Watch Your Words: Poor Language Choices Can Affect Health Care Outcomes

A 2022 Stat article asked who is more likely to get better care: an addict, or a person with substance use disorder? In the midst of a national crisis with 200,000 people a year losing their lives to drugs and alcohol, the article argues for looking hard at negative language. Calling someone a “junkie” or “druggie” could be humiliating enough to prevent that person from seeking help. Even the terms “addict” and “alcoholic” tend to reduce people to their disease. The implication that a moral failing rather than a disease, is behind a “drug abuser’s” problem—that it’s their fault—could deter health professionals from offering treatment. Even with heightened awareness, stigmatizing language persists. Government agencies tasked with better understanding substance-use disorders use this type of offending language. Case in point: National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism.

Change can happen, however. In 2013, the federal government issued a memo for its agencies to switch from using “mental retardation” to “intellectual disability.” Slowly, the more accurate, less hurtful descriptor took hold. Disability advocates, too, have worked to stop usage of words like “special needs” and “differently abled,” pointing out that the preferred terms are “disabled person” or “person with disabilities.” 

As advocate Kelsey Lindell wrote in a recent Star Tribune article, even well-intentioned people use euphemisms “because they are uncomfortable saying someone is disabled because they view disability as a bad thing. Disability is not a bad thing, it’s a part of who we are. Removing the stigma from the word and seeing it as a descriptor helps the fight for equity between disabled and non-disabled people.”

Negative language in medical records can lead to disparities

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Equitable treatment is at the heart of another area for care teams to examine word choice, and that is how they talk about their patients in medical records. A study published in JAMA in 2021 pointed to paternalistic and stigmatizing language. A review of 600 encounter notes by 138 physicians categorized ways they expressed positive feelings, but also negative ones including disapproval, discrediting and stereotyping.

“Negative attitudes toward patients can adversely impact health care quality and contribute to health disparities,” the authors wrote, pointing to other research that has shown a patient’s age, race, class, obesity or substance abuse often means they won’t be treated equally in the U.S. health care system. “Stigmatizing language written in a patient’s medical record can perpetuate negative attitudes and influence decision-making of clinicians subsequently caring for that patient,” the authors said.

In other research, a survey of 665 emergency medicine physicians found that those who used the term “sickler” for patients with sickle cell anemia were more likely to have negative attitudes toward those patients. Their attitudes were “associated with lower adherence to pain management and prescribing medications,” resulting in poorer care than that provided by physicians who did not use the term “sickler.” The authors encouraged physicians to be aware of biased attitudes and of language that “could potentially transmit bias and affect the quality of care that patients subsequently receive.”

Word choice in medical malpractice insurance

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Word choice is important beyond describing conditions and disease. Constellation recently conducted a terminology survey with a small segment of their health care clients. Results showed that some word choices proved off-putting; for instance, the form used to report a medical incident to Constellation is called a First Notice of Loss (FNOL). Customers pointed out that while it’s filled out after an adverse outcome, there hasn’t necessarily been a loss of life. “It implies an expected loss,” one survey-taker noted.

Another sought more neutral language that would allow them to “report an incident that might turn into nothing,” not necessarily open a claim. Similarly, when asked if they had a negative reaction to descriptions of a situation leading to a potential claim or lawsuit, respondents pointed to the terms “medical error” and “bad outcome.” Sometimes, one said, harm happens without error. Another noted use of the word “bad” is, well, bad. It can add a layer of shaming to people who did not intend to cause harm. Two people said they might forego reporting an incident because of the language used on the form. As a result of this customer-focused research, Constellation is making changes to how we refer to unanticipated outcomes and the form used to report them.

Medical jargon is already confusing enough—“occult” just means hidden, not something witchy, and we probably should avoid talking about “putting patients to sleep.” So, health care professionals who use clear communication to show respect, value equity and offer compassion will be truly using their words wisely.

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