Is ‘Borderline’ the Most Abused Term in Medicine?

The term “borderline” seems innocuous on the surface. A placeholder. A soft warning. A linguistic shrug. But in modern medicine, it may be one of the most vague, misused, misunderstood, and overused terms in both clinical conversations and medical documentation.

Ask ten clinicians what “borderline” means in a given context—borderline personality disorder, borderline anemia, borderline glucose intolerance—and you might receive ten very different interpretations. And yet, the term persists. It fills discharge summaries, permeates handovers, and slips into diagnostic labels with unsettling ease.

This article takes a close look at how the term “borderline” has evolved—or devolved—in clinical use, what kind of harm it can lead to, why we tend to lean on it so frequently, and what better alternatives might exist.

The Clinical Comfort Blanket of Uncertainty

Doctors are trained to seek precision. We quantify lab values, stage cancers, assign ICD codes, and track biomarkers. But when we encounter a gray area that resists exact categorization, we often reach for “borderline” like a verbal comfort blanket.

Why?

Because it:

• Buys time
  
  
• Helps avoid hasty decisions
  
  
• Communicates uncertainty without admitting lack of knowledge
  
  
• Offers a form of medicolegal protection by not stating anything definitive

But the comfort it provides to clinicians often comes at a cost—typically, to diagnostic clarity and patient understanding. What we gain in flexibility, we may lose in effective communication.

‘Borderline’ in Labs: Medicine’s Middle Child

Laboratory values exist on a continuum. However, clinical practice frequently categorizes them in binary terms: normal, abnormal—and the dreaded “borderline.”

Some examples illustrate the issue well:

• Borderline anemia: Is it a sign of early iron deficiency? An evolving chronic disease? Or just a normal variation?
  
  
• Borderline high cholesterol: Should we start treatment? Monitor? Consider lifestyle changes?
  
  
• Borderline creatinine: Are we seeing the start of chronic kidney disease or is this temporary, dehydration-induced?

Rather than encouraging a nuanced interpretation of evolving lab values, the term “borderline” often shortcuts our thinking and delays meaningful action. What these values typically require is trend monitoring, reference to patient-specific baselines, and thoughtful risk assessment—not a vague label that clouds more than it clarifies.

The BPD Dilemma: When ‘Borderline’ Becomes a Label

No discussion about the misuse of “borderline” would be complete without addressing Borderline Personality Disorder (BPD).

Here, “borderline” is not a vague clinical adjective but a formally defined psychiatric diagnosis. Unfortunately, it’s frequently misused in casual, often pejorative ways, such as:

• Colloquially: “This patient’s so borderline,” often without any proper psychiatric evaluation
  
  
• Pejoratively: To imply manipulation, noncompliance, or behavioral difficulty
  
  
• Dismissively: As a shorthand to avoid deeper psychological engagement or referrals

This misuse is harmful. BPD is a legitimate diagnosis, with clear DSM-5 criteria and validated treatments such as Dialectical Behavior Therapy (DBT). When misapplied, the term fosters stigma, derails appropriate care pathways, and alienates patients—especially in high-pressure settings like emergency departments or primary care.

Prematurely labeling someone as “borderline” without proper evaluation can:

• Delay referrals to psychiatric or behavioral health services
  
  
• Bias future providers against the patient
  
  
• Undermine rapport and therapeutic alliance

In Imaging Reports: The Radiologist’s Eject Button

We’ve all read imaging reports peppered with statements like:

• “Borderline cardiomegaly”
  
  
• “Borderline enlarged lymph node”
  
  
• “Borderline disc bulge”

In these instances, the term is often used when a finding doesn't meet full diagnostic criteria for pathology but also isn’t entirely within normal limits.

The downside of these descriptors?

• They rarely prompt definitive action
  
  
• They sow confusion for referring clinicians
  
  
• They may cause either underreaction or overtesting
  
  
• They often provoke undue anxiety in patients when disclosed

More informative language—such as “likely within normal variation,” “needs clinical correlation,” or “suggests early change”—could improve clinical decision-making and reduce ambiguity.

Borderline Diagnoses in Clinical Practice: Neither Here Nor There

Certain diagnoses naturally fall along a spectrum, yet we often categorize them as “borderline” without further clarification:

• Borderline gestational diabetes
  
  
• Borderline hypothyroidism
  
  
• Borderline hypertension

This approach may suggest nuance, but it often leads to more questions than answers. Should this patient be treated? Observed? Educated? Will this condition resolve on its own or progress?

