番茄社区

The language used during a medical encounter plays an important role in the patient-provider relationship, and if not carefully considered, can cause harm, according to a recent analysis.

Phrases like "substance user," "fat," "obese," and "non-tolerating" hurt how patients relate to their doctors, and in some cases discourage them from returning for appointments, said Caitríona Cox, MBBChir, and Zoë Fritz, PhD, MBBS, of the Healthcare Improvement Studies Institute at the University of Cambridge in England.

"Language that is belittling, doubting, or blaming continues to be commonly used in everyday clinical practice, both verbally and in written notes," they wrote in .

Such language "can insidiously affect the therapeutic relationship," they added. "Changing language to facilitate trust, balance power, and support shared decision making is unlikely to harm patients and should be viewed as a positive step in promoting a healthy therapeutic relationship."

To make their case, the authors gathered recent research on commonly used language in medical narratives, and the effects of the language used, whether in health records or patient-doctor interactions.

According to research on what patients find offensive in patient notes, language that casts doubt on patient accounts, such as "presenting complaint," "denies," and "claims," has negative connotations and can imply that what a patient says to their doctor is inauthentic or inaccurate, Cox and Fritz noted.

Similarly, certain terms may cast the patient as passive or childlike. In studies on the language used in diabetes management, for example, patients are often described as being not "allowed" to eat certain foods, which may come off as moralistic "scolding." In addition, patients who haven't taken medication are often called "non-compliant." More neutral options like "adherence" can reframe the relationship between doctor and patient as collaborative, the authors suggested.

Cox and Fritz also highlighted language that implicitly blames patients for negative outcomes. In the management of diabetes and epilepsy, for example, phrases like "poorly controlled" diabetes or seizures can sound judgemental. Such terms hide the complexity of factors that are outside of a patient's control and can contribute to stigma. "Failure to progress" or "patient failed immunotherapy" can also suggest that patients are the cause of the failure. Providers can instead use "treatment failed" or other more neutral adjustments, the authors said.

When this type of language is used, it can affect how healthcare workers see patients. In , workers agreed more strongly that patients were "personally culpable and that punitive measures should be taken" when more stigmatizing language was used, Cox and Fritz noted.

"Physicians don't want to ... do anything to offend, to harm, or to disrespect our patients. Hopefully, we respond well to patients who bring up these concerns to us," Michael Sun, an MD candidate at the Pritzker School of Medicine at the University of Chicago, who conducts research on physician language, told 番茄社区.

Sun led a study that analyzed more than 40,000 electronic health records for negative descriptors pointing to racial and other biases, finding that Black patients were more than twice as likely to have negative descriptors in their records as white patients. Unmarried patients and those with government insurance were also more likely to have negative descriptors.

A number of the studies that the current analysis cited showed consequences for using stigmatizing language, such as and they'd be less likely to visit a doctor. "At the bottom line, the stakes of this are actually about patients who might not feel comfortable going to you for care," Sun said.

But a social and cultural shift -- along with that provide more transparency -- signal meaningful change, he added. "With Open Notes now, with patients having more autonomy to access their records, they're able to provide a little bit of a mirror back and say, 'Hey, I actually don't prefer these terms.'"

As for how physicians may feel, "I think more than anything, people don't like being told what to do," he noted. "And I think the pushback often comes when people don't understand that this language is wrong."

For instance, when the American Medical Association and the Association of American Medical Colleges came out with , Conor Friedersdorf of criticized it as far-left language policing gone too far.

"When we put out statements or guidelines like that, the appearance is often that if you have been using this language, then you're bad or you're doing something wrong," said Sun. "Oftentimes, physicians have loads of patients and great patient relationships and great patient care, in spite of their language ... It's not to say that they've been doing something wrong, but there are things that we can do better."

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