clear with coughing.
Sometimes, of course, it is impossible to tell whether the clause is restrictive
or nonrestrictive,
in which case you can choose to use the comma or not. And sometimes, perhaps for
the sake of
emphasis, the dictator will pause before the clause. In those cases I put the
comma in because it
does add emphasis and more accurately reflects the dictator's delivery.
By JoJean Loflin, Director of Student Affairs/Graduate Services, Career Step
Medical Transcription Training Course
