Language Matters: The Power of Words in the ED

EMS is bringing in “an agitated and combative 85-year-old man with dementia”. What perception of the patient do these words create? You might be thinking that the patient could harm you. But what if the description was “85-year-old man with dementia who is acutely confused; screaming, and attempted to slap paramedic when IV started”. Did your perception change? You might be thinking that the patient is experiencing a medical emergency such as delirium. Words are powerful. They shape our perspectives, and in turn, can impact patient care.

Language can create negative attitudes (questioning patient credibility, stereotyping) which can contribute to inappropriate care. (Goddu et al., 2018; Hall et al., 2015; Park et al., 2021; Sun et al., 2022). For patients, hearing or reading stigmatizing language can affect their self-image, belief in their abilities, and can lead to feelings of shame and anger. Patients may feel judged and avoid seeking care (Dickinson et al., 2017; Puhl et al., 2013; Wang et al., 2008). Person-centred language (PCL) is a tool you can use that focuses on communicating in a specific, objective and respectful way, resulting in appropriate care and better outcomes.

PCL clearly describes an interaction. It provides a way for the care team to understand what the patient is trying to communicate and in turn, can help focus care in a way that limits behavioural responses. Choose words that are specific: a brief description of the behaviour that includes precise details: who, what, where, and when something happened; avoiding the use of vague words that could be misinterpreted by others. Choose words that are objective: observable or verifiable facts, devoid of personal opinions. And, choose words that are respectful: emphasize the person instead of the disease, use words that do not infantilize.

You can start using PCL today with these strategies:

1. Be kind to yourself. We all have implicit biases and assumptions that influence our words and actions. Explore these and take steps to expand your knowledge.
2. Some questions to consider: Does my communication reinforce stereotypes? Does it include unnecessary opinions or information? Does my language express disapproval? How would my patient feel if they read my documentation? (Valdez, 2021)
3. When you hear others using words that are negative or open to misinterpretation, ask for clarity and additional details. Role model a more person-centred way of describing the person or their behaviour.
4. When you encounter vague or negative words in drop-down menus or forms (such as agitated, aggressive or confused) find a place to describe the behaviour.
5. Explore PCL resources on the RGP’s website, including a pocket card, video reels, teaching aids, posters, an e-course, a mobile app, and more.

References

1. Goddu, A.P., O-Connor, K.J., Lanzkron, S., Saheed, M.O., Saha, S., Peek, M.E., Haywood, C., Beach, M.C. (2018). Do words matter? Stigmatizing language and the transmission of bias in the medical record. Journal of General Internal Medicine, 33(5), 685-691. https://doi:10.1007/s11606-017-4289-2
2. Hall, W.J., Chapman, M.V., Lee, K.M., Merino, Y.M., Thomas, T.W., Payne, B.K., Eng, E., Day, S.H., and Coyne-Beasley, T. (2015). Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. American Journal of Public Health 105, e60_e76, https://doi.org/10.2105/AJPH.2015.302903
3. Park, J., Saha, S., Chee, B., Taylor, J., Beach, M.C. (2021). Physician use of stigmatizing language in patient medical records. JAMA Network Open, 4(7):e2117052. doi:10.1001/jamanetworkopen.2021.17052
4. Sun, M., Oliwa, T., Peek, M.E., Tung, E.L. (2022). Negative patient descriptors: documenting racial bias in the electronic medical record. Health Affairs, 41(2). doi: 10.1377/hlthaff.2021.01423
5. Dickinson, JK., Guzman, SJ., Maryniuk, MD., O’Brian, CA., Kadohiro, JK., Jackson, RA., D’Hondt, N., Montgomery, B., Close, KL., Funnell, MM. (2017). The Use of Language in Diabetes Care and Education. Diabetes Care, Dec;40(12):1790-1799. https://doi.org/10.2337/dci17-0041
6. Puhl, R., Peterson, J.L., & Luedicke, J. (2013). Motivating or stigmatizing? Public perceptions of weight-related language used by health providers. International Journal of Obesity, 37, 612–619; doi:10.1038/ijo.2012.110
7. Wang, F., Shen, X., Xu, S., Liu, Y., Ma, L., Zhao, Q., Fu, D., Pan, Q., Feng, S., & Li, X. (2008). Negative words on surgical wards result in therapeutic failure of patient-controlled analgesia and further release of cortisol after abdominal surgeries. Minerva anestesiologica, 74(7-8), 353–365.
8. Valdez, A. (2021). Words matter: Labelling, bias and stigma in nursing. Journal of Advanced Nursing, 77, e33–e35. https://doi.org/10.1111/jan.14967