'Presenting complaint', 'poorly controlled diabetic', 'non-compliant patient': as Caitríona and Zoë describe in their analysis, doctors often use language like this. Deeply embedded in medical practice, the risk is that such language confers negative traits such as passivity or petulance on to patient. In this interview, Caitríona and Zoë emphasise that it’s long overdue for change. They explain more about the origins of this work, potential barriers to progress and the positive steps that should come next.
Why did you become interested in the ways in which the use of language might affect the relationship between healthcare staff and patients?
Working on the wards, we heard ourselves saying things which we wouldn't want said about ourselves - surely we would never be 'sent' home from hospital? That's the kind of language which is used about children: they are 'sent to their rooms' or 'sent home from a party' in disgrace.
Once this idea was triggered, there were all kinds of phrases we used or heard which struck us as troublesome because they devalued or blamed the patient or elevated the doctor. Even though we personally try to stop using them, they are so deeply ingrained that it's a real challenge. We both know there are phrases we hate which we still use.
We read the literature, and identified some interesting papers about specific phrases as well as some blogs (by both patients and doctors). But we couldn't find any peer-reviewed work on the general problems we had observed in the day-to-day language that doctors use.
What are the challenges to creating change?
Language evolves, but, strangely, the phrases we refer to in our analysis haven’t. Many are at least 50 years old, and we think one of the reasons they haven't changed is because they are taught in medical textbooks and handed down through the generations.
Given how deeply engrained these phrases are, dropping them is tricky even for us. It is important to change the teaching and the text as well as the spoken language. We think that alternative phrases need to be co-designed, agreed upon and tested for change to happen. Then, if they work (that is, they accurately relay the same information and are acceptable to patients and doctors), they’ll be adopted and spread.
We need to change the text in electronic medical records too. Some digital systems refer to a patient leaving the emergency department as their 'disposal'. There is an opportunity to use electronic medical records to positively change language, but if we are not careful, they will embed old bad habits even further – or even create new ones!
Unfortunately, not much progress has yet been made in developing alternative phrases, so there's plenty of work to do.
How might future research in this area improve healthcare?
Research in this area would lead to phrases that are co-designed and acceptable to patients and clinicians. The aim is that the new phrases would improve patient experience.
It would be hard to show that changes in language lead to improved objective patient outcomes too – but it would be interesting to explore, for example, whether talking about managing sugars in diabetes in a more collaborative way might lead to lower HbA1c (average blood sugar levels), or whether talking about challenges to taking medication might lead to better blood pressure readings.
Read Caitríona and Zoë's expert analysis on the BMJ's website, and listen to their interview on the Radio 4 programme Inside Health. We are grateful to them both for sharing their insights, and look forward to hearing more about their work in this area.
How have you been affected by negative language in a healthcare setting? Caitríona and Zoë would love to hear your perspective.