Should We Not Use Certain Medical Terminology

An article was posted by MedScape about some words that need to be removed from medical language and we wanted to discuss it will you all! Personally, we have noticed a shift in how we talk to and about our patients regarding their medical conditions. Now, using the right words can be a struggle on a good day, especially taking your patient's native language, education level, and other factors into account. Some things have begun to fall out of fashion, so to speak. We think this is due to a shift in our understanding of disease process, changes in insurance reimbursement, and social factors. We're going to break down this discussion by each of these categories. Then we'll talk about some specific conditions.

Better Understanding
Medicine is constantly changing! Tomorrow there could be a dozen new drugs on the market for various ailments. Our understanding must grow and be flexible. This flexibility includes our use of various terms with our patients. We must be consistent with our choice of words and considerate of their implications. The next two examples are some reasons for those implications.

Changes in Insurance
We have found at our own facility that physicians are often discouraged from coding their patient as CHF patients and when asked a few of them have said they and the hospital are not reimbursed fully if at all if the patient comes back within 30 days of discharge. If left poorly treated, CHF'ers will come back to the hospital within that time. So, they code the discharge in such a way as to not indicate heart failure for coding purposes. The physicians we have spoken to agree that this is unfair to the patient and the clinical staff. It isn't quite dishonest, but it doesn't truly paint the picture of the patient's stay with us.

Social Factors
It is no secret that the use of certain words can affect how your patient will behave or perceive a diagnosis or plan of care. All you have to do is mention the big "C" word to see your patient start to bristle. HIV/AIDS is another condition that will bring forward all these preconceived notions for your patient.

Do you think there are other reasons we should watch out language with patients and their families?

Heart Failure
This is perhaps the word that has the biggest misconception for clinicians and patients. The word failure sounds so final and disruptive, which it can be. It also describes a whole set of conditions and etiologies that just are not adequately covered by the word "heart failure". Do you mean right-sided or left-sided heart failure? Your patient may have family or friends who have been diagnosed with this and they have an idea of what their heart failure was, but it doesn't adequately describe their own condition.

"Heart dysfunction" and "cardiac insufficiency" have been tossed around as better words to be using in this situation. If you do continue to use the term "heart failure" it is advised that you explain to your patient what their specific condition means for them.

The article presented "intensify" in terms of treatment as a word that needs to be softened so as not to alarm the patient. We have not heard that particular term used when educating patients, but it could be a little aggressive for the patient and family to hear.

Mid-Level Provider
This term is just starting to come up more often. With the shortage of MD's to handle the local patient loads, many nurse practitioners and physicians' assistants are coming on the scene to save the day. This term could downplay the role that ARNPs and PAs have in the healthcare team. One NP in the article stated she felt "belittled" by the term and it doesn't reflect the scope of practice that she is providing to the public. Many individuals are not only seeing "mid-level providers" for their primary care service. Should we not just call them primary care provider or do we really need that distinction?

This may leave some people confused to have this term on the list! When we use diabetic in a phrase we often say, "245 is a diabetic and their sugars have been in the 150's and is scheduled to go to surgery later today." This phrase reduces the person to their condition. While we often get in the habit of remembering our patients by their conditions, we must make an effort to make them feel like people first. It would be more correct to say, "Mr. Smith in 245 has diabetes and will be going to surgery today. His blood sugar was 153 this morning and was covered with R." This pulls the focus to the patient as a person who has diabetes while the other reduces him to just a diabetic.

This is definitely offensive to a patient or family member if you tell them this! If you feel a patient is not following the treatment plan, you must address it in their plan of care. There could be any number of reasons they don't take their medication or go to their appointment. Have a discussion with your patient to find out the reason. Don't just dismiss them as noncompliant and tell them to do better.

What other words do you think should be included in this list of possibly abrasive or offensive words in the healthcare setting?

Join us next week for another post and as always - continue to monitor...

Banish These Five Terms From Medicine? - Medscape - Sep 26, 2018.

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