Using Our Good Words

doctor-and-patient

In the old days, writing in Latin was as useful as feeding your content into a translation app, because no matter what language they spoke in everyday life, literate people could understand it. Latin is a very sensible language with logical rules, and the medical profession adopted it not to weave a blanket of obscurity, but so their writings would be comprehensible to colleagues. No matter what part of the world they inhabited, medical experts could learn from each other and benefit from one another’s discoveries.

In recent years, another language has become vital for doctors to learn, and the same is true of other primary care providers, and in fact anyone at all who deals with patients. That is the language of understanding, compassion, and respect. It is language that abandons judgment and stigmatizing attitudes.

Over and over again, studies have found that our unconscious mindsets are shockingly vulnerable to influence from the speech of people in the environment. When words issue from the mouths of authority figures, like doctors, they have extra potency and can impact a patient to a startling degree.

People who are in pain, who are coping with an illness, are also likely to be depressed, so encountering language that inflicts additional stress is the last thing they need. In fact, there is evidence that patients who feel shamed or diminished by the language or attitude of medical personnel are less likely to seek followup care. The advice is to avoid any words that imply helplessness, or a lack of motivation or effort on the part of the patient.

Nobody tells me what to do

Additionally, a certain number of humans, including patients, are politically sensitive, and apt to react negatively against words like “compliance,” which suggest that they are being controlled in an authoritarian, autonomy-threatening relationship. To them, the phrase “doctor’s orders” is just as odious as “dictator’s decrees.” In an extreme case, unhealthy adherence to the “Live free or die” philosophy can extend to literal death.

A worrisome example is a study where observation of the subjects was referred to as “surveillance,” a word that hopefully was not used where the patients could hear. Nobody wants to be under surveillance.

The goal is to employ nonjudgmental language that provides hope and empowerment, and facilitates collaboration rather than resistance and divisiveness. It is based on the patient’s strengths, needs, and goals, and uses value-neutral descriptions of facts and actions.

Leadership from the diabetes community

Recently the American Diabetes Association and American Association of Diabetes Educators published their recommendations that were designed to improve communication in diabetes care and education. Much like the modern tendency to speak of “an enslaved person” rather than “a slave,” conscientious healers now favor “a person with diabetes” instead of “a diabetic.”

This page contains a comprehensive chart with entries in three categories: “Instead of…,” which are the outdated, possibly damaging terms; “Try saying…,” which are the helpful and preferred terms used by woke people, and “Explanation.”

For instance, to use the word “normal” implies that people with diabetes are abnormal. While that may be technically accurate in a laboratory sense, in everyday conversation it won’t do. So instead of “normal” or “nondiabetic,” the preferred term is “person without diabetes.”

To explore this more deeply, see Adam Brown’s illuminating essay on why it is better to check, rather than test, a glucose level, and why we seek not to control our blood sugar, but to manage it. Brown does not want to experience a sense that “my glucose level is a grade on my diabetes performance — a “test.” He believes the word capable of these things:

It drives a lot of self-blame, negativity, and guilt.
It can stimulate endless negative thought loops and frustrated questions.
It might even encourage less glucose monitoring – if getting a number is a negative experience, I may do it less often.

Words count.

Your responses and feedback are welcome!

Source: “Diabetes Language Recommendations: How To Avoid Judgment and Stigma,” Diatribe.org, 11/15/17
Source: “Blood Sugars Are Not “Tests”,” Diatribe.org, 08/14/17
Photo credit: hang_in_there on Visualhunt/CC BY

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
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Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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