Noun Clauses as Subjects and Objects

• Advanced medical discussions often require nominal clauses to frame diagnostic uncertainties as subjects or direct objects. Using structures like 'what', 'whether', 'how', or 'the fact that' allows consultants to express complex clinical hypotheses smoothly.
• Function
• Structure / Marker
• Example in Clinical Context
• Subject Clause
• What + clause + verb
• What worries me is whether this is IgG4-related disease.
• Object Clause
• the fact that + clause
• We must consider the fact that multiple organ systems are involved.
• Indirect Inquiry
• whether / how + clause
• Dr. Vance investigated how the rare symptoms correlated.
• Remember
• Use 'What' clauses as subjects to highlight a specific clinical issue or mystery.
• Use 'the fact that' when introducing a concrete diagnostic reality that cannot be ignored.
• Use 'whether' to present an unresolved alternative or binary differential diagnosis.
• Ensure the noun clause takes a singular verb agreement when functioning as the subject of a sentence.
• Examples
• What puzzled the specialists at Johns Hopkins Hospital in Baltimore was whether the rash constituted a new syndrome.
• The board examined how the conflicting lab results could coexist in a single patient from Seattle.
• We cannot dismiss the fact that this presentation defies Occam's razor entirely.
• Common mistakes
• What worries me are whether we should defer the biopsy.
• What worries me is whether we should defer the biopsy.
• The fact which she presented a fever changed our hypothesis.
• The fact that she presented a fever changed our hypothesis.

Complete the sentences

• (what / concern) ____ is whether the patient can tolerate ambiguity.
• We must evaluate (how / manifest) ____ across various systems.
• (the fact / that) ____ has emerged complicates our care.
• Dr. Miller questioned (whether / overlap) ____ explains the multisystem involvement.
• (what / puzzle) ____ in Boston was the lack of tissue diagnosis.
• She focused on (how / approach) ____ the pending diagnostic closure.

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