The language of health care

Awhile back, I wandered into an Internet discussion about the use of the word “non-compliant” to describe patients who didn’t follow the doctor’s instructions or take their medications as directed.

Don’t use that word anymore; the correct and less judgmental term is “non-adherent,” one person wrote.

A home health nurse shot back: She’d been using the term “non-compliant” for years, there was nothing wrong with it and she wasn’t about to change, thankyouverymuch.

Health care has a language of its own. Not just the technical words, although there are plenty of them. No, this language consists of ordinary words used in ways that convey certain shades of meaning. Sometimes patients are confused by it, sometimes they’re offended, and sometimes it subtly reinforces the paternalism and power imbalance that have historically existed between health care professionals and their patients.

Were your test results “negative”? Breathe a sigh of relief, because negative results in most cases are positive news for the patient. If the doctor notes that your symptoms are “unimpressive,” it’s not meant to be denigrating, it just means you’re having symptoms that aren’t severe or pronounced. That abbreviation in your chart that says “s.o.b.” doesn’t indicate what you think it does; it just denotes that you’re having shortness of breath.

As you venture farther into this terrain, it gets trickier. Why, for instance, do patients “deny” having chest pain or whatever other symptoms they don’t have? (One of my newsroom colleagues says that whenever she hears this term, she pictures a conversation that goes something like this: “You have chest pain!” “No, I don’t!” “Yes, you do!”)

What is an “incompetent” cervix, and what kind of value judgment does this term imply?

Does it matter what words we use? Are they just a neutral collection of letters and syllables with no deeper meaning? Or is the language of health care more than this?

As patients become more engaged in their care and the doctor-patient relationship becomes more of a partnership and less of a dictatorship, the language has correspondingly come under greater scrutiny. In this brave new world, do doctors issue “orders,” or do they provide “instructions”? Do they talk about collaboration or do they make all the decisions?

The whole debate over the use of the word “compliant” illustrates the extent to which the sands have been shifting. Although the term is still frequently used, critics point to its connotations: obedient, submissive, acquiescent, yielding, docile. In short, not the words many people would like to see associated with the doctor-patient relationship. The term is increasingly being replaced by “adherent,” which sounds vaguely like it might have something to do with duct tape but at least doesn’t appear to carry some of the same emotional baggage as its predecessor.

It might seem like political correctness run amok. But words often do matter, and they can influence our thinking in ways we might not realize. For instance, it’s common to record the reason for the patient’s visit to the doctor as the “chief complaint” – a rather psychologically loaded term, since the patient might not literally be complaining and might in fact be reluctant to complain in the truest sense of the word. Does the use of this word create subtle attitudes about patients and perhaps consign them to an unwanted role?

What about the common practice of referring to the patient’s current history of ailments, issues and chronic conditions as a “problem list”? Does this invite doctors and nurses to view patients as a collection of problems in need of fixing? Does the focus on “problems” make them overlook other aspects of the patient’s health in which he or she is doing well?

What does it mean when the patient “didn’t tolerate the procedure”, and whose fault does this imply?

I’m not sure whether these terms ought to be replaced, or what we could replace them with. There’s no vocabulary police in health care, after all, and no real consensus on what the best words should be. In any case, it’s a moving target. The debate over “compliant” vs. “adherent” isn’t going to go away any time soon, and within a few more years the favored term could drop out of favor in exchange for something better.

Occasionally, however, attention to language results in real change. At one time, patients who were in pain were said to “complain of pain.” It’s a phrase that can be freighted with emotion and value judgment, however, and health care providers began to realize that many patients with treatable pain weren’t speaking up because they didn’t want to appear to be complaining. With heightened awareness of this issue, providers began using the term “reporting pain” instead. This more neutral language is now so widespread that it has become rare, at least in the professional literature, to find references anymore to patients “complaining of pain.”

And occasionally patients themselves put the medical community on notice that some language is unacceptable. Karen Parles, executive director of the Lung Cancer Online Foundation, fired off a letter a few years ago to oncology specialists about the commonly used phrase “the patient failed chemotherapy.” She wrote:

Have the patients really “failed” when chemotherapy drugs do not work? Of course they haven’t. So why use a phrase that implies blame?

… This unfortunate convention is used in the medical literature, at professional conferences, and not surprisingly, in the clinic. It is common for oncologists to tell patients that they “failed drug X.” By telling patients they failed to respond to treatment, doctors may increase the guilt that many patients already struggle with as a result of their cancer diagnoses. For others, like me, it becomes an annoying refrain. At minimum, it puts emotional distance between doctor and patient and undermines the doctor-patient relationship. Just imagine under the same circumstances if the patient said to the doctor, “You failed to give me the right drug to treat my cancer.” The question isn’t who failed, but what failed.

Dr. Bruce Chabner, the editor-in-chief of The Oncologist, responded with an apology and a thank-you to Parles for pointing out “the all-important use and impact of our words.”

“I assure her that I have expunged ‘that phrase’ from my vernacular… and I urge my colleagues to do likewise,” he said.

