Article from the Boston Globe’s On Call Magazine, November 2000

By Helen Osborne, M.Ed., OTR/L
President, Health Literacy Consulting

Words not only convey information, they also reflect values and beliefs. As health professionals, we convey a sense of respect or a lack of it by the words we choose when we communicate with patients and colleagues.

Regardless of whether you are speaking or writing, it is important to chose just the right words to get your point across. But sometimes finding the right word can be a challenge. While books, such as the American Medical Association Manual of Style, can clarify the rules,” there are still plenty of issues to consider. Using the wrong word can not only make your messages obscure, it can also show a lack of respect for the people with whom or about whom you are communicating. It doesn’t matter whether or not that lack of respect is real. If it seems to be there, it can get in the way of what the words are supposed to do.

According to Carol A. Patsdaughter, PhD, RN, ACRN, director of research and scholarship at the School of Nursing, Bouvé College of Health Sciences, Northeastern University, our current view of what is “proper language” has been heavily influenced by the feminist, civil rights, and disabilities movements of the 1960s and 1970s. To be both effective and “proper,” our words need to not only be clear, they also need to be inclusive. Among other things, the words we choose should convey respect for differences in people’s gender, race and ethnicity, age, abilities, and sexual orientation.

Here are some of the considerations that need to govern your choice of words when communicating about health.

Should You Use the Simple or the Complex Term?

Communicating clearly often means using common words rather than complex terminology. But the simplest term isn’t always the best term to use. For example, when health professionals talk with patients about pain medication, they can refer to “the pain pill” or they can specify “10 mg morphine.” While the simpler version can be easily understood by most people, regardless of their language skills, Professor Patsdaughter points out that there are benefits in using the more specific language.

Teaching patients the correct terms, she advocates, can give them a tool they can use in multiple contexts. For instance, it will help them when they see a new provider or when they have a middle-of-the night emergency.

One way to help patients learn the proper term is to use both terms initially: “10 mg morphine – a pill you take for pain.” That way patients are able to put the technical terms into a context that is easy for them to understand.

How Do You Refer to a Person’s Condition?

The words we use to talk about someone both reflect and affect the way we think about that person. They also affect the way others think about that person. Keep these points in mind:

• Terms such as impaired, disabled, and handicapped are not synonymous. An impairment is an abnormality of a person’s body structure, appearance, organs, or system functioning. A disability is the functional limitation a person experiences as a result of an impairment. A handicap is the social consequences of the disability.
• The American Psychological Association’s guide Enhancing Your Interactions with People with Disabilities suggests that when you are referring to someone with a medical condition, you should speak of the person first and the condition second. For example, say “a person with AIDS,” rather than “an AIDS patient.” Doing so keeps attention focused properly on the individual rather than the condition.
• The guide also suggests avoiding the use of words that sensationalize a situation. For instance, don’t say that Bob is “suffering from” or “stricken with” an illness. Bob “has” an illness keeps the situation in perspective and avoids making pity the central concern.
• Whenever possible, use active words rather than passive words to describe a patient’s condition. That way you continue to focus on the patient’s abilities rather than the lack of them. For example, write that “Mary uses a wheelchair,” rather than saying “Mary is in a wheelchair.”

How Do You Make Your Language Inclusive?

Inclusive language is language that respects a person’s gender, race and ethnicity, age, disability, and sexual orientation. Most health professionals agree it is important to use such language. But it’s not always clear which term is the best to use. For example, should you refer to patients as “older,” “senior,” “aged,” “elderly,” or “geriatric”? To be respectful, it is important to find out which terms are preferred by the people you are referring to, and then to use this terminology consistently when communicating.

A Dialogue About Words

Here are two other common word-choice problems that consistently seem to cause communication headaches:

• Pronouns. When you write or speak about people in general, you face the dilemma of what pronoun to use. “S/he” or “him or her” can be awkward constructions. One way to avoid this is to use the plural rather than singular form when possible. “When a patient is admitted to the hospital, s/he needs to register,” can be restated as “Patients need to register when they are admitted to the hospital.” But not everyone agrees that using the plural is the best answer. Also, there are times when the plural just doesn’t seem appropriate.
• Relationships between patients and providers. It’s important to be sensitive to the use of possessives such as “our,” and “your.” A while ago, I was promoting my workshop, “Communicating with Your Patients Who May Have Trouble Understanding.” A colleague challenged this wording, saying that “our patients” suggests ownership. I disagreed, saying that in my own experience I find it comforting when a physician refers to me as her patient. I still don’t know the right answer.

Finding just the right word can be a challenge. Health professionals do not always agree on terminology, and stylebooks do not always provide the needed guidance. I encourage you to participate in a dialogue about words. I’m interested in hearing what guiding principles you use when looking for just the right term to communicate an idea to a patient. Take a few moments to jot down your ideas about how to choose the proper term and send them to:

In Other Words
On Call
27 Otis Street
Westboro, MA 01581

We’ll share what you have to say in a later column.

Resources for Thinking About the Right Word

• Carol A. Patsdaughter, PhD, RN, ACRN, is Director of Research and Scholarship, School of Nursing, Bouvé College of Health Sciences, Northeastern University.
• Enhancing Your Interactions with People with Disabilities is a useful publication from the American Psychological Association. You can find it on the Web at www.apa.org/pi/cdip/enhancing.html

Two printed resources that you will find useful are:

• Gething, L: Person to Person, 2nd edition. Paul H Brooks Publishing Co. 1992.
• Iverson C (Editor): American Medical Association Manual of Style, 9th edition. Lippincott, Williams and Wilkins. 1997.