Practice Perfect 786
Language Matters

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Jarrod Shapiro, DPM, FACFAS, FACPM, FFPM, RCPS Glasg

Practice Perfect November 30, 2021

In medicine, we spend much of our patient care time talking, using our voices to communicate in various ways with those around us. Whether it is patients, family, other medical professionals, or trainees, our use of language is a fundamental part of what we do. Unfortunately, our use of language often goes unconsidered and may have potentially detrimental effects. A colleague of ours recently reminded me that November is diabetes awareness month and brought to my attention an important consensus statement within the UK community about the use of language in reference to diabetes. As an educator and communicator, I find it interesting and a little disturbing that I spend relatively little time considering this important topic. Let’s rectify that oversight by examining together the use of language in medicine. To start things off, here’s a quick review of the UK consensus statement from 2018 authored by Cooper, et al.¹

This group of 16 healthcare providers, stakeholders, and patients with diabetes created an evidence-based consensus statement about the use of language when caring for patients with diabetes. They identified a set of principles, discussed examples of common language and effective alternatives, and provided specific words and phrases that may be helpful. This document was concrete and concise with the highlights as follows.

The basic paraphrased principles recommended by the consensus group are:

1. Verbal and nonverbal language is powerful with potentially positive and negative effects. 
2. Some words, phrases, and descriptions are problematic despite good intentions.  
3. Use language with the following characteristics: 
   1. Free from judgement or scolding. 
   2. Be “person-first”. For example, avoid description such as “diabetic patient” adjusting it to “a patient with diabetes.” Avoid making the person the disease. 
   3. Be collaborative rather than controlling.
4. Consider common expressions and what attitude they convey.  
5. Avoid attributing blame in the language used.  
6. Avoid generalizations and stereotypes.  
7. Use empathetic language that seeks a person’s point of view.
8. Listen for the patient’s choice of words and what those choices mean.
9. Remain conscious of language use watching out for negative effects.
10. Consider the ways to diminish the negative effects of language.

Here are a couple of examples from the consensus statement to help solidify some of these concepts. These are quoted directly from the paper.

“It’s probably one of those non-compliant Type 2 diabetics who couldn’t care less about looking after himself.”

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It’s pretty clear this statement is judgmental and defines the patient in terms of their disease rather than being an aspect of their lives. The authors instead recommend  avoiding judgement and moving away from “compliant/noncompliant” as a concept. They also recommend working with the patient to better understand their current condition and factors contributing to it.

“I’ve been a bad diabetic, I know you’re going to tell me off.”

I found this one interesting because I’ve heard this type of statement before from a number of patients. The funny thing about this is I never “tell off” my patients. It appears they do this in an attempt to prevent being chastised, but that implies they feel like they will be judged or may have experienced that in the past. The authors of the consensus statement suggest avoiding judgmental language and engaging the patient with questions like “why do you think I’m going to tell you off? Let’s talk about that.” Try to avoid shaming the patient.

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To many healthcare providers these recommendations may sound like “coddling the patient” or avoiding difficult discussions, but a fair amount of research has been done that shows scaring or shaming patients does not motivate them to change unhealthy habits. Motivational interviewing, engaging patients, and empowering them to make changes appears to work better. Similarly, the old “patient as diagnosis” (the abscess in room 1, for example) is now being replaced with more humane labels using the “person-first” method (the patient in room 1 with an abscess). In future Practice Perfect editorials, we’ll explore the power of language to help and hinder, but for now my best suggestion is to consider the recommendations from the UK consensus statement and try out these patient-centered communication methods to build strong provider-patient relationships.

Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]

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