When Words Do Harm - Daily Nurse

Last year, the American Diabetes Association prohibited the use of the word “diabetic” to describe patients in its publications. And at a recent conference, the group cautioned health care providers against using the “ic” term and other words that might alienate patients.

Among the objectionable words: “uncontrolled,” “non-adherent,” and “non-compliant.” Even using words like “good” and “bad” to characterize a patient’s blood glucose levels can have a negative impact, diabetes experts say, leaving patients feeling judged and stigmatized.

Better choices, they say, would be “in range” or “out of range,” or “high” or “low” — and it’s not just a matter of semantics. How we talk about diabetes directly impacts patients’ behavior.

If this sounds a bit far-fetched, think about it this way: When you tell the night shift nurse during bedside shift report that “Mr. Smith is a 54-year-old diabetic” you’ve just defined Mr. Smith’s entire being by his disease. When you jot down that Mrs. Jones has been “non-compliant” because she hasn’t been regularly testing her blood glucose levels, she feels the sting of a scolding—and maybe a sense of personal failure, too.

At the end of the day, these judgmental words and phrases can erode an individual’s motivation and actually worsen their blood glucose control. That’s because it contributes to “diabetes distress”—the fear and futility that creeps into a patient’s head when the process of managing diabetes begins to seem overwhelming.

It’s not just in the endocrinology clinic that words can do harm. A 2010 study published in the journal Spine found that patients with low back pain had a more negative perception of their prognosis when their physicians attributed their back pain to a “degenerative” process involving “wear and tear” of the spine or “crumbling” or “collapsing” discs. In essence, when it sounded bad, the patients viewed their condition as worse than it necessarily was—and that hopeless mindset made them more hesitant to engage in therapies that might actually improve their health.

The impact of word choice is especially evident in psychiatric care and nurses should be careful to avoid using stigmatizing language. In an article published last year in the Journal of the American Medical Association, then-drug czar Michael Botticelli and Harvard professor Howard Koh opined that it wasn’t all that long ago that individuals with mental illness were referred to as “lunatics” and the hospitals where they were treated as “insane asylums.”

Just as those insensitive terms were appropriately abandoned, we need to rethink the way we talk about problems like addiction. A patient isn’t a “drug abuser;” they’re a “person with a substance abuse disorder.” Instead of referring to drug results as “clean” or “dirty,” they should be characterized as “positive” or “negative,” or “substance-free.” The word “drug habit” is problematic too, because it can imply that a substance abuse disorder is a personal choice, rather than simply a disease.

As we incorporate a better vocabulary into our practices, we must also remember that non-verbal language can be just as powerful as the spoken word.

For me, that lesson became crystal clear several years ago while caring for a patient who’d been hospitalized for a warfarin-associated G.I. bleed.

It had been a rough 24 hours, but after several bags of vitamin K, the patient appeared to be improving significantly. His INR was coming down and the attending had just told him that he was out of the proverbial woods. So I was flummoxed when the patient burst into tears as I was taking his vital signs.

“Are you in pain? What’s wrong?” I frantically asked.