I’ve said it before, and I will say it again: words matter.
Pay systems and policies aren’t the only things that are becoming more patient centered in healthcare. Over the last several years, I have noticed that the language of healthcare is changing, too. When I contracted meningitis, the word that was casually thrown around to describe my likely future was “vegetable.” It came from the use of “vegetative state” to describe a person who appeared to have no awareness of either internal or external circumstances (comatose). It was a term that had been used for almost 100 years, and the ancient Greeks actually used it to indicate a lesser form of life, one that had no soul. Like a plant or a vegetable. Now, we recognize that this word is more than a little insensitive.
That is an extreme example, though not uncommon. It’s almost as if medical staff didn’t think we, or our family, friends, or other loved ones, can hear them when they talk about us.
Other examples are more subtle. When I went through my teens purposely not following the recommended diabetes regimen, they called me “non-compliant”. Now, they would say non-adherent. Compliance accusatory even as it implies submission, I think, and passivity. Adherence implies a choice to act, so healthcare has decided that it is a more positive angle. But I ask you, if you are talking about the negative – non-compliance vs. non-adherence – which is the more negative, that you are ignoring recommendations, or because you are actively working against it?
Another one is that healthcare now deems me a “person with diabetes” as opposed to a “diabetic.” I see the intent. And they are right to identify us as people with a condition as opposed to someone completely defined by a condition. I am indeed more than my conditions, as are we all. However, I am proud that I have survived everything diabetes has thrown at me. The amount of time, energy, blood (literally), sweat, and tears I have poured into coming into my own and finding my path with this condition makes me feel like I have earned my title as a diabetic woman.
That being said, I recognize that this view isn’t for everyone. In fact, it may not be for most patients. Many will prefer not being labeled as their condition(s) and the more egalitarian “adherence”. It is easier to hear this language and to think about yourself in these terms.
For examples two and three (I think we can agree that no one, especially those who can’t speak for themselves, wants to be referred to or thought of as a “vegetable.”), I actually think it is more important to ask people what words they are comfortable with. That is the more humanizing and empowering approach.
Here’s one more example, this one from the other side. I recently came to understand that the word “provider” which I used often in my earlier work on this blog, as well as in my advocacy work, is a term that is like fingernails on a blackboard for many medical staff. They don’t identify with it at all – not surprising, since the term originated with insurance companies. And considering the time, energy, blood (not-so-literally), sweat, and tears they have sunk into education, building practices, and hospital rounds, I am happy to ask how they see themselves, and in more general settings, make the switch to “clinician.”
It’s been my job to nitpick words for decades. We have to think about what we want to communicate, but also how it will be received by its intended audience. I once had an argument over the use of “could” vs. “would” when asking someone to do something. Believe it or not, one is much more aggressive than the other. And sometimes attention to those kinds of details can make all the difference.
It’s a matter of semantics.