Historically, healthcare has been littered with out-of-date language which sets health professionals up to deliver less than optimal care. Paternalistic terms such as ‘date of confinement’ (date a pregnant woman should be contained to her chamber to prepare for childbirth) and hysterical (a mental disorder thought to have been related to the uterus) have now been replaced with more appropriate descriptors, such as estimated due date, and anxiety disorder. However, judgemental, biased, paternalistic and stigmatising language still permeate contemporary healthcare.
We now know that our language can influence patient care. When a paramedic documents sepsis as the primary impression, the patient is administered antibiotics significantly earlier than when sepsis is not mentioned (Studnek et al, 2012). Our language can also set up biases which can negatively impact patient outcomes and has been proven to alter clinicians' attitudes and decisions (Goddu et al, 2018). Patients are also increasingly accessing their medical records and research demonstrates that patients often find clinicians' language in their medical notes to cause offence, reducing their trust in the healthcare system (Fernández et al, 2021).
Even the word ‘complaint’ can set up an unconscious bias. After all, who complains? A child who is trying to get what they want. More objective phrases such as ‘Patient presents with’ can remove any paternalistic undertone. Paramedic use of the term ‘illicit’ also sets up a response bias, whereby the patient may be less likely to give accurate information (Allen, 2019). The concept of a drug being illicit is a legal term and is better suited to law enforcement and the judicial system than healthcare. It may be seen as judgemental and could add stigma to substances which may be used by patients with mental health conditions for self-medication. Which line of questioning is more likely to find an accurate answer: ‘Have you taken illicit drugs today?’ vs ‘Have you used any substances not prescribed by a doctor today?’ Using the terms ‘recreational drug use’ or ‘non-prescribed drug use’ can help to de-stigmatise and normalise the drug history.
‘Denies’ is a rejected accusation: are we suspicious that the patient does actually have pain in their chest, but are concealing it from us? This type of judgemental language can easily be avoided. Instead of terms such as ‘denies’ or ‘admits’, consider the objective and non-biased ‘patient reports they do not have chest pain’.
‘Compliance’ refers to acting in accordance with a command, carrying undertones of dominance. Instead, paramedics could consider non-paternalistic terms such as ‘medications not taken according to prescription’. This is a factual statements, without passing judgement on patient behaviour. There could be myriad reasons why the patient has not taken their medications, including lower health literacy, inability to afford the medications or to access medications due to mental health issues such as agoraphobia.
As an emerging profession, it is time to think critically about our use of language to move beyond the use of judgemental, biased, paternalistic and stigmatising language to present a more professional approach and improve patient care.