Stigmatizing language iII

· “The patient has a substance use disorder” or “The patient is an IV drug abuser”

· “The patient is not tolerating treatment” or “The patient refused treatment”

· “Patient with complex health issues” or “Frequent flier”

· “Difficulty taking meds due to…” or “Noncompliant”

· “Patient has been incarcerated” or “inmate, felon, convict”

 

I think we would all agree that the first statements have a better tone, a more neutral tone, than the second statements.

 

My last two posts looked at studies that investigated the characteristics of stigmatizing language used to describe patients in the medical record and revealed the potentially damaging effects of such language.

 

How can we practically address this issue?

 

Various medical literature and patient advocacy groups have suggested guidelines on how to promote humanization of a patient’s medical record, but it has been difficult to find a source that consolidates the recommendations until recently. The Temple University Hospital in Philadelphia, PA, embraced this task and pulled these guidelines together into nine core principles (check out their website below!). Here they are:

 

1. Use person-first language (a person with diabetes, not a “diabetic”). This is an easy change to make!

2. Avoid stereotypes and generalizations (“non-compliant, “poor historian” – I had difficulty taking a history because the caregiver wasn’t at the bedside, or an interpreter wasn’t available. This approach suggests ways to improve the situation)

3. Assign blame to the system, not the individual (What are the broader structures at play? Be attentive to verb selection describing choice. Pt chooses one treatment over another or patient declines. This moves away from individual blame)

4. Eliminate pejorative terms (convict, alien – there are neutral alternatives: patient who has been incarcerated, immigrant)

5. Think critically and be intentional about using social identifiers (race and socioeconomic status don’t belong in the one-liner. They easily transmit biases.)

6. State the facts – avoid interpretations (“patient alleges/claims 10/10 pain” rather than “has 10/10 pain”)

7. Use inclusive language (“patient uses a wheelchair” rather than “wheelchair bound”. Describe the tool and avoid describing the patient with a tool)

8. Use the active voice (“I prescribed antibiotics” rather than “antibiotics were prescribed”. This helps with taking ownership)

9. Don’t weaponize quotes (don’t quote patients in a way that is humorous or belittling. “Patient is having ‘horrendous’ pain”)

 

Perhaps all these principles can be summarized into one golden rule: when in doubt, ask yourself, “If I were the patient reading/hearing this, how would I feel?”