Language Choice in Health Care

Recently I read a fantastic blog post by @RenzaS, a writer with Diabetes who shares her perspectives on the patient experience and is a patient advocate. You should first read her post here on “Difficult Patients” to get background on this discussion.

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How we say things matters as much as what we say.

As a physician, an avid reader, and an unrefined, unexperienced writer, I understand the importance of our language and word choice. In my line of work, daily, I must pick my words carefully to help explain complex medical problems in a way my patients and their loved ones and caregivers can understand. I feel one of the services I provide my patients is actually translation – I translate the complex medical problems, treatments, and research I am tasked with understanding into terms my patients can understand.

That being said, I have to say that many health care professionals, in my experience, use language and terms that can be construed as offensive and derogatory. I bring up the issue because I want to encourage readers who are physicians, nurses, physician assistants, nurse practitioners, technicians, paramedics, etc, to consider changing the way they discuss patients and their care.

Below are some examples of terminology I have heard over the past 13 years which makes me uncomfortable. When I hear these terms, I cringe. I refuse to use them myself.

  • Patients in rooms or beds referred to by their room number, not their name, or even worse, by their disease or chief complaint.
    • Example 1: “Dr. Smith, the chest pain in 1…”
    • Example 2: “Dr. Lee, room 1 needs…”
  • Patients referred to by their disease process in a made up, often derogatory phrase.
  • Patients referred to as “difficult”

These are just some of the examples I have heard. Now keep in mind, I myself refuse to use these terms, or refer to patients in this way. The reasons why should be obvious. It is offensive and unprofessional! I know there may be those who disagree with me, and they might claim that how they discuss patients in private conversation is up to them. I have heard all to many times that in 2016, we worry too much about being “politically correct.” However, this is not about being politically correct.

This is about changing the current culture of health care which finds as many ways as possible to make the patient experience matter as little as possible, and which places the power in the physician-provider and patient relationship squarely in the hands of the physician-provider instead of in the hands of the patient, the most important person in health care!

So, the only term I have seen used that is quite frequently used is “difficult patient.” Healthcare providers often use the term “difficult” to refer to patients who are in distress of some kind which affects their decision making capacity. For example, a patient who is under the influence of mind altering substances like alcohol or PCP. Healthcare providers also use the phrase “difficult patient” to refer to patients who are angry, hostile, combative, or physically abusive. Especially in the Emergency Department, we often take care of patients who present via law enforcement or EMS because they are psychologically unstable, who may have diagnosed psychiatric illness, and are making it hard for us to care for them. Lastly, some healthcare providers use “difficult patient” to refer to patients who have many questions about their care or who question decisions made by the healthcare team.

All of these situations are different, but what I can honestly say in all of them, is that there is no need to use the term “difficult patient,” ever. It’s ambiguous and open to interpretation. I venture a guess that most patients actually take that phrase to refer to the last scenario above, referring to a patient who has many questions or concerns about their treatment. This term has a negative connotation and perpetuates a culture where the patient’s voice is less important or implied to be irrelevant, when in reality, the patient’s voice should be the loudest, and we healthcare providers should be working to augment their voices.

Renza recommended in her article here that we use the phrases “empowered” or “assertive.” I thoroughly agree with her, because these terms have positive connotations, and elevate the patient to the center of the healthcare provider-patient relationship. Renza also referred to @annareisman who wrote a wonderful article covering the inappropriate use of the term “difficult patient” and she emphasizes that patients who asks questions are excellent teachers. She stated, “Don’t dread patients bearing questions, I told my students. Welcome them. They’re some of the best teachers you’ll encounter.”

At the end of the day, patients are simply trying to receive care for their medical problems. As healthcare providers, it falls on our shoulders, based upon our years of training and commitments to our patients, to always do what is right for them. This doesn’t stop at our medical decision making. It absolutely includes our communication, because how you say things matters just as much as what you say!

 

7 Comments

  1. You make an excellent point about “difficult patients”—their frequent questions can be frustrating to a team with a full census of patients and lots to achieve in a limited time, but they present great opportunities for education.

    As the medical student on a service, I have more free time than others on the care team. Therefore, when a patient presents with a list of inquiries and complaints, I can take the time to work through their issues and do some in-depth teaching in the way the residents or attending can’t. It’s a valuable chance to connect with a patient and address their concerns, and it reinforces my own understanding of disease pathophysiology, diagnosis, and management to educate someone else. [Just throwing that suggestion out there, for the med students or residents who are reading!]

    Liked by 1 person

  2. Sumit, I love this toon & this post. Drives home some very key points. Critical thinking & collaborative care on both ends leads to better decisions by all. I really value the docs that appreciate that I ask questions about new research but then also about new subjects. I love the fact they also don’t assume because I may have a lot of experience that I know or remember everything either. I blush at being labeled anything positive or negative. I just look for a willing partner to help me navigate the system & help me take better care of myself and manage my illnesses better. They don’t have to be know-it-alls either. They just have to take time to care & listen & I’m fortunate with as many specialists and clinicians as I have to see the majority have that mindset. I think it makes both our “jobs” easier in the end. I will point out too that extenuating circumstances like severe drug interactions or certain medical problems can make someone who is normally even tempered a bit unruly. Still, you’re right, they are still have the basic right to care & respect

    Liked by 1 person

    • Nicole, thanks for your confirmation that I’m thinking along the right lines. I must give credit to Renza because she first discussed this on her own blog and inspired me to share my perspective for the HCP side of the coin.

      In general open and respectful communication is key. Often, I find that HCP do not maintain patience with their patients. Patients are dealing with illness and that illness colors their experiences whether they want it to or not. Patients don’t choose to be ill, and don’t choose to need health care. The onus falls on HCPs to be patient, empathetic to patients, and create an environment for mutual respect, learning, and conversation.

      In our current system it is challenging for patients to be heard but so hard as an HCP due to time and resource constraints. I do think with time we can make things better but it will take effort from patients their doctors and so many others. I’m hopeful.

      Liked by 1 person

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