Watching our Words

We have all heard the Latin phrase primum non nocere, meaning first do no harm. While many of us may think of this phrase in terms of how we select the optimal treatments and make the best management decisions for our patients, this phrase should guide physicians in all interactions with patients. Most of the time, our first interactions with patients are verbal – taking the history. And if we are not as thoughtful about the way we speak to our patients from the beginning as we are when it comes to developing our plans, we may do them harm from our very first interactions. As physicians, we have devoted our lives to keeping ourselves up-to-date on the latest medical knowledge; we ought to embrace the same expectation when it comes to the way we speak to and about patients. I will provide three examples of language use that will demonstrate sensitivity toward patients, with the corresponding pitfalls which may actually cause harm.

First, the use of person-first language should be the default way that physicians address and discuss their patients. The American Psychological Association first began emphasizing person-first language in 1992 as a way to communicate information about individuals that limits that information’s ability to cause initial bias. For example, this means rather than referring to a patient as a “bronchiolitic” he/she should instead be referred to as “the patient with bronchiolitis.” It is also a way to prevent patients who have the same disease from being lumped together (i.e., “people with chronic pain” rather than “chronic pain patients.”) In general, medical trainees are taught to use this kind of language, but in practice, it is not always our habit. Similarly, while most of us would likely not refer to a patient as “the sickler in room 5” to their face, we may be tempted to use this disease-first language when discussing with colleagues. When we fail to use person first language when describing patients, we ignore their immediate personhood, choosing instead to focus on their disease condition as their identity.

However, the astute physician must be aware that there are exceptions to person-first language. One notable counter-example is the Deaf community. In general, the Deaf community prefers the use of the word Deaf (“deaf people” rather than “person with deafness”) because the overall opinion by the community is that deafness is a medical condition, not an impairment and that their identity as Deaf is not something of which to be ashamed. This serves as an example of the fact that physicians must become aware of the particular values of the communities they serve rather than attempting to learn oversimplified rules about language. Just as we pour ourselves over the details of scientific journal articles, looking for subtleties in disease manifestations and treatments, we must pay similar attention to detail when it comes to the preferred way to speak about and to our patients.

Finally, not only should we as physicians learn the ways patients would like to be addressed, we must also be those innovating change in language. One current medical frontier is the way we think about and treat mental illness. As we continue to remove the stigma of mental illness, we must deliberately change the words we use to speak of it. For example, it may not seem harmful to use the phrase “commit suicide.” On the contrary, while this phrase has been the customary way to speak, it actually does harm. The word “commit” places moral blame on the person who died, seeing as the word’s synonym include “perpetrate” and “violate.” Using the phrase “commit suicide,” rather than the more neutral phrase “die by suicide,” places unnecessary burden and judgment on surviving family members and friends who are already experiencing complex grief.  They often report feeling that they must obtain permission prior to grieving their loved one who died by suicide. Removing the stigma on mental illness includes removing judgmental phrases from our professional and personal lexicons.

Just as medical knowledge is constantly evolving, one need only look at the branching and twisted tree branches that map the progression of modern languages. We interact with our patients through language first and foremost and thus need to ensure that the words we use reflect our mission to serve.

Katie Dolak, MD

References

“Community and Culture – Frequently Asked Questions.” NAD. National Association of the Deaf, 2019, https://www.nad.org/resources/american-sign-language/community-and-culture-frequently-asked-questions/​ . Accessed 25 Nov. 2019.

Crocker, Amy F and Susan N Smith. “Person-First Language, Are We Practicing What We Preach?” Journal of Multidisciplinary Healthcare​, vol. 12, 2019, pp. 125-129.​

Shields, Chris, Michele Kavanaugh, and Kate Russo. “A Qualitative Systematic of the Bereavement Process Following Suicide.” Journal of Death and Dying, vol. 74, no. 4, 2017, pp. 426 – 454.

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