Language that belittles or blames patients is overdue for change

Working to change medical language is not for political correctness, but to improve shared-decision making, say experts

Medical language that casts doubt, belittles, or blames patients for their health problems continues to be commonly used in everyday clinical practice, but is outdated and overdue for change, argue experts in The BMJ today.

Caitríona Cox and Zoë Fritz at the University of Cambridge draw on existing research to describe how such language, while often taken for granted, can insidiously affect the therapeutic relationship by altering the attitudes of both patients and physicians. They suggest how it could be changed to foster a relationship focused on shared understanding and collective goals.

Language that belittles patients includes the widely used term “presenting complaint” rather than referring to a patient’s reason for engaging with healthcare, they write. Similarly, use of words such as “denies” and “claims” when reporting a patient’s account of their symptoms or experiences, suggests a refusal to admit the truth, and can hint at untrustworthiness.

Other frequently used language renders the patient as passive or childlike, while emphasising the doctor’s position of power, they add. For example, doctors “take” a history, or “send” patients home.

The terms “compliance” and “non-compliance” (in relation to taking medication) are also authoritarian, and they suggest that doctors should focus on changing their language to instead focus on reasons why patients might not be taking prescribed medications, promoting a more collaborative doctor-patient relationship.

Patients too have objected: “Being described as ‘non-compliant’ is awful and does not reflect the fact that everyone is doing their best.”

Language that implicitly places the blame on patients for poor outcomes is also problematic, argue Cox and Fritz. For instance, the term “poorly controlled” in conditions such as diabetes or epilepsy can be stigmatising and make patients feel judged, while “treatment failure” suggests that the patient is the cause of the failure, rather than the limitations of the treatment or the doctor.

Research shows that specific word choices and phrases not only affect how patients view their health and illness but also influence doctors’ attitudes towards patients and the care and treatments offered, they explain.

For example, a study of neutral language with language implying patient responsibility (not tolerating oxygen mask v refuses oxygen mask), showed that the non-neutral term was associated with negative attitudes towards the patient and less prescribing of analgesic medication.

The authors note that using the right language “is not a matter of political correctness; it affects the core of our interactions” and say research is now needed to explore the impact that such language could have on patient outcomes.

Much of the language highlighted here is deeply ingrained in medical practice and is used unthinkingly by clinicians, they write. Clinicians should consider how their language affects attitudes and choose language that facilitates trust, balances power, and supports shared decision making.

Prominent public health expert retires

Dr Stephen Duckett (PhD) has officially left his role at the Grattan Institute after almost 10 years pushing health reform at the think tank.

The former secretary of the federal Department of Human Services and Health, Dr Duckett has been one of the country’s leading health policy gurus and an occasional bête noire for the AMA.

His most recent major fights with the medical profession have centred on his advocacy for capitation in primary care, while his final report took aim at the rising average fees charged by specialists around the country.

“Governments need to act, so that people who need healthcare can get it in a reasonable time frame, rather than face prolonged waits for an outpatient appointment or miss out on care altogether because of unaffordable out-of-pocket payments,” he argued.

In a blog post late last year Duckett said he was particularly proud of his advocacy for so-called COVID-zero over the past few years.

But his impact had been far wider.

“What I’ve been on about at Grattan…is trying to change the way people think in the health sector and in public policy,” he wrote.
Dr Duckett said he was now planning to focus on writing, with a book on the ethics of healthcare funding already underway.

He said he also planned to continue as chair of Eastern Melbourne Primary Health Network and on the boards of the Brotherhood of St Lawrence and the Royal Melbourne Institute of Technology.

Cardiovascular benefits seen after bariatric surgery

Bariatric surgery has substantial cardiovascular benefits for people with obesity, reducing the risk of heart failure, myocardial infarction and stroke by up to 50%, according to international research.

A study from the Cleveland Clinic analysed outcomes for almost 95,000 obese patients who underwent bariatric surgery with a matched group of people who did not have surgery.

They found that after a median follow-up of four years bariatric surgery was associated with a 37% lower risk of mortality (9.2 vs 14.7 per 1,000 person-years; Hazard Ratio: 0.63), 54% lower risk of new-onset heart failure (HR: 0.46), 37% lower risk of MI (HR: 0.63), and 29% reduced risk of stroke (HR: 0.71) (P < 0.001).

The number needed to treat with bariatric surgery to prevent death at three years was 64 and to prevent a major cardiovascular event was 15 patients.

The benefit of bariatric surgery was most evident in patients who were 65 years and older, the authors wrote in the Journal of the American College of Cardiology.