The words we choose can have impact on those we interact with

Language matters. The words we choose can have far-reaching impact on those we interact with. This is arguably more true in medicine than in any field.

Ryan Madanick wrote a recent blog post on the use of descriptor terms used by physicians in patient’s charts. He felt that the use of phrases like “is a very pleasant 52 y/o woman” or “is an unfortunate 16 y/o boy” is inappropriate. I agree. However, in response to this post one reader commented that he felt Dr. Madanick was nit-picking. He isn’t.

When I see such comments in colleagues’ note I wince. I was taught well by attending physicians who appreciated the power of language. I was taught to leave judgements like “pleasant” and “unfortunate” out of my notes. I was even taught not to use the ubiquitous term “complains of “or complaining of” (as in Mrs. Jones is a 43 y/o woman who complains of stomach pain”). When I was a medical student I had a trauma surgery rotation. The attending during that time was a wonderfully dynamic and caring man. One morning he brought his wife to rounds to listen in (this was pre-HIPAA). Afterwards he asked her what she thought of the experience. She was outraged. Outraged by our use of language. The patients who needed us most were “unfortunate”, “demanding” and “complaining”. Those we liked were “pleasant” and “stoic”. Those we did not were “difficult”. She asked how pleasant, fortunate and stoic we would each be if we were stuck in the trauma unit after a  car accident left us unable to walk or, a bullet to the chest left us struggling to breathe pain-free? She volunteered that it was likely we would all be pretty darned demanding and complaining.

These words aren’t only judgmental and fault-finding, they are dangerous. Dangerous in their tendency to narrow our thinking. I had an experience early on that made this point loud and clear to me. Before seeing a patient one night I was handed the chart by a nurse who asked if I knew the child. I did not. She went on to tell me how difficult the parents were and how the kid was a “frequent-flier”. I glanced at the chart before seeing the child and read a few notes all with comments about this “unfortunate” child and her demanding parents. Several days later I learned that after seeing me, and returning to another physician she eventually presented to the ED in extremis. I sat down alone and went back over my visit. The only error I could find in my care was one of perspective. I entered her room biased. Biased by descriptive words used by the nurse and found in her chart that should not have been used. Did I miss her diagnosis because she was in my office too early in the disease process? Or did I miss it because I was viewing her as a complaining frequent-flier with difficult parents?

When we enter into care for a patient we need to approach them as if they are a tree of possibilities. The choices of diagnosis and the decisions around care should be narrowed not by our own bias and judgment but by careful medical thought. To speak of our patient’s with critical descriptors is not only rude but it is medically dangerous; doing so hurts them, and leaves us at risk as well.

Kate Land is a pediatrician who blogs at mdmommusings.

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  • http://makethislookawesome.blogspot.com/ PamC

    Brilliant. I wish this was required reading for all doctors.

    • Anonymous

      Thanks. I feel I was well taught; feel free to share :-)

  • Gil Holmes

    It’s called a ‘chief complaint’.

    Most of the time I have seen ‘unfortunate’ used in a dictation it is because the patient’s case was particularly unfortunate.
    Is it necessary to say ‘unfortunate’? Well, no. But it doesn’t color my judgement negatively or positively.

    Telling me they are a frequent flier or have difficult parents might color judgement, but then those comments didn’t come in a dictation.

    And of course we all know ‘difficult’ and ‘stoic’ and’demanding’ patients. Knowing that in advance I can explain rationale more explicitly for the ‘difficult’ patient, assess the ‘stoic’ patient more closely for signs of pain or other physical/mental sufferring, and answer ‘demands’ logically before they are made. 

    • Anonymous

      There is certainly a balance to be found that allows for useful description without bias. And to that end – gaining insight as you describe can help us meet the individual needs of patients more efficiently.Certainly stoicism is something that is useful to understand. However, I have always found the term unfortunate used in reference to a patient to be dehumanizing. They are not. Their circumstances are.

  • http://www.facebook.com/people/Craig-Koniver/100001463176810 Craig Koniver

    I liked what you wrote here and your perspective. I certainly think language is very powerful and we as physicians tend to undermine that many times. I do think, though, that descriptive words can help in our charting. I know for me, I use descriptive words because it helps me remember the mood and feel of the patient at the visit. Certainly I am biased about my perceptions, but that is okay, because I am the doctor for the visit. I think descriptive words can help while the problems arise when we use judgemental terms. So it is far better to document that the patient was disheveled appearing, than say that the patient was a slob. Thanks for this important reminder!

    • Anonymous

      Absolutely – there is a skill to charting these observations respectfully and yet fully. I like your example!

  • Anonymous

    As a patient, I am so appreciative of this perspective and so very thankful that there continues to be a true bedside manner and care-of-patient view in the medical world. This is also truly applicable to all walks of live and professions. Thank you Dr. Land for the wonderful review of how to treat others with care and concern, and the reminder that each of us, no matter our role in the world, can make false judgements when biased by others comments.

    • Anonymous

      It is true that the ability to be biased by comments expressed around us extends beyond just the medical profession.
      And, BTW, I am certain your father was one of those wonderful teachers that I spoke of! :-)

  • http://twitter.com/LittlePatient Haleh

    I deeply appreciate the importance of language that you raise in this article.  Ultimately, the patient/doctor interaction is a relationship and one which can only be at its best when there is mutual respect.  Certainly the doctor’s role is challenging- the doctor has to be an expert yet be open minded enough to recognize that something may be going on beyond their expertise. Having the basis of respect for a patient and valuing the relationship that needs to be formed by watching the words that they use, puts the doctor in the best position to be a true healer.

    Haleh Rabizadeh Resnick, Esq.- Speaker and Author of Little Patient Big Doctor  http://www.littlepatientbigdoctor.com

    • Anonymous

      Yes, that is the point. Respect. And, respect even when it is hard to feel respectful or hard to find respectful words. This is a challenge!

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