Recently, we posted an article on an app that measures spine curvature in scoliosis and were taken to task for including the word "deformity" in the title. http://www.imedicalapps.com/2012/01/smartphone-aided-measurement-of-spinal-deformity-proves-superior-to-manual-methods/#comments
Clearly, language that physicians use in everyday clinical conversation can be inadvertently distressing to patients.
What words or language do you think are best avoided when talking with patients ?
I made some comments in the original thread, but I'm glad this has been moved to an open forum. I can understand why the term "deformity" would be hurtful to a person with scoliosis, but I can also understand how it is a specific and meaningful word in a clinical context.
It's also inevitable that the linguistic habits we slip into behind closed doors creep into our more public speech in front of patients, so I don't know if it's a simple matter of being politic when the situation demands it. We should be sensitive to loaded language all the time. But can we do that without sacrificing efficiency and precision in our speech?
This is an interesting topic, and I look forward to hearing about other examples.
As one commenter noted, the question often revolves around context. Knowing your audience is critical for good communication. There are patients for whom leaving out any details of planned testing or proposed diagnoses would be offensive. For others, delving into the weeds might completely miss the point of what they need, which is to be reassured that you care and that know what you're doing.
We all have groaned internally hearing a colleague talking to a patient in a string of medical jargon and watching the patient's eyes glaze over. All of us in a profession also understand there is a place for back room talk. We don't begrudge school teachers talking freely in the teacher's lounge.
With that, here are few clinical terms may be slowly disappearing
stump
retarded
obese
narcotic
terminal
Anybody have others to add ?
Interestingly we are now being taught to be very cautious of the word cancer. Many people have now been led to believe through various health beliefs that cancer is synonymous with terminal. Whilst cancer is obviously very serious, it is certainly not always terminal. Now we use terms like neoplasm and tumour rather than 'cancer'.
Anybody else experience this?
I must say I found the original discussion quite interesting. As a non native english speaker, I often miss on the subtleties of the language... it took me a good 5 minutes to figure out what term was offensive (I'm not kidding). Looking forward to that list so I don't end up in embarrassing situations.
@ Felasfa: You consider "Obesity" a term "slowly disappearing"? What would you recommend instead?
@ Tom: I believe the term "neoplasm" confuses most patient and "Tumour" is not always associated with cancer. I think lots of MD use those terms as a way to "tell the patient without telling them", to make the difficult discussion easier; hence my (almost) daily "I was never told I had cancer; the doctor told me I had a tumour!" (I'm a rad onc resident).
@Marc-Emile, you are definitely right about the term 'Neoplasm' confusing many patients and as we all know medical jargon is a thing to avoid when talking to patients. I imagine it can be quite hard to strike the right balance when talking to patients especially in your role as a rad onc resident.
On another interesting note regarding the term obesity, many healthcare professionals in the UK are calling for terms like 'Fat' to be ok for clinical use. Their argument is that obese people feel embarassed when called 'fat' and thus they may be more likely to engage in healthy behaviours if their doctor calls them 'fat' rather than obese etc. Personally I am on the fence with that one because whilst I can see their point, I wonder if a doctor calling a patient 'fat' may cause irreversible damage to the doctor-patient relationship.
@Marc-Emile, you are definitely right about the term 'Neoplasm' confusing many patients and as we all know medical jargon is a thing to avoid when talking to patients. I imagine it can be quite hard to strike the right balance when talking to patients especially in your role as a rad onc resident.
On another interesting note regarding the term obesity, many healthcare professionals in the UK are calling for terms like 'Fat' to be ok for clinical use. Their argument is that obese people feel embarassed when called 'fat' and thus they may be more likely to engage in healthy behaviours if their doctor calls them 'fat' rather than obese etc. Personally I am on the fence with that one because whilst I can see their point, I wonder if a doctor calling a patient 'fat' may cause irreversible damage to the doctor-patient relationship.
I think the question about the terms "fat" and "obese" is an empirical one. I haven't seen any evidence that anything a doctor says has an impact on patient's weight, and I wouldn't want to see physicians start intentionally humiliating patients on the basis of conjecture.
(There is evidence that a physician's advice to stop smoking is somewhat effective, but I've just never seen the equivalent evidence for weight loss.)
I think obese people know they have a weight problem, and they often want to do something about it. They need good, consistent advice and measurable goals from their physicians. I agree with Tom, the doctor-patient relationship is important here.
I have heard of patients being offended when they have asked for their medical records and found themselves described as "obese". I have resorted to using more neutral terms like "over weight" or over BMI target. I have friends who specialize in bariatric surgery and I'll ask them what they're doing
I think my opinon on this is a bit skewed since I'm in the ER. There are planty of teachable moments we face on a daily basis due to the various levels of acquity presented. E.g. If I have a patient who has pickwickian syndrome, I don't hesitate to let them know their weight is a direct cause of this (i don't call them fat of course, and say it politely). Obviously there are reasons that could exacerbate a particular patient's situation that should be taken into account, but patient's should know the sequale of various co-morbidities.
What is most shocking to me is that often times physicians don't tell their patients the sequale of their co-morbidities because they are afraid of hurting feelings (thats my assumption). I've had more than one conversation with patient's who have end stage COPD and still don't realize it. And when I ask them if they have been told the severity of their disease, they are often in shock -- they are still smoking, etc. Obviously, in hyperacute situations I don't bring this up, e.g. if they are having an active COPD exacerbation. I worry with patients getting more access to their records this will only make the situation worse -- however, I do agree patient's should be provided this access. But will physicians be afraid to talk about patient's in a "negative light" because of this access?
Sorry for the some what tangential thoughts!
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