Doctors sometimes become overly absorbed in the challenge posed by uncertain diagnoses. A recently deceased friend was upset when two consultants, speaking across him at either side of the bed, finished up a conversation with, “Worst-case scenario, it could be cancer.”
In fact it was, and it killed him before a definitive diagnosis could be made. But the conversation was an unthinking and somewhat brutal way for him to hear that cancer could be the cause of his symptoms. Neither doctor set out to do this, but in the intensity of trying to solve a difficult case, they forgot about the person lying in bed before them.
Communication faux pas such as this continue to occur and are regularly addressed in both undergraduate and postgraduate training. Still, I hadn’t been aware how even single words or phrases could irritate certain patients.
Tessa Richards, patient partnership editor at the BMJ, describes how the journal recently invited its patient panel to say what words and phrases irked them and to suggest alternatives.
“While it’s convenient to categorise people by their disease and its severity, few of us look in the mirror and see ‘a poorly controlled diabetic’ or ‘terminal cancer patient’,” Richards says. “And who would introduce themselves as a ‘co-morbid patient with multiple complaints’?
"Language evolves, and the BMJ is seeking to stimulate debate on what is acceptable or unacceptable terminology in today's world, and amend our house style accordingly."
Here are some of the responses:
Doctors who spoke about “managing” the patient rather than the condition. Other phrases, such as “referring, admitting, discharging patients” portray the patient “as a bit in the system” being moved around.
Being called a client: “When my dad went from being cared for in hospital to being cared for at home, he suddenly became ‘a client’ – a word that irritates me not to mention my dad.”
Seem oblivious
Leaving off the term “patient”: “I hear the doctors just say, for example, ‘Rheumatoids’ when referring to patients with rheumatoid arthritis . Doctors who use these words think it’s fine and seem oblivious to how insulting and rude they sound to people who are patients.”
I suspect “diabetics” and “epileptics” feel the same.
Under the care of – “I hate this term. I self-navigate my way through a wealth of different sub-specialists whose views on best management vary. The only person whose care I have been consistently ‘under’ is myself.”
Adherence, and failed therapy or failed treatment – “Like we somehow failed an exam for not trying hard enough.” And another person found the term “be compliant” unhelpful. “I suggest flipping it from compliance (to the doctor’s orders) to achievement (of my goal).”
‘Freed by wheelchair’
Confined to a wheelchair – “That is so wrong. It should be ‘freed by a wheelchair’ – freed to move around independently, freed from exhaustion, freed from being homebound and isolated, freed from broken bones that will plague you forever, free from falls that can kill you, free to add normalcy to your life.”
“When your treatment stops working, then you ‘fail the treatment’. But it’s the medicine that fails, not the patient.”
“Discharged from the care of X – This term is militaristic. As if care starts and ends with a hospital consultant.”
“How we describe children with developmental disability and genetic syndromes is important, for it not only reflects but also informs parents’ and society’s thinking about kids like mine. For example, ‘Defect’ or ‘abnormality/abnormal’. I prefer anomaly.”
“Mental retardation – almost everyone prefers intellectual or cognitive disability.”
While medical paternalism is on the wane, the medical lexicon is littered with words and phrases that can feel top-down and demeaning. Readers who would like to share medical terms that have annoyed them are invited to send them to mhouston@irishtimes.com.
@muirishouston