Instead of resorting to imprecise labels, clinicians could:

• Contextualize with comorbidities and risk profiles
  
  
• Track values over time
  
  
• Use tools like ASCVD risk scores or HOMA-IR
  
  
• Engage in shared decision-making to personalize care

Medicine is not black and white. But that doesn’t mean it must be gray and vague.

Borderline as Code for “We Don’t Know What This Is Yet”

In certain cases, “borderline” is a stand-in for diagnostic limbo:

• Borderline lupus
  
  
• Borderline connective tissue disease
  
  
• Borderline seizure disorder

This usage often reflects genuine clinical uncertainty. Yet simply labeling a patient as “borderline” does little to move the diagnostic process forward.

Instead, clinicians should:

• Clearly document which diagnostic criteria are met—and which are not
  
  
• Specify a plan for re-evaluation, testing, or specialist referral
  
  
• Communicate openly with the patient: “We are investigating a possible condition; here’s what we’re watching for.”

Owning diagnostic uncertainty is not a weakness—it’s an honest reflection of medicine’s complexity.

The Medicolegal Mirage: Defensive Vagueness

“Borderline” can also serve as a medicolegal safety net.

Clinicians might use it to:

• Avoid committing to a specific diagnosis prematurely
  
  
• Cover themselves in documentation
  
  
• Leave room for reinterpretation later

But this defensive vagueness can create clinical risk. Take, for instance, a patient discharged with “borderline QT prolongation” who later receives a QT-prolonging drug like a macrolide—and develops torsades.

Could clearer documentation or risk communication have prevented that outcome?

By relying on vague language, we may inadvertently introduce risk rather than avoid it. Clarity protects patients—and providers.

The Impact on Trainees and Interdisciplinary Teams

On teaching rounds and in multidisciplinary handovers, the term “borderline” can create confusion for junior clinicians, nurses, and allied health professionals.

Examples include:

• “Borderline septic”
  
  
• “Borderline stable”
  
  
• “Borderline dischargeable”

These phrases often lack concrete meaning. Does “borderline septic” mean the patient is febrile with no source yet? Does “borderline dischargeable” mean we’re waiting on one final test?

To improve communication, we should:

• Be explicit about concerns and differential diagnoses
  
  
• Define thresholds for intervention
  
  
• Clarify monitoring plans and escalation triggers

Especially in team-based care environments, vague language can hinder coordination and delay critical actions.

Patient Perception: The Anxiety of Ambiguity

Patients frequently ask, “Doctor, what does borderline mean?”

And the honest answer—“You’re in a gray zone”—often sounds like medical limbo. They may feel:

• Falsely reassured, thinking no action is needed
  
  
• Ignored or dismissed, if symptoms persist but aren't taken seriously
  
  
• Confused about follow-up plans
  
  
• Anxious about what the future holds

Poor understanding can result in reduced compliance, lost to follow-up, or avoidance of future care altogether.

Clinicians must remember: the words we use not only inform; they influence emotions and behaviors. Clear, compassionate explanations foster trust and adherence.

The Language We Choose Reflects the Care We Deliver

Language is not incidental to medicine—it’s foundational. The words we choose shape how we diagnose, how we communicate, and how patients engage with their own care.

The term “borderline,” when used carelessly:

• Blurs diagnostic clarity
  
  
• Perpetuates stigma and bias
  
  
• Obstructs interdisciplinary communication
  
  
• Undermines shared understanding

Instead of abandoning the term entirely, we can commit to using it with greater care:

• Always define the context and criteria
  
  
• Pair with clear follow-up or monitoring plans
  
  
• Prefer descriptive or quantitative alternatives when available
  
  
• Avoid casual or stigmatizing usage, especially in psychiatric settings

Conclusion: Medicine Deserves More Than Vagueness

“Borderline” is not an inherently bad term. But its overuse and misuse point to a deeper problem: how medicine navigates uncertainty.

As we strive for more data-driven, personalized, and transparent care, our language must evolve in parallel.

Let’s move beyond vague descriptors and choose words that reflect thought, clarity, and respect for the complexities of medicine—and the people we serve. In a profession built on precision and trust, ambiguity disguised as diagnosis has no place.

Our patients—and our colleagues—deserve better.