How political correctness interferes with healthcare

Political correctness and sensitivity training are interfering with medicine and healthcare. In a recent article published in the journal, Pediatrics, a group of researchers published their findings regarding parental perceptions of the terminology that doctors use to describe childhood obesity (ages 2 to 18). The researchers found that it was undesirable to use the term “fat,” “obese,” or “morbidly obese” because they were stigmatizing, blaming, and the least motivating to lead one to lose weight. What should be used instead? The term “weight” and “unhealthy weight” were rated as the most desirable. The term “overweight” fell in the middle of the pack.

When I write reports for patients and other healthcare providers, I always try to avoid use of casual terminology and stick to medical terminology. It looks more professional that way because the terms have a scientific basis. While the word “fat” is a colloquial term, the words “obese” and “obesity” are not. They have specific scientific meanings in the medical community. Don’t believe me? Grab a medical dictionary. I just looked up the terms “fat” and “obese/obesity” in the two most popular medical dictionaries: Mosby’s and Stedman’s. Mosby’s does not even have an entry for the word “fat’ as a descriptive term and Stedman’s only briefly noted that it is a common (i.e., colloquial) term for obese. However, both dictionaries contain extensively detailed scientific entries on obesity. Neither dictionary contains the term “unhealthy weight” which is vague since it can also apply to people who are underweight.

So, while I agree that we should avoid using colloquial terms that can feel degrading, we should not abandon the use of scientific terminology because someone does not like the stigma attached to it. The problem that emerges when we start to substitute euphemistic phrases for scientific terminology is that we start to de-emphasize the seriousness of the problems. For example, for people who do not like the stigma of being called “anorexic” should we just say that they are “too skinny.” Some people do not like the stigma of being a cancer patient. Should we just say they just have “really bad cells?” What about people who don’t like the stigma of major depressive disorder? Should we just say the have “the blues?” Should we tell patients they have “unhealthy sugar” instead of telling them they have diabetes mellitus? Where does it stop?

The terminology is becoming so diluted that I have even heard that some overweight people are being referred to as “persons of size.” That term means absolutely nothing since everyone is technically a person of size.

I do not doubt that the parents in the study feel the way they reported, but I would like to see some evidence that less stigmatizing terminology makes a difference in terms of the actions people take to reduce weight, as there was no such evidence of this cited in the above study. A good study would be to divide patients into two groups, call one “obese” and say that the other has “unhealthy weight” during appointments, prescribe a weight loss routine, and see who loses the most weight after controlling for other variables between the two groups that could contribute cause difference between the two groups. If the obese group loses more weight than the unhealthy weight group, then that is what really matters in the end. Sometimes, people need to feel that something bothers them in order to be motivated to really make a change.

Dominic A. Carone is a neuropsychologist who blogs at MedFriendly.com.

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  • http://www.facebook.com/jonathan.marcus.ca Jonathan Marcus

    No need to make a mountain out of a molehill with regards to language, which BTW is in a state of constant flux and alway will be.

    I’m a family doctor from Toronto and I think think it really does not matter what you call it.  What matters is how you present the problem to the patient. if indeed overweight patients have health concerns, physicians need to motivate them to gain control as much as possible over their health.  I’ve seen patients who would be defined as obese who are fit and healthy and I’ve seen patients of normal weight who are neither fit nor healthy.  It’s not a matter of political correctness, it’s about communication.  I say speak to patients in whatever language creates a meeting of the minds.

  • Christie Babinski

    Didn’t you answer the question asked in the last paragraph in the first?  Stigmatized terms were not motivating.  Is your next next column going to be dedicated to nostalgia for medical terms like “idiot” and “dumb”?

    • http://www.facebook.com/brianpcurry Brian Curry

      While it may appear so, my reading of this entry leads me to believe that they are two different questions. In the first paragraph, he writes that patients rated such terms as making them FEEL less motivated to take action. The last paragraph, however, asks whether avoiding valid, clinical terms in order to make the patient feel better actually correlate to improved outcomes.

  • http://twitter.com/LittlePatient Haleh

    Ultimately what matters is the doctor’s ability to connect in a meaningful way with their patient.  Docs need to take time to truly know their patient. Then you’ll be able to use the term that will hit home and motivate your patient without scaring or demeaning them into inaction.

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

  • horseshrink

    I like Pinker’s commentaries re: euphemism treadmills.
    http://www.google.com/search?q=pinker+euphemism+treadmill

    In the mental health world, the euphemism treadmill runs full tilt.  Personally, I detest the term “consumer” because it trivializes and insults the real suffering of the people we serve. 

    Consume derives etymologyically from concepts of destruction, laying waste to, squandering and using up.  Nice, huh?  Sounds like a term I might use for someone I don’t much like.

    “Patient” etymologically derives from the concept of suffering.  I don’t see a need for anybody to see me unless there IS suffering, or a real risk of suffering.

    http://www.etymonline.com/?search=consume
    http://www.etymonline.com/?search=patient 

  • Anonymous

    I like Pinker’s commentaries re: euphemism treadmills, which happen to be running full tilt in my field.

    “Patients” have morphed multiple times, and are now “consumers,” a name I detest because of the ironic disrespect it conveys.  In frantically beating an incomprehensible retreat from the term “patient,” a pejorative label is chosen instead.

    “Consumer” etymologically derives from consumere “to use up, eat, waste.”  A consumer is “one who squanders or wastes.”  Synonyms of consume: destroy, swallow up, ingulf, absorb, waste, exhaust, spend, expend, squander, lavish, dissipate.
     
    Sounds like a name you might use for someone you really don’t like.
     
    By contrast, “patient” derives etymologically from the concept of suffering.  That gives much more respect to the experience of those who see me.  In fact, people who are not suffering, or at strong risk of suffering, shouldn’t be seeing me in the first place.

  • Anonymous

    I attended the Canadian Cardiovascular Congress in Vancouver in October, where I was enlightened by pediatric cardiologist Dr. Brian McCrindle (Hospital for Sick Children, Toronto) during an outstanding presentation (straightforwardly dubbed by Shelly Wood of theheart.org as “Fat, Unfit, Unmotivated: Cardiologist, Heal Thyself”).

    Dr. McC. warned physicians in his audience that his talk would be “tiptoeing
    the thin line between naming and shaming”, his bottom line: many docs themselves are NOT
    living, eating, and acting like the kind of physicians who can truly
    motivate patients to improve their own health.  In a survey of pediatricians, for example, 40% were overweight based on BMI
    calculations, yet more than half of these overweight physicians classified
    themselves as “normal” weight. In another survey of over 3,200 Canadian
    physicians, 91% reported themselves to be in “good to excellent” health,
    yet 37% had a BMI between 25 and 30, and 8% had BMIs over 30. Would you suggest that somebody – perhaps their patients? – should be calling a spade a spade, and letting these doctors know that they are not just “persons of size” – but downright FAT?

    Dr. McC. might actually agree. Tellingly, he warned us: “Please feel free to be uncomfortable and to
    take this personally, because people change when the pain of change is
    less than the
    pain of staying the same.” 

    PS Here’s a pretty graphic example of what FAT looks like: http://myheartsisters.org/2011/12/07/what-your-body-fat-really-looks-like/