On Language

Given the medical professions tradition of compassion it is indeed remarkable that some of our language regarding patients can be so adversarial and even brutal.

Looking at the words doctors use in their clinical notes makes the point.  

The patient is said to have "refused" the test, suggesting recalcitrance and an overall lack of cooperation.  Why not say instead that the patient declined the test,  a non-judgemental way of putting it, which allows the clinician, in an unloaded atmosphere,  to explore the reasons the test was declined?  

Perhaps a family member died from the very same test or procedure.  Perhaps they didn't have insurance.  Perhaps similar tests have led disastrously to false conclusions in the past.  These insights are not easily gained when words like "refused", charged with opinion and insensitivity, are deployed.

In the artillery of hostile language there is a special place for the word "denied".  Here patients are said to have denied, for example, chest pain rather than saying, non-judgementally, that they did not report any chest pain.  The typical office visit report is characteristically colonized with the word "denied".

Reading and creating such notes invariably conjures up images of the patient in an interrogation room,  replete with naked light bulb hanging from the ceiling and gray metal desks and chairs,  where trust, the coin of the realm,  runs low indeed.

The most egregious word usage is possibly saying that the patient "claimed" various things such as dizziness, headache, toe pain.  Why claimed?  Why not reported or indicated?

When medical records are reviewed and the word "claimed"is seen over and over, patients may be regarded more as liars than historians.  The results of this transformation can be calamitous as medical decisions are founded on mutual trust.

Words can not only be judgmental and insensitive but brutal too. For example, there is no convincing justification for telling someone they have heart failure.  Look someone in the eye and tell them they have heart failure or say kidney failure and you will invariably see all the air go out of their tires.  

It is not euphemistic to instead say they have cardiac or renal dysfunction.  One can even give an assessment of the degree of dysfunction, using words like significant or very significant.

Similarly, the tendency to tell patients they have dementia instead of memory loss is regrettable.  For many the word dementia is a biological hand grenade that evokes the terror of losing one's mind.   Softening the blow and holding out hope wherever possible is neither euphemistic or sugar coating.  It is humane.

So our words can tear apart or they can heal.   It remains unclear why the caring profession of medicine uses words  in ways that transforms patients into adversaries and sometimes uses words that terrorize.

The above practices suggest that for all of medicine's nobility, it has a tiny, but very significant flaw;  a concoction of arrogance and authoritarianism, rooted in a part of its history, still with enough force to make its way into modern medical care. 

It will not be easy to eradicate these practices. As physicians we are nursed on words like "claimed" and "denied",  but the job surely belongs to our medical schools where sensitivity to language and words can be taught as a way of discovering the best in our patients and ourselves, as well as a venerable tool to heal and comfort .  Encouraging literary pursuits and a fierce appreciation of language in medical training will assist future physicians to develop a vocabulary that is both caring and non-judgmental.