Editor's note: This popular story from the Daily Briefing's archives was republished on May 12, 2023.

The language providers use, whether written or spoken, can significantly impact the patient-provider relationship, and certain "belittling, doubting, or blaming" terms may even harm patients, according to a new analysis published in BMJ.

Cheat sheet: Incorporating inclusive language

How certain language choices can harm patients

For the analysis, Caitríona Cox and Zoë Fritz of the Healthcare Improvement Studies Institute at the University of Cambridge examined the language used in medical narratives, such as health records or patient-doctor interactions, and how it affects patients.

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According to Cox and Fritz, language that "belittles, infantalises, or blames" patients can negatively impact the relationship they have with their providers. Phrases like "substance user," "fat," and "non-tolerating" hurt how patients relate to their doctors, and in some cases discourage them from returning for appointments, MedPage Today reports.

Language such as "presenting complaint," "denies," and "claims" has negative connotations that can make it seem like the information a patient is relaying is inaccurate or inauthentic. According to a study on reactions to outpatient notes, researchers found patients responded negatively to language that seemed to question their experiences.

"I did not deny [having certain symptoms]," one patient in the study stated. "I said I didn't feel them. Completely different. Language matters."

In addition, certain terms may infantilize patients or make them seem more passive. This issue is particularly prominent in the language used for diabetes management, Cox and Fritz write.

For example, patients with diabetes are often described as not being "allowed" to eat certain foods, which may be perceived as "scolding" from providers. In addition, describing patients as "compliant" or "non-compliant" suggests that they "must obediently comply with the doctor's recommendation," Cox and Fritz write.

Providers may also use language that implicitly blames patients for poor health outcomes, which may be out of their control. Saying a patient's diabetes or epilepsy is "out-of-control" can sound judgmental and contribute to stigma. Similarly, the terms "failure to progress" or "patient failed [a treatment]" can imply that the patient is the cause of the failure, rather than the treatment itself.

Stigmatizing language can also affect how health care providers view and treat patients. For instance, a study on substance abuse found that health care workers agreed that patients were "personally culpable and that punitive measures should be taken" when they were referred to as "substance abusers" instead of "having a substance use disorder."

In addition, a separate study comparing neutral language to language that implied patient responsibility found that the non-neutral terms were associated with negative attitudes towards patients and fewer medications being prescribed.

Commentary

According to Cox and Fritz, "[l]anguage that is belittling, doubting, or blaming continues to be used in everyday clinical practice, both verbally and in written notes," which " … can insidiously affect the therapeutic relationship."

To help improve their relationships with patients, Cox and Fritz suggest providers change their language "to facilitate trust, balance power, and support shared decision making[.]" Doing so is "unlikely to harm patients and should be viewed as a positive step in promoting a healthy therapeutic relationship," they added.

Michael Sun, an MD candidate at the Pritzker School of Medicine at the University of Chicago who conducts research on physician language, said he hopes physicians will respond positively to patients who bring up language concerns.

According to Sun, a social and cultural shift, as well as new policies aimed at transparency, suggest meaningful change may be on its way. "With Open Notes now, with patients having more autonomy to access their records, they're able to provide a little bit of a mirror back and say, 'Hey, I actually don't prefer these terms.'"

"Physicians don't want to … do anything to offend, to harm, or to disrespect our patients," Sun said. " … At the bottom line, the stakes of this are actually about patients who might feel comfortable going to you for care."

However, he noted that some physicians may push back on changing their language to accommodate patients.  "I feel like more than anything, people don't like being told what to do," Sun said. "And I think the pushback comes when people don't understand that this language is wrong."

For example, when the American Medical Association and the Association of American Medical Colleges released new guidelines on language to advance health equity, it was criticized as "far-left language policing gone too far," MedPage Today reports.

"When we put out statements or guidelines like that, the appearance is often that if you have been using this language, then you're bad or you're doing something wrong," Sun said. "Oftentimes, physicians have loads of patients and great patient relationships and great patient care, in spite of their language ... It's not to say that they've been doing something wrong, but there are things that we can do better." (Putka, MedPage Today, 4/28; Cox/Fritz, BMJ, 4/27)