It all started with this tweet and the question of what kind of terms should not be used in medicine. And so I want to write about words which should not be used.
The question of what kind of words should or should not be used by doctors and other healthcare professionals is asked regularly. After all, ‘language matters’. However, such questions typically only focus on words, as the fact that language does not consist only of words somehow falls flat in medicine. And so, typically, a few nouns (language in medicine doesn’t seem to contain verbs, adverbs, or pronouns – it only has nouns, sometimes with adjectives) are identified.
So, let’s have a look at the responses. Those who responded focused on words that describe the patient. And so, they talked about ‘bed blockers’, ‘frequent fliers’ or ‘poor historians’, adding a few diagnostic terms. It’s hard to disagree with the suggestions made. And yet, for me, the most interesting part was that no one assumed that the question could be understood not in terms of what medics say about their patients, but what medics say to their patients (this is, indeed, why I responded with ‘symptoms’). It seems that the default ‘medical language’ is about healthcare professionals speaking to each other, not to us, patients.
Does it matter? Yes, I think it does. This is because while I appreciate the concerns expressed in the answers, to a considerable extent I really don’t care how medics speak about me. Moreover, I think it is inevitable that occasionally (or more often than occasionally) medical people will talk about me in a way I’d better not hear. And that’s fine. I might let you on a secret – I also talk about some doctors I see in a way that I’d prefer them not to know. Yes, of course, potential consequences of their talk might be more serious, but, if every ‘bed blocker’ or ‘idiot’ of a patient resulted in poor healthcare, there wouldn’t be any good one. I accept, however, things might be more complicated.
In contrast, I would prefer that for medics the default medical language should mean speaking to me, the patient. That the initial reflection should be about how doctors speak to people in their care. What kind of words should you use when you talk to me, doctor? Unfortunately, the responses didn’t offer any suggestions, so I shall make my own. Just off the top of my head, here are few words I’d suggest medics didn’t use when speaking to their patients. Let me start with a pronoun; some linguists say it’s the most manipulative word there is:
‘we’ – I hate when a doctor suddenly allies himself with me, creates ‘us’, as if any such thing were possible. I am very sceptical of any possibility of a ‘we’ between a medic and their patient.
Here are some more:
- symptoms – don’t ask me about my symptoms, I don’t have any – symptoms are constructs;
- empower – this is a verb that only tells me how powerful you are;
- evidence – use only if it’s really not only you who decides what evidence is.
- ICE (ideas, concerns, expectations) questions – in my experience you only pay lip service to the current ‘empowering’ fad;
- promise – don’t, just don’t promise me, especially when it comes to how I feel.
- shared decisions– there is nothing (well – little) shared about SDM, but that’s the term we have.
That’s just for starters – over the lifetime of this blog, I have written about them and others.
But should they really be banned? Well, the problem is that there isn’t a simple ‘yes/no’ answer, because it all depends. Yes, the context. Just like the words I listed above, I suspect that all the words suggested under the abovementioned tweet, given the right context, can be used. For example, I can easily imagine ‘bed blockers’ used either ironically or as an indictment of a bed management system.
Yet another time I come to the issue of all-or-nothing rules about language. They simply don’t work. There are always contexts (be it relationships or situations) which make such rules counter useful. I think the rules and lists of words not to be used give a false sense of security. Now we have ‘the list’, now we can avoid ‘the words’ and so, we become better communicators. Alas, I don’t think it works that way at all.