HealthBeat photo by Anne Polta

7 thoughts on “The language of health care

  1. interesting blog. i have conversations with my spouse all of the time about the meaning of words and the differing intrepretations we have of the exact same word- what I meant to say and how it was received/defined. Clearly, the words/phrase and definition within the medical community have have specific meanings that we as patients may interpret differently. Is it important for doctors to communicate in a universal language to maintain best care between one another and effectively and efficiently get info recorded? Does reading our records and a different interpretation of the words then hurt our healthcare or relationship with our doctor if we read it as a negative comment? I have read my records in the past and found them to be an interesting interpretation of what I said had done – but then I am only one half of the conversation/exam and have a skewed and probably very affected perspective. Probably more skewed than the doctor who has come in to examine or treat me. Like hearing my voice on tape, I sound different – hmmm- my own filter keeps me from really seeing/hearing how it really is sometimes. I believe I need to be open that my doctor is working to help me? It’s a hard position, vulnerable position to be in but I don’t feel like it’s my fault if meds or treatment don’t work. I only feel like I am responsible if I am not proactive in trying to do things recommended to get better…sometimes it takes trying lots of different things that may fail (that doesn’t mean that I fail – but treatment fail as it wasn’t right for me). Words are definitely loaded but we also have a responsibility not to overreact to what they really mean. (If a doctor is saying negative, disrespectul things clearly that is not okay). Doctors are swamped with keeping up with patients, continuing medical education on diseases and prevention, learning new electronic charting systems and filling out endless paper work. In the end, I respect the concern with the power of words but with all the stress in medicine, I hope doctors don’t have to worry about standard wording that they’ve used to communicate universal meanings in healthcare because of how some patients interpret the words. The doctors I know care so deeply about their patients and are almost killing themselves to take care of them day and night. I can’t imagine the stress they would feel if the issue becomes focused on having to change the documented wording of their medical care. Just my opinion 😉 I suppose they could train the up and coming med students in new verbage. Has the wording bothered you?

  2. Does the terminology bother me? Not really. Medicine is a culture, and like all cultures, it has its own language and vocabulary. I just think it’s interesting how we’re seeing some of the language change in response to how the doctor-patient relationship is changing. This evolution has probably been going on since the days of Hippocrates, but the whole patient empowerment thing is perhaps a bigger shift than we’ve seen at any other time in the past.

    Maybe reporters are more conscious of language than other people, because words are the tools we work with every day. The media has an extensive reach, and to some extent helps shape the public discussion. There’s quite a bit of discussion in the industry about being careful with language so we don’t sensationalize, don’t perpetuate hurtful stereotypes and so on. Race relations, mental illness and disability are three areas that have been particularly sensitive. If you look at news coverage from the 1920s or the 1950s and compare it to today, you would see some significant differences in the language that is used. Some of this change has been deliberate, and some of it has just evolved over time to reflect changing attitudes.

    We do sometimes get negative feedback about the words we use – the whole debate about whether to call it “swine flu” or “H1N1” or something else being a case in point. Are they nitpicking or is there some validity to what they’re saying? It’s not always easy to distinguish, but at least it makes us stop and think.

    I pay a fair amount of attention to the words I choose. In fact I see it as a responsibility to try to choose the words carefully. For instance, I would not call someone “a diabetic” – not because I think it’s insulting or the wrong word to use, but because I would rather not define someone by his or her chronic disease. That’s just my preference. Maybe it doesn’t matter to anyone else except me and I’m just being a geek about it.

  3. Oh no, you are NOT a geek! And as a writer, you surely must choose your words carefully, artfully and accurately all day long! I think it is a good thing to think about and talk about. For me sometimes I think about word choices way to much – it’s like being PC about things and then feeling limited by what you are trying to say or worried about it. I never want to upset or offend anyone. Certainly a doctor wouldn’t want to make a patient feel guilty or hurt their health by the use of offending words. It is definitely something to keep in mind – I do think our society can overanalyze and be overly critical of things. On a side note, it’s funny- I’ve never thought of this – I have asthma and refer to myself as an asthmatic – it is not who I am but a part of how I am and how I manage my life. It what I live with and because of it, I need to respect the role the disease plays in my health. I think embracing my health issues (not loving them) and being open about them has helped me live a healthier life. I can’t deny that I have the disease but rather I can be proactive to manage it. I can look for all sorts of reasons not like it including the words a doctor uses to tell me about my health or the actual word – asthma – the diagnoses – but that won’t change the fact or help me be as well as possible. Call me whatever you want, Doc, just get me well! ha ha – just kidding. Thanks for the blog. I’m curious – I’ll pay more attention to what my doctor says and records next time I’m in the clinic!!! :) Thanks, Anne.

  4. Well, obviously there is a balance here. How we interpret words can be very subjective, so we need to be careful about getting too hung up on the exact, precise, accurate word to use. Depending on the situation, some words might be better than others, but euphemisms and politically correct language don’t necessarily serve us well either.

    I don’t think the physicians in Willmar, Minnesota, need to worry that I’m going to pounce on them for using the so-called wrong word. In the final analysis, you have to look past the words and see the intention that is there. If someone is sincerely trying to do well by their patients, I’m not going to start bludgeoning them with the dictionary. That would just be petty and inappropriate.

  5. I think you are so right – the intentions of words are so important. Some people are so good at communicating – so comfortable and the “right” words just flow. Others struggle to express what they think which contributes to the issue of interpretation. I love the image of someone being bludgeoned with the dictionary! hee hee. It also makes me think of my father-in-law who corrects our speech ALL of the time. I am nervous to speak or write to him because of it – or I used to be – after being in the family for almost 20 years I’m getting over it. Maybe that is why I am sensitive the other way – I’ve been corrected in my attempts to express myself through years and have found it to negatively affect me. Hmmm hadn’t really realized that either…your blogs are like therapy for me!!! :) Good to know… By the way, I am going to keep a dictionary near by for my own interactions with the spouse! May need to do a little bludgeoning with the book of words if my intentions are misinterpreted-ha ha! I LOVE THAT!!!!

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