The words clinicians use with their patients make a difference. They can help or hinder efforts to reduce health care disparities. Therefore, it is important that clinicians strive to use inclusive language and avoid labeling people. To that end, this article offers six principles of inclusive communication that clinicians should keep in mind.
During my morning rounds, the patient, a 29-year-old woman, immediately let me know that she did not want to be called “hypertensive”.
“It makes me look hyper, tense, or both,” she said. “I prefer people to say that I am a person with a history of hypertension.”
When patients are so upfront with their preferences, I listen carefully and make note of them in their chart so that I and other caregivers can honor their wishes. Stronger connections with patients lead to better outcomes.
For clinicians, these notes are a reminder that the person before us is a person with unique wants and needs that go far beyond their medical condition. Using inclusive language and avoiding labeling that equates people with their condition, such as “hypertensive” or “diabetic,” also reduces bias and disparities. Other examples include using “disabled person” instead of “disabled person” and “person living with diabetes” instead of “diabetic patient” and avoiding “suffers from” when referring to people suffering from chronic diseases.
The ancient Greek physician Hippocrates taught, “First, do no harm,” an oft-quoted principle of the medical profession. Although physicians have sworn to uphold this value for millennia, it is only in recent years that we have begun to fully understand how the words we use with our patients can both help and harm them.
Numerous studies have shown that how healthcare professionals talk to patients – and about them – can affect their mental and physical health as much as the healthcare they receive. A recent analysis of more than 18,000 patients found that negative descriptors such as “resistant” or “non-compliant” were 2.5 times more likely to appear in electronic health records of black patients than white patients. which raises concerns about stigmatizing language and its potential to exacerbate racial and ethnic health disparities. While such bias can clearly lead to discrimination in health care, research also shows that when physicians provide socially, culturally, and technologically appropriate information, outcomes often improve.
As physicians work to address the disparities in health care in the United States that the Covid-19 pandemic has exposed, they must focus not only on clinical quality, population health management and appropriate technology, but also about culturally appropriate care, including how they communicate with patients. Here are six principles of inclusive communication that we should keep in mind.
1. Consider the impacts of discrimination.
Avoid perpetuating health inequalities by considering how racism and discrimination unfairly disadvantage people; Avoid implying that any individual, community or population is responsible for their increased risk. Instead of adjectives like ‘vulnerable’ and ‘high risk’, think of descriptors like ‘marginalized’ or ‘lack of resources’. Instead of racial code words like “downtown” or “urban,” describe the area itself (“downtown” or “downtown”).
2. Address systemic inequalities in health.
Engage with communities to develop culturally relevant and unbiased communication strategies that promote good health and build trust through listening and shared decision-making. Instead of using words with violent connotations such as “target”, “attack” or “combat” when referring to health conditions in specific people, groups or communities, think of words such as ” treat”, “treat” or “manage”. “, which work just as well.
3. Remember intersectionality.
Many people belong to more than one group and may have overlapping health and social inequalities; likewise, there is diversity within groups and not all members are the same. Kaiser Permanente research found that people from different parts of Asia had significantly different prevalence of chronic diseases such as diabetes, hypertension and heart disease. For example, people of Filipino descent were twice as likely to have diabetes as those of Chinese descent.
4. Recognize diversity.
Use language that is accessible and meaningful to the community you are trying to reach and tailor interventions to their unique circumstances. Focus on positive solutions that highlight community strengths and recognize that some may not follow public health recommendations due to cultural norms, beliefs or practices.
5. Promote health literacy.
Provide plain language health materials in the languages patients speak, train health care professionals in best practices, and review health materials such as insurance forms and medication instructions with community members to make sure they understand the information and what action to take. To help communicate with patients in a respectful manner, the Centers for Disease Control and Prevention has proposed Health Equity Guiding Principles for Inclusive Communication, which the American Medical Association has used as a framework for its comprehensive, evidence-based guide. evidence for fair and inclusive language. .
6. Remember that context matters.
Language is constantly changing and context always matters – what works for one doctor and patient may not work for others, and what works for one group of people may change over time.
We must always respect the preferences of our patients. This includes using their personal pronouns such as “they/them” when speaking with and about non-binary patients and providing context for such use in written materials.
In my own healthcare organization, we continually review and revise our editorial protocols for internal and external communications, based on updated style guidance and the preferences of the people and communities we serve. Examples of terms we’ve recently changed include “Black” (now always capitalized) and “Latino/Latinx” (only use “Latinx” if a particular person prefers it). To promote gender-neutral language, we have also addressed the terms we use in our administrative roles, for example, ‘Chairman of the Board’ rather than ‘President’.
As we understand and address the inequalities, structural racism, and injustices experienced by the marginalized populations we serve, health equity has become a watchword of modern health care. With this comes a commitment to providing equitable, as well as high-quality and accessible healthcare, and a responsibility to choose our words carefully when communicating with our patients. In doing so, we are taking giant steps to help them, rather than hurt them.