I'm not a provider; I'm a physician. I don't give a commodity; I give care. The people I help aren't customers; they're patients. Language does more than just express thought; it shapes thought. Words matter.
English equips us with more than a million word choices, each with its own nuance of meaning, each that evokes emotions and shapes perceptions. Using words with negative connotations or that are dismissive can undermine our well-being, just as those with positive connotations can empower us.
The ED is no place to let the wrong words fly out of our mouths like grenades that can't be repinned. Why do we say “she failed outpatient antibiotics” when the reality is that outpatient antibiotics failed her? Imagine feeling horrible and being told, “It's just a cold” vs. “It's an upper respiratory infection.” Which sounds to a layperson like I took her complaint more seriously? Subtleties like these make all the difference in how patients connect to us. We would be doing them, ourselves, and our profession a disservice if we didn't try to find the most compassionate words to soften and soothe their fears.
We must be especially careful at the end of life. Which has a more positive connotation: do not resuscitate or allow natural death? A study comparing those word choices found that 61 percent requested CPR when “do not resuscitate” was discussed, but 49 percent wanted CPR when “allow natural death” was used instead. (Crit Care Med 2013;41[7]:1686; http://bit.ly/2Lmx8z1.)
Researchers concluded using “allow natural death” made family members feel they were honoring the patient's last wishes, while DNR implied that they did nothing to save them. The words “death,” “dead,” and “dying” may not be the most palatable, but some truths shouldn't be sugarcoated. A fine line delineates avoiding brutal language from avoiding truths that patients deserve to know. It is kinder to deliver bad news unequivocally rather than using euphemisms. Let patients and families hear the words “death” and “died.” Avoiding them can be detrimental to understanding and acceptance.
Words shape how patients perceive their illnesses and even themselves. The unknown is scary, so don't make their illness more intimidating by using medical jargon they can't understand. No patient should ever feel defined by his illness. Evidence shows that referring to a patient as a “substance abuser” resulted in more negative attitudes and assumptions about her than referring to her as a person who “has a substance abuse disorder.” (Int J Drug Policy 2010;21[3]:202; http://bit.ly/2KLLAiZ.)
It is far kinder to say someone has bipolar disorder rather than someone is bipolar. You would not say someone is pneumonia. People are people first, not their illness. Keep this in mind the next time you say, “Bed 1 is a hypertensive” rather than “Bed 1 is a man with hypertension.” I am guilty of this myself and need to be more cognizant of how such phrasing can insidiously influence my patients' self-image.
‘Burnout’ Blames Victims
Words affect physicians too. I take great care with the words I say to patients, but what about the words spoken to me? It's impossible not to feel differently about patients when I hear over and over that they are customers. The word commercializes an interaction that should be intimate and personal. Good doctoring is motivated not by financial gain but by love for your fellow humans. The word patient implies an inherent vulnerability and garners more tenderness and charity. Physicians care more about patients and go out of their way for patients. The more we use business terms about the sacred doctor-patient relationship, the more we depersonalize and commodify the art of medicine.
Words that physicians hear over and over also affect our self-perception, wellness, and morale. “Burnout” and “resilience” are demoralizing terms that attribute problems to the individual rather than the broken system. Burnout blames the victims who are enduring increasing demands from all directions. Resilience implies that it's up to physicians to suck it up no matter how broken the system gets. The most morale-crushing word choice, however, is one that strips us of our true job title and lumps us under a generic provider label. Patients do not come to the hospital to see a provider. No kid ever dreams of being a provider. I did not incur a substantial debt and sacrifice my 20s to the education and training it takes to be a provider.
Nazis used “provider” to devalue Jewish physicians, so there is a historical precedent of using the word to subordinate. (Isr Med Assoc J 2006;8[5]:324; http://bit.ly/2KHIDj6.) Please call us physicians. It connotes the privilege and respect we earned for what we do. Hearing the word “physician” affirms that we are practicing one of the most noble professions, and we need that empowering morale boost in today's culture of health care.
The way we speak to each other matters, and the way we let ourselves be spoken to matters. The right or wrong word choice can be the difference between an inspiring message and a demoralizing one. In a health care culture that seems to be turning into one of profit instead of compassion, caring word choices can retain the spirit of why we entered medicine. We can all do a better job of finding the best words for the well-being of patients and physicians. There is never a right time for the wrong words.
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