In medicine our motto is first do no harm. Words matter. Choose them wisely. Here are 7 words that shame, blame, and injure people who need our help.
1. Don’t say COMMITTED suicide. Committed implies a crime. Committed rape, burglary, murder. Suicide is not a crime; it’s a medical condition that has been taboo for too long. Let’s come out of the dark ages and use proper language to discuss the cause of death. It’s died OF pneumonia, heart attack, stroke, suicide. Say died OF suicide (or died BY suicide).
2. Don’t say she IS bipolar. People are people first. Some get physical and/or mental health conditions. The health condition is not their identity. She HAS pneumonia, heart disease, depression, not she IS pneumonia, heart disease, depression. Say she HAS bipolar disorder (or she is a person WITH bipolar disorder).
3. Don’t say he IS an addict. As in #2, people are people first. He is not a disease. He is not a behavior. Thus, he is not a substance abuser or an addict. He is a person who may have an addiction or a substance abuse disorder. Say he HAS an addiction.
4. Don’t say patient IS NON-COMPLIANT. Non-compliant blames the patient for not following a plan that she may have not understood or agreed to follow. Maybe she simply did not have money to buy the medication or the recommended treatment. Be precise and accurate with words, especially when placed in a permanent medical record. Don’t blame or shame. Be curious and engaging. Ask, “IS THE TREATMENT WORKING?”
5. Don’t say PROVIDER. A provider is a person who provides something. How nebulous. In medicine, a provider is an economic term used to lump all the revenue-generators together into one pile (often to see how much more money can be squeezed out of them). It’s a dehumanizing word that lacks precision and, honestly, it’s offensive to the people who have spent so many years of their lives to achieve mastery in their chosen profession. Use proper terminology. Say NURSE PRACTITIONER, MIDWIFE, PHYSICIAN. If you must use a collective term, say HEALTH PROFESSIONALS. Sometimes, I say HEALERS.
6. Don’t say MIDLEVEL. What is that? Maybe it’s when an elevator gets stuck between two floors? Again (see #5) this is a word used by health care administrators to describe revenue generators who are somewhere halfway between a nurse and a doctor (I think). Use proper terminology. Say PHYSICIAN ASSISTANT or NURSE PRACTITIONER.
7. Don’t say BURNOUT. Physician burnout is a term of oppression that blames the doctor for not keeping up with an inhumane schedule (30-hour shifts, 120-hour work weeks) in a toxic workplace that may include hazing, bullying, and no time to eat or take bathroom breaks. Even on their so-called time off, doctors may still be working on chart notes at home in bed on the weekends. Burnout blames the victim and deflects attention from the perpetrator. Speak the truth. Say HUMAN RIGHTS VIOLATION or HUMAN RIGHTS ABUSE. Don’t say burnout, say ABUSE.
Know of any other shaming words that should be lost from our lexicon? Add your comment below.
Pamela Wible, M.D., is a practicing physician who reports on human rights violations in medicine. She is author of Physician Suicide Letters—Answered and leads popular retreats for health professionals. Come join us! Image: Shutterstock.
I too believe that word choices are very important. It took me a long time to begin referring to myself as a survivor – not a victim – of sexual assault. Similarly, it took me a long time to say the word “rape” instead of saying “sexual assault”.
Sexual assault is PC, it’s a fluffy kind of term that can be used and nobody gets upset or offended. It takes away from seriousness of rape, it sugar coats a horrific experience and takes it from vile to tolerable.
I’ve found another word that I don’t like being used, for much the same reasons as above. I recently discovered that my university has a policy on intimidation and harassment. The “bullying” I’d experienced as a medical student was deemed harassment by university standards.
The term “bullying” somehow relegates my experience to a childish schoolyard tiff… It takes away from the seriousness of the experience and the long lasting deleterious effects such abuse had on me. I was not bullied, I was harassed. As a person who was bullied on occasion in my schoolyard days, I feel like I can confidently say the two experiences are much different. Let’s call it what it is even if the word harassment is much uglier. No more sugar coating.
