As you may already know, stigmatizing language influences provider attitudes and judgments. Let’s take some time to talk about the why behind this.
A great example are issues related to addiction. A study from the International Journal of Drug Policy engaged participants in reading materials in which patients were described as “substance abuser” or “having a substance use disorder.” The results were telling: the term “abuser” evoked judgments from mental health professionals of the subject’s personal culpability and that punitive measures should be taken. This is one example of how stigmatizing terms can subtly influence provider attitudes.
When patients likewise access these notes, they may make decisions against advised treatment based on the way they're described. A similar finding by the journal of Substance Use & Misuse makes it clear terms have evolved, and medical staff should evolve with them.
How has medical language evolved over time?
Below are just a few working examples of how medical language has evolved, and how Temple wishes to carry on this sense of evolution. Remember: language changes over time and across different contexts, and we need to continually re-evaluate the words we choose.
It's no longer acceptable to use terms like “mental retardation” or “cripple,” even though these terms were used in professional medical contexts not long ago.
Medical terms such as "obesity" allow us to characterize the relationship between weight and health, but technical diagnoses are not the best words to use to communicate with patients. A study in the International Journal of Obesity surveyed a sample of Americans and found that terms such as "unhealthy weight" and "weight" were desirable and motivating, while "obese," "morbidly obese," and "fat" were stigmatizing and blaming. Further, 21% of respondents indicated that they would seek care elsewhere if they felt stigmatized by their doctor.
Another prime example of the evolution of language and danger of stigmatizing terms was the moniker GRIDS, which stood for Gay-Related Immunodeficiency Syndrome. Although the terminology changed as understanding of the illness we now know as HIV and AIDS evolved, the original term created stigma for the gay community and those who contracted the disease. And that stigma has continued to impact care of patients with HIV and AIDS.
Fortunately, these previously accepted terms all have 3 things in common: research, knowledge, and societal norms all evolved and language was updated accordingly.
What happens when your notes are passed onto other team members?
Hopefully, we have begun to show that stigmatizing language can negatively impact medical decision-making. For example, one vignette study showed providers chose less aggressive pain management when stigmatizing language was used.
A study in the Journal of General Internal Medicine reminds us that your notes travel with patients, and that negative or pejorative attitudes can be passed on to other medical professionals. This has the potential to result in biased future care. The authors demonstrated that “Stigmatizing language used in medical records to describe patients can influence subsequent physicians-in-training in terms of their attitudes towards the patient and their medication prescribing behavior.”
Trainees may look to you as a mentor and adopt your terminology in their own practices. This can impact their future attitudes and behaviors. In addition, with the electronic health record, your notes travel and are read by a number of other professionals. The impact of language can be far reaching.
How can we leverage clinical communication to advance equity in healthcare?
We’re called to strive for health equity for the communities in which we practice. Emerging research shows a link between stigmatizing language and the perpetuation of healthcare disparities for marginalized groups. For example, a 2018 paper in the Journal of General Internal Medicine examined the pathway from stigmatizing language to bias in prescribing patterns and attitudes for physicians-in-training.
Temple Health plays an essential role in providing care for our North Philadelphia community, many of whom carry the downstream effects of social and structural determinants of health that stem from Philadelphia’s history of redlining, segregation, and structural racism.
The Century Foundation’s 2019 publication entitled "Racism, Inequality, and Health Care for African Americans" reveals the depths of disparity many Black Americans may experience in their care. We see these same disparities in our community. Temple Health’s 2016 Community Health Needs Assessment shows that, for Black residents in the Temple catchment, compared to Philadelphia and surrounding suburbs, there are: higher rates of low birth weight, higher rates of infant mortality, higher all-cause mortality rates, higher rates of HIV/AIDS, and overall lower health status.
Systemic solutions are necessary to create the upstream changes necessary to lessen these health disparities. However, one step medical professionals can take today is to improve their practice at the individual level, including the language they use, to advance equity for patients.