On ‘private parts’

The Guardian reports another victory of ‘ordinary’ over medical language. Their lead reads: The health service is ditching words such as faeces, urine and vomit in favour of simpler language that everyone can understand. Fair enough? Well, not exactly.

So, the NHS has indeed produced a list of words it would like to be replaced. For example, ‘abdomen’ is out, to be replaced by ‘tummy’; ‘disease’ is out, to be replaced by ‘condition’. Even ‘doctor’ is not really good, unless it’s in hospital. Just as the Guardian suggested, ‘urine’ is out, ‘stool’ is out, together with ‘prognosis’.

The no-no list is introduced thus:

These are some of the words and phrases we use to make our content about health and the NHS easy to understand. We try to use the words we know that people use themselves when they talk about their problems and when they search for information on the internet.

I find this not only patronising, but also problematic in other ways. Here is my account.

1.  The NHS language supremo/committee has not yet understood that people are a fairly heterogeneous (I am quite certain that is a big no-no word) group and while some of us may not understand what ‘stool’ or ‘prognosis’ mean, others really do. Personally, I must admit that if a doctor (I do beg your pardon – a GP) writes to me about my poo, I will feel quite angry and probably write back detailing where s/he can shove the poo. The assumption that I don’t understand what for me are words from the very basic dictionary is quite offensive. And while I appreciate that I might not be assumed to understand what ‘transcendental’ (in Kantian sense) means, ‘stool’ is really not a difficult word.

The assumption that patients are all stupid and the NHS, doctors in particular, need to go down to our level is extremely annoying. I do wish this idea would penetrate the NHS language supremo’s skull on its way to their brain. No, I don’t hold my breath.

2. Now, dumbing down, as I have little doubt that this is what the list attempts to do, has other consequences. The use of words such as ‘tummy’ can very easily be associated with the language used by children and for the children. It might be surprising to the NHS that we are not and should not be spoken to like children.

There is, however, an unlikely upside of the list. I am frequently patronised by clinicians (last time, a couple of days ago, by a trainee psychologist) both on Twitter and in real life, but at least I now understand (at least to an extent) its source. The list quite explicitly positions us, patients, as children, so, I guess, a fairly unreflective clinician (i.e. – in my humble opinion – most of them – I’m sorry) will simply treat me as such. The NHS actually encourages their staff to think we’re stupid. The staff seem to oblige.

And yet, I still don’t want to be talked to as if I were a child. And I will not be.

3. And now a little dig. All those of you who bang on about ‘neutral’ language, disposing of medical language etc., do you see what you’ve done? What you’ve achieved is an NHS edict which openly patronises us and constructs us, patients, as nitwits. The assumptions behind such statements:

People often aren’t interested in the kind of bacteria that caused their problem. They want to know what to do about it. Only mention the name of the bacteria (full or short name) if your audience (users) need it.

are staggering. Yes, I’d imagine that a lot of people are not interested, but please, for pity’s sake, don’t generalise.

I’m sorry to say that a statement such as:

We avoid words like “disease” and “disorder” as they can sound negative.

is just stupid. Those words sound negative because they refer to negative things. Am I really supposed to look forward to my condition, just because some idiot decided not to call it a disease? But, I’m sorry, I’m collecting myself….The rant is over. Unpicking the stupidity of the sentence above would require an entire blogpost.

4. Now, what really bothers me is that under the guise of correctness or understandability, the NHS is sneaking changes that have to do with neither, but offer an ideological stance. For example, the document reads:

We don’t use “suffering from”. We talk about people having or living with a disability or condition.

Why, for pity’s sake?! I suffer, I suffer every day from my bloody fatigue, I have never stopped. I haven’t started and I don’t live with CFS, I bloody suffer. And I do take exception to depriving me of my ability to suffer (I wrote a post about it before).

This is a polite academic blog, so I cannot really write what I would now like to write. I would cross the politeness line by a country mile or two.

5. Now, when I was reading the Guardian piece, I was interested only in one group of words (don’t judge, consider the argument). If the NHS really wanted to help the patients and clinicians, rather than offer some, I’m sorry, idiotic list of language rules, they would actually consider discussing one particular group of words. And so, here it comes, the words I couldn’t find in the document are those which refer to, shall I say, people’s private parts.

If you care to do a google search, you will find evidence that people find it difficult to use the word ‘penis’, ‘vagina’, ‘vulva’ (actually, many don’t understand the difference between the latter two), while the word ‘glans’ seems to come from Klingon and ‘anus’ is all too close to Anubis. I did consider offering some alternatives, but I thought better of it.

And yet, one time or another ‘we’ occasionally need to talk about ‘private parts’. How do we do it? How does the doctor do it? Given that strictly medical is out, is it ‘Adolph’ and ‘flower garden’, as was suggested by a couple of websites, or something else entirely? I haven’t looked for any research, but I suspect that difficulties with speaking of such matters puts people off seeking help. Teaching us, both clinicians and patients, how to speak of taboo topics could, for once, be something quite useful. But instead we’re getting fatuous nonsense that the word ‘disease’ is too negative to use.

And here I come to my main point. The NHS yielded to the unhelpful and, quite frankly, stupid idea of policing the language its staff use. There cannot be any such policy, especially if it is to be based on how people understand things. There isn’t and there cannot be one group of people the NHS addresses, there is no one level of understanding they have, and therefore there cannot be one way of addressing them. For me, the list of words or phrases is only irritating, occasionally getting to extremely irritating. In other examples, it’s just stupid.

But where some advice might be useful, the NHS chickens out. I doubt very much that a significant number of people will have trouble understanding the word ‘stool’ in the context of clinical interaction. But they are likely to wonder how to refer to their genitals and other ‘taboo’ things (e.g. various aspects of sex, masturbation – there is no entry for either of those), as they are likely not to have access to discourses outside either swearing or intimacy, or might not have access even to those.

So, what do I say to the authors of the authors “A to Z of NHS health writing”. Well I said before about a psychological guide (here is the link to the post):

Shred it.

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