Recently I read a fantastic blog post by @, 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.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.
- Example 1 (referring to a patient with sickle cell disease): “The sickler in bed 1…”
- 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 @ 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!