Great call. Harass: subject to aggressive pressure or intimidation.to disturb persistently; torment, as with troubles or cares; bother continually; pester; persecute. Bully: to act the bully toward; intimidate; domineer. I think the issue here is that bully is associated with schoolyard intimidation while harassment has (in our minds) no limitation to age.
This quote from a letter on page 38 in Physician Suicide Letters—Answered: Too many people, even the medical boards who apparently are not even physicians anymore, are unaware of the abuses in medicine! The woman reviewing my application at the medical board mocked me when I said I was bullied. “The bullies?” she said. And I could hear the condescending smirk, like she wanted to laugh at me for mentioning bullying as if it was something for children.
I recently read that page of your book… and my gosh did it ever resonate with me! I knew I was not alone, I knew that my thoughts and inklings, that sense that something was wrong, were not wild or completely off-base. I am certain now that many in the profession scoff quietly, or openly, at the learners and colleagues who complain of being bullied.
Anything to deflect blame back on the individual. Too often seems to be the M.O. of corp med.
I think “malingering” should be included. As a second year student, I’ve heard it multiple times in lectures already, and it just makes me cringe.
Malingering: to pretend illness, especially in order to shirk one’s duty, avoid work, etc. I’m sure some people have exaggerated or faked illness to get out of work. And then many have been accused unfairly (probably in medical training). What would you replace malingering with? Do you have a personal experience with this word that is particularly upsetting?
Thank you, Dr. Pamela, for addressing these words and phrases. I did not spend 24 years of my life to be called a “provider”. I’m a doctor, not a tool to be pimped out by hospitals, pharmaceutical industries, and insurance companies to generate revenue.
Damn straight. It’s time to take back our profession. Let’s start with our vocabulary.
And yet, I think “malingering” is a more accurate/appropriate term than “drug-seeking”, which I absolutely hate. You’d be looking for pain medication too if you were in severe pain, but that’s never what people mean when they say a patient is “drug-seeking”. We need to stop assuming people are guilty until proven innocent, but I’m trying and failing to come up with a better term for someone who is deliberately faking their symptoms for personal gain (vs. factitious disorder).
I HATE drug-seeking (the label, not the behavior of under medicated people in pain engage in)!
It’s an encoded judgment, condemnation and snap diagnosis all in one.
Treat a person’s pain. They are then far less likely to seek more meds!
Words matter. To add: Do not ever say that a patient has a psychiatrist AND a “medical” doctor. We are all medical and to differentiate promotes stigma and is demeaning to psychiatrists.
Great one. Thanks.
LOVE THIS!! Absolutely.
Oh my word.
I treat people with eating disorders and with EVERY case in 20 years of practice have had to clarify that complete teams have TWO medical doctors- one trained in IM or peds and one trained in psychiatry!
“ but you know what I mean. I mean DOCTOR doctors, you know, real doctors, plus a psychiatrist.”
Thanks, Descartes for inventing mind body dualism.
Grrrrr
Words do matter, very much. I was “complaining” that my diabetes 2 was making me sleepy. No matter what time I had breakfast, like clockwork I’d get sleepy about half an hour later. My doc said it was the sleep aids I was taking. I tried to explain the connection with breakfast, and insisted she change my metformin. She finally agreed to the change, but her dx was “polypharmacy”, despite the actual cause of the sleepiness. That shit follows you around, potentially interfering with treatments, insurance, and respect by practitioners. I’d have fired her, but it’s hard finding a primary.
Anyway, may I add a `don’t`? Don’t say “alleged rape” or “alleged sexual assault”. Doctors are not the ones to decide legal cases. You’d never say “alleged throat pain” or “alleged motor vehicle accident”. Why doubt the victim straight out of the gate? Her chief complaint isn’t alleged rape, it’s rape. Her subjective information tells HER POINT OF VIEW, her story. The objective portion of a report will show if there are any physical findings to prove her complaint. The diagnosis should be probable rape, unless findings dictate otherwise. Let the courts decide the validity of her statements. Docs are there for the patient, not her attacker.
Thank you!!!
I also believe that we should stop using the words “clean or dirty” to refer to patients who stopped using drugs and those who are still using… Patients who are struggling with addiction have enough stigma to deal with. Let’s not use these words.
