Gawande explains his sentence-level discipline: I generally use the language we use rather than I really dislike it when someone... it feels like I'm reading someone who's talking down to me and not giving me the terms that they use... I try as much as possible to not use the kitty words, but to use the actual words.1 He uses enamel, pulp, atrophies, saliva in writing about teeth aging — actual dental terminology. He doesn't substitute the white outer layer for enamel. He uses the precise term and trusts the reader to either know it or pick it up from context.
The discipline is anti-condescension. Writers who substitute kitty-words (cute approximations of technical terms) signal to readers that they think the reader can't handle real vocabulary. Readers detect the signal. The condescension produces a flattening of the text — everything reduced to general-audience approximations.
Actual-words is the vocabulary-precision discipline that requires writers to use the real terms of their subject rather than approximations. Three components:
Use the technical word. Enamel, not the white outer layer. Cardiologist, not heart doctor. Atrophies, not shrinks. The precise word does specific work.
Define when necessary, in context, briefly. A new word can be defined in a phrase. The pulp — the inner soft tissue of the tooth — atrophies with age. The definition is embedded, not parenthetical. The reader picks up the word and the meaning together.
Trust the reader to either know or learn. Readers are smarter than condescending writers assume. They either already know the word or can absorb it from context. Either way, the actual word communicates more precisely than the kitty word.
The need fires for writers covering technical material who fear losing general audiences. The fear produces over-translation — every technical term replaced by approximation. The result is text that loses specificity without gaining accessibility.
Three mechanisms:
Technical words carry precise meaning. Enamel is enamel. The white outer layer could be many things. The precision matters because the precise word activates specific meaning the approximation can't.
Reader-respect produces engagement. Readers who feel respected by writers engage more deeply. Readers who feel condescended-to disengage.
Vocabulary builds across pieces. Readers who pick up enamel in one piece carry it forward. Readers who only ever encountered the white outer layer don't build technical vocabulary. The actual-words discipline contributes to the reader's intellectual development.
Actual-words pairs with steadicam-voice (show what's happening with sensory detail). It pairs with sentence-craft (visual + action verbs + each sentence necessary). The three together produce Gawande's signature prose — technically precise, sensorially vivid, structurally efficient.
The hardest substance in the human body is the white enamel of the teeth. With age, it wears away nonetheless, allowing the softer, darker layers underneath to show through. Meanwhile, the blood supply to the pulp and the roots of the teeth atrophies, and the flow of saliva diminishes.2
Read the vocabulary:
Enamel: actual word. Not outer layer. Pulp: actual word. Not inner part. Atrophies: actual word. Not gets worse or shrinks. Saliva: actual word. Not spit.
Each is defined by context — the reader who didn't know what pulp was learns from the roots of the teeth atrophies. No explicit definitions slow the prose. The technical vocabulary lands as natural, not jargon-y, because the surrounding prose is concrete and visual.
The combination produces text that's simultaneously medically accurate and immediately readable. General audiences finish the passage; medical readers don't feel talked-down-to. The actual-words discipline serves both audiences.
You're writing about technical material. Audit your draft for kitty-words.
For each instance of approximation (the part that does X), check: is there a precise term? Replace the approximation with the term. If the reader might not know it, embed a brief contextual definition. Don't apologize for the term. Don't parenthetically explain it. Trust the embedding to do the work.
After the pass, read the draft. Most writers find the prose has gotten more readable, not less, because the actual words carry meaning more efficiently than approximations.
You'll know condescension has trapped you when your prose is filled with approximations. The fix is the actual-words pass.
You'll know jargon has trapped you (the opposite failure) when readers struggle with vocabulary that wasn't defined in context. The fix is embedded definitions, not approximations.
Karlsson's body-state writing doesn't depend on technical vocabulary — it depends on sensory-somatic vocabulary. Different vocabulary register; same underlying respect-for-reader principle.
The compound insight: actual-words is anti-gatekeeping jargon-discipline + contextual-vocabulary-acquisition pedagogy applied to writer practice.
The Sharpest Implication
If your work is criticized as either too jargon-y or too dumbed-down, the diagnosis is wrong calibration. The fix is actual-words-with-embedded-definitions. Use the precise term; let context do the defining.
Generative Questions