by Carolyn Thomas ❤️ Heart Sisters (on Blue Sky)
I love this list. When Johns Hopkins University asked healthcare professionals to weigh in with their own lists of hurtful words that should no longer be used in patient care or medical charting, the responses were brilliant and thoughtful. Dr. Colleen Christmas, who teaches at Johns Hopkins University School of Medicine, has this to say on why words matter so much to the patients hearing them.
“”Our medical language is filled with negativity and dehumanization.”
Here are some of my favourite examples of widely-used words that healthcare professionals themselves wish would go away – along with the thoughtful reasons these words can hurt patients (with thanks to the JHU Lifelong Learning in Clinical Excellence program): .
♥ We’ve really got to ditch ‘compliance.’ The paternalistic and judgmental overtones have no place in a time when we’re moving more and more towards shared decision-making.” (Leslie Ordal, MSc, Genetic Counselor, Toronto, Canada) See also: First, there was compliance. Then, adherence. Now, concordance!
♥ I would delete ‘poor historian’ – there’s a always a history to be elicited if we persist. Stories reveal so much about a patient.” (Sam Kant, MD, University of Maryland Medical Center)
♥ And what about ‘difficult patient’ and ‘uncooperative with the history’ – I was taught to say, “I was unable to win the patient’s cooperation,” shifting the responsibility to me as the physician instead of blaming the patient. (Margaret Chisolm, MD, Johns Hopkins University School of Medicine) See also: When you fear being labelled a “difficult” patient
♥ It’s always upsetting when the reference is made that a patient with a life-limiting illness ‘failed” treatment – like one can somehow study and pass? (Elizabeth Dougherty, MSW, Burlington, Ontario)
♥ I’m not a fan of ‘patient complains of…‘ It’s very negative. Replace it with ‘patient concerns’ or “presenting symptoms.” (Anisha Gupta, Dentist, UK)
♥ Replace ‘instruct patient‘ with ‘ask patient’ (J. John, Healthcare Agent of Change, Boston, Massachusetts)
♥ Replace ‘patient refused’ with ‘patient declined.’ The word refused carries an unfair undertone. (Shoba Stack, MD, University of Washington Medicine, Seattle, Washington)
♥ ‘Uncooperative’ – usually patients are unable to participate due to acute illness or confusion. (Eileen Barrett, MD, MPH, University of New Mexico School of Medicine) See also: When patients worry about being judged
♥ “Never, ever, ever, ever refer to a person as a disease, a body part, or an inanimate object. Ever.” (Colleen Christmas, MD, Johns Hopkins University School of Medicine). CAROLYN’S EXAMPLE: I overheard the Emergency Department staff repeatedly referring to me as the “MI in Bed 8” (and yes, Emerg docs, I know that you’re too busy to develop a meaningful relationship with each cardiac patient, but I didn’t know at the time that MI meant “heart attack”, and my own reaction hit only when I realized that I was the person in Bed 8 (“so they had all been talking about ME!”)
♥ I would eliminate all words that we would not say with our patient listening. (Stuart Ray, MD, Johns Hopkins University School of Medicine) See also: When doctors use words that hurt
♥ Delete ‘patient claims that…’ – This makes it sound like we don’t believe our patient. (Amita Sudhir, MD, Charlottesville, Virginia) See also: Must women bring an advocate along so doctors will believe us?
♥ I would delete the use of ‘case‘ when referring to a patient. It turns a person into an object, and can insidiously foster thinking “thing”, not “person.” (Randy Barker, MD, Johns Hopkins University School of Medicine)
♥
Q: What hurtful words in medicine would you like to see thrown out?
NOTE FROM CAROLYN: I wrote more about why words matter in medicine in my book, “A Woman’s Guide to Living with Heart Disease” (Johns Hopkins University Press). You can ask for it at your local library or bookshop (please support your favourite independent neighbourhood booksellers, or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 30% off the list price).
Heart Sisters 
This list is eye-opening, Carolyn. The examples of “compliance,” “poor historian,” and especially your own experience with “the MI in Bed 8” truly illustrate the dehumanization that can occur through careless language.
The suggestion to replace “patient complains of” with “patient concerns” is such a simple yet powerful shift. It’s clear that a conscious effort to use more empathetic and respectful language is long overdue in healthcare.
Marie
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Hello Marie – You’re so right: all it takes is a conscious effort, but most of the examples offered by healthcare professionals themselves are commonly used because “This is the way we’ve always done it!” These are arguably examples of UNconscious hurtful words. I’ve written about how that excuse often unravels when doctors become patients (these are the docs who are so stunned by the lack of “empathetic and respectful language” that they sometimes are compelled to write books about this “new” reality!)
Dr. Itzhak Brook‘s book “My Voice“, for example, is his memoir of surviving throat cancer, in which he tells this horror story:
“The tracheotomy tube the doctor wanted to place back was still dirty, and when I asked him to clean it better, he abrasively responded: ‘We call the shots here!’ and left my room…”
Until I read those words, I’d always assumed that if a doctor was the patient, hospital staff would offer preferential treatment as colleagues, but maybe not always so.
Take care. . .❤️
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