Words matter – especially in medicine

An editorial in The Lancet (a medical journal that’s been published for over 200 years) has revisited a subject that’s been niggling at me and many other patients: what the editorial authors called blame-ridden language – which they describe as being “pervasive throughout medicine.”(1)

For example, why do doctors include chart notes like :“Patient claims her pain is 10/10” ?  Choosing the word “claims” somehow implies that the patient is lying. In the real world, we would say:  “She is experiencing 10/10 pain”. 

Or consider how doctors often use the word deny:  “Patient denies having fever or cramps.”  In the real world, that word can also imply that this patient is untrustworthy. Here’s how one of my Heart Sisters readers openly corrected her doctor’s chart notes:(2):

“I did not DENY these things.  I said I didn’t feel them. Completely different!  Language matters.”              .

The Lancet editors suggest that the use of thoughtless words in medicine doesn’t come from a place of malice, but more from a lack of awareness:

“They’re not reflective of an intentional effort to offend. These phrases are typically used as shorthand in an effort to aid communication.” 

One of my readers has worked in maternal/child health for many years, and   she mentioned in response to a post here that her OB-GYN colleagues routinely use hurtful words like incompetent cervix, failure to thrive or elderly primigravida.  (I’d add angry cervix and hostile uterus to her list, too). By the way, the term elderly primigravida was first used in 1958 by the International Council of Obstetricians and Gynecologists referring to women aged 35 years or older who were pregnant for the first time. I’m guessing that most OB-GYNs do not actually believe that a 35-year old woman is “elderly”, but many in the profession kept repeating that terminology anyway because that’s just the way it’s done.  The American College of Obstetricians and Gynecologists, by the way,  has finally announced new preferred terminology for its members to now use instead: “pregnancy at age 35 years or older”).  (There, that wasn’t so hard, was it?) 

The Lancet authors also admit:

“The medical literature regularly uses blame-ridden language, stating for example that patients failed treatment, failed to reach a treatment endpoint, failed screening, or were unsuccessful.”  

Speaking of FAILURE, too many heart patients worldwide must still endure hearing their cardiologists say out loud: “Your heart is FAILING!” – despite the need to immediately reassure these horrified patients that the cruel diagnosis of heart FAILURE doesn’t actually mean that their hearts are FAILING. But if physicians truly believe that FAILURE does not mean failure, then stop saying it – and come up with a more appropriate name for this diagnosis.

For a list of more accurate names from Harvard cardiologist Dr. Lynne Warner Stevenson, read my editorial published in the British Medical Journal (BMJ):  “Heart Failure:  It’s Time to Finally Change the F-Word”

Here’s another area where words in medicine matter: many people – including physicians – still tend to describe their patients using disease-first language e.g. calling them diabetics or epileptics – instead of a person with diabetes, or a person with epilepsy (which are examples of person-first language).  The Lancet editors warn that disease-first language is  “a common practice that can dehumanize the patient, equating them with their disease rather than as individuals.”

Dr. Tessa Richards is not only the senior editor of the British Medical Journal  but she also lives with a number of serious chronic conditions. In her BMJ opinion piece called “Words That Annoy, Phrases That Grate” (3), she weighed in with her own thoughts on the dehumanizing practice of disease-first language:

“Doctors who use these words think it’s fine and seem oblivious to how insulting and rude they sound to people who are patients. While it’s convenient to categorize people by their disease or its severity, few people look in the mirror and see ‘a poorly controlled diabetic’. And who would introduce themselves as a ‘co-morbid patient with multiple complaints’?

“Medical paternalism may be on the wane, but the medical lexicon is littered with words and phrases that can feel top-down and demeaning.” 

When Diabetes Australia wanted to improve its communication with and about people living with diabetes, the organization issued a revised Position Statement covering what they called “a new language”. Here’s how they described the importance of this new language:(4)

“Language has the power to persuade, change or reinforce beliefs and stereotypes – for better or worse. Words do more than reflect people’s reality: words create reality and affect how patients view the world and their diagnosis. Language needs to support people in their self-care efforts.

“Importantly, language that de-motivates or induces fear, guilt or distress needs to be avoided and countered.“

(Perhaps somebody over at Diabetes Australia could have a wee chat with the cardiologists who have had decades of experience inducing “fear, guilt or distress” in heart patients and their family members simply by delivering their thoughtlessly cruel heart FAILURE diagnoses).  See also: A Patient, a Caregiver and a Cardiologist Walk into a Bar…

Physicians use hurtful words because they were taught as trainees in medical school by professors who had learned the same hurtful words from their own profs for generations. An insightful 2015 paper published in the Journal of Graduate Medical Education suggests that this medical language is deeply rooted in tradition as old as the profession itself. In fact, physicians’ routine use of hurtful words like complain, deny and fail  when describing their patients dates back more than 300 years.(5)

Yet the lesson starts anew the very next time any young medical student is asked about an assigned patient’s chief complaint (instead of being asked about the patient’s chief concern like the real world would say). The required response then goes  something like this:

“Ms. Smith is a 74-year-old hypertensive diabetic complaining of chest pain. She denies shortness of breath. She has a history significant for metastatic colon cancer, and recently failed chemotherapy.”

Good job, young med student! You’ve learned to include as many blame-ridden words as possible, which will be heard and then repeated by your classmates, too.

1. Editorial, “Patient First, Person First”. The Lancet. Volume 24, ISSUE 10, P1053, October 2023.

2. Fernández  et al.“Words matter: what do patients find judgmental or offensive in outpatient notes?” Journal of General Internal Medicine, 2021;36:2571–8. 

3. Tessa Richards, “Words That Annoy, Phrases That Grate”. BMJ Opinion, April 7, 2017.