Yes! Excellent.
Agree.
Patient ‘refused’ treatment. No, patient had a choice and DECIDED not to have treatment, something well within their right to do.
Oh yep. Break down the hierarchy.
Agree. Our job is to educate the patient as best as we can to help them chose the best path for themselves. Found myself as a patient in a hospital recently, I was “refusing” much of the treatment advised, which might label me “non-compliant.”
I typically use the term “declined” rather than “refused.”
Just FYI, I recently found out that escorts call themselves ” provider” now a days.
Oh no. Lump us all in together 🙂
Haha, the oldest profession
I Love this. Physicians have to not say what you said in all the above and also realize that patients may have multiple medical conditions that require more than one treatment whether it be medications or pain management etc. No one provider whomever it may be should harass a patient and like Dr. Barbara Mack said, “non-compliant” is used way too often when a patient chooses not too have a treatment dictated to them that may not be to their entire best knowledge. This is a stigma and has to be stopped in healthcare in order for the patient-physician relationship to move forward and heal the people we love and take care for.
Calling patients “difficult” is a huge one. Patients are certainly sometimes crabby or rude, but being in a state of distress while in the hospital is not the same thing as having a personality disorder. The level of crabbiness or rudeness is also highly dependent on how you treat patients in all but a few cases. People who don’t follow the doctors orders to the letter (i.e. the “non-compliant” patients) also get labeled as “difficult”. “Challenging” might be a better term, since it does take more skill to deal with someone who is unhappy or has trouble understanding or following their treatment regimen or who disagrees with the plan of care, but even that might be too derogatory.
A related one that bugs me is doctors, especially non-psychiatrists, throwing out psychiatric diagnoses after spending less than 5 minutes with a person. Calling patients “borderline” and “histrionic” seem to be favorites. Crabbiness/rudeness etc. in an acute setting do not equal a personality disorder, and these labels are a convenient way to disregard patients and treat them as inferior.
I SO agree with you! The whole psychiatric “trashcan” approach when one can not diagnose or help a patient has always irked me. Punt to the psychiatrist what one doesn’t understand or want to deal with.
This is very educational, Everything you do is!
Thank you 🙂
Thanks! I just added the expanded podcast. Listen in on the blog above. LOVE to know what you think of it. I’ve only done 2 podcasts so far. Any feedback is appreciated.
This is an excellent description of things we may have said in the past or may say in the future therefore we are forewarned. It is excellent and I like the mid-level idealogy. Good work. Thanks for sharing. Bob Blumm
Thanks Bob! This is just the beginning of a long overdue conversation. Thanks for jumping in.
Calling a pt. a “drug addict” by his wife helped get him out of denial and into treatment. Being overly fearful of shaming in this regard can perpetuate addiction.
Don’t say ‘health care administrator’ when talking about managers. It is a way for health care professionals to denigrate managers by pretending they only ‘administer’ things rather than manage.
One minor thing: I would suggest using ‘substance use disorder’ rather than ‘substance abuse disorder’ as the latter can feel like blaming for the individuals with substance use disorders that we serve.
YES! Thank you!
Another similar one to ‘midlevel’ is ‘allied health professional’s to refer to everyone other than doctors. Doctors are individuals and all other health workers are ‘allied’? Wonder who is in charge here!
This blog has opened my eyes to so many follies of my own in the words I use. It is remarkable how we can sense something we are saying or have said: “isn’t quite right” but not know how to change it. To finally hear a different, better, inclusive and non-judgemental way is so empowering.
Language is really a great way to perpetuate stigma or create culture change.
I’m sorry Pam but while I know your heart is in the right place, I just cannot play along. I hate this PC world we have created. I realize some words are bad but some are perfectly descriptive. While I am trying to get my life on track, I cannot waste time trying to figure out the most PC way to phrase something.
I find that the words “should, could” and the phrases “if I were you I would” are all shaming words that are used to dictate someone else’s truth, as if applying their “method” to your situation has anything to do with you and your process. People are so adamant about imposing their own judgments on others they forget that what they do is all about them, not the person they are shaming, unconsciously or not