Cook Children's Experience Corner: Words Matter
Words Matter
When I meet with families during such a stressful time of hospitalization, I acknowledge and say that “Life doesn’t stop outside of the hospital”. Parents are often under an immense amount of daily life stress regardless of the health of their children. There are demands on their time from their jobs, from their friends and from their communities. Once their child is hospitalized, none of those things stop. It can be hard to juggle being present in the hospital or making clinic appointments or trying to get labs and studies done when necessary.
It is important that we think about this when we sit down to do our documentation when perhaps a patient or family hasn’t been able to follow our prescribed treatment plan. While we have been trained to use language such as “non-compliant”, what else is that language saying? Do we read it as a negative or simply just an objective statement? Does it imply the patient was refusing to follow or blatantly ignoring the plan? That could be true, but it is imperative that we explore the reasons for “non-compliance”. Is it that their pharmacy didn’t stock the formulation or their insurance couldn’t authorize the medication we prescribed? Perhaps they had no transportation to the clinic visit or to the radiology center for imaging?
We should strive to document exactly the reason rather than use a term that implies possible intentional lack of responsibility. There was an interesting study done comparing two different HPI’s for a patient presenting to an emergency department with a sickle-cell anemia related pain episode, one with more stigmatizing language compared to one with more neutral language1. A total of 413 physicians-in-training were then asked to read these HPIs and complete a survey on their attitudes and thoughts on the hypothetical patient. Not surprisingly, exposure to the stigmatizing language note was associated with more negative attitudes towards the patient.
Thinking about the language we use in the medical record can be a form of reducing bias towards our patients and recognizing how their lives may impact the care we are recommending. For example, changing “non-compliant with medications” to “unable to obtain medications due to pharmacy availability” really can change the context and lessen bias. If we can understand more of our patients’ and families’ personal life and challenges, we can work towards a relationship-centered care model where we can partner with them on care plans that meet them where they are.
1. P Goddu A, O'Conor KJ, Lanzkron S, Saheed MO, Saha S, Peek ME, Haywood C Jr, Beach MC. Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record. J Gen Intern Med. 2018 May;33(5):685-691. doi: 10.1007/s11606-017-4289-2.
Amit Singh, M.D., on behalf of the Cook Children's Experience Team