Certainly agree with the point about “framing” in patient discussions. Even though we say patients get to make decisions (as opposed to the overt paternal routines of the past), how we frame those discussions still unavoidably steers them in our preferred direction. It would require the physician to convey complete neutrality, which coul…
Certainly agree with the point about “framing” in patient discussions. Even though we say patients get to make decisions (as opposed to the overt paternal routines of the past), how we frame those discussions still unavoidably steers them in our preferred direction. It would require the physician to convey complete neutrality, which could be the ideal, but likely unattainable….since we generally would prefer one course of action over the other.
OTOH, I don’t agree with the suggestion of biased language with some of the examples given. If your A1c is 10, I don’t know how else to describe that besides “poorly controlled diabetic”. Just like if your urine tox screen is positive for cocaine, my note will say “cocaine user” and not “person with coke in tox screen”. Part of that is just for sake of brevity. Why say with 6 words what you can say with 2? Same with “pt denies something something” vs “pt said she did not something something”.
Thanks for your comment. If a patient has an HbA1c of 10, in the medical records - which are also read by the patient - I would write "poorly controlled diabetes" instead of "poorly controlled diabetic". As for the phrase "the patient denies", I used this expression in the past, without giving it enough thought. Then, I happened to read my own clinical notes as a patient and I sensed a subtle distancing effect created by the verb "denies" that, even unconsciously, influenced trust. Since then, I have been striving to be more mindful of my language.
Dr. Alderighi, I wonder if something is getting lost in translation here. Are you speaking of the phrase "the patient denies" in its Italian equivalent, or in English? I don't speak Italian, but I can easily imagine that some phrases in one language may carry a more pejorative connotation than the "equivalent" words in another language, and perhaps that's the case here.
I cannot imagine any medical professional would infer “poorly controlled diabetic” to mean anything other their diabetic control. The occasional hypersensitive pt might impute some comment on their overall self, which requires a simple re-orientation….and probably a separate note record as to such proclivities.
Complete neutrality is a fantasy. The best we can do is "own" what's going on under the hood when we use something like "diabetic" (e.g., what is diabetes and what are things that look like diabetes but aren't? Is A1c the best measurement of diabetes at this point or is it a construct of historical use and there's actually false positives? etc.) and be transparent about it.
Neutrality is a fool's game, but transparency and intellectual honesty can be practiced at any time.
Certainly agree with the point about “framing” in patient discussions. Even though we say patients get to make decisions (as opposed to the overt paternal routines of the past), how we frame those discussions still unavoidably steers them in our preferred direction. It would require the physician to convey complete neutrality, which could be the ideal, but likely unattainable….since we generally would prefer one course of action over the other.
OTOH, I don’t agree with the suggestion of biased language with some of the examples given. If your A1c is 10, I don’t know how else to describe that besides “poorly controlled diabetic”. Just like if your urine tox screen is positive for cocaine, my note will say “cocaine user” and not “person with coke in tox screen”. Part of that is just for sake of brevity. Why say with 6 words what you can say with 2? Same with “pt denies something something” vs “pt said she did not something something”.
Thanks for your comment. If a patient has an HbA1c of 10, in the medical records - which are also read by the patient - I would write "poorly controlled diabetes" instead of "poorly controlled diabetic". As for the phrase "the patient denies", I used this expression in the past, without giving it enough thought. Then, I happened to read my own clinical notes as a patient and I sensed a subtle distancing effect created by the verb "denies" that, even unconsciously, influenced trust. Since then, I have been striving to be more mindful of my language.
Dr. Alderighi, I wonder if something is getting lost in translation here. Are you speaking of the phrase "the patient denies" in its Italian equivalent, or in English? I don't speak Italian, but I can easily imagine that some phrases in one language may carry a more pejorative connotation than the "equivalent" words in another language, and perhaps that's the case here.
Thanks for your response.
I cannot imagine any medical professional would infer “poorly controlled diabetic” to mean anything other their diabetic control. The occasional hypersensitive pt might impute some comment on their overall self, which requires a simple re-orientation….and probably a separate note record as to such proclivities.
How would one rephrase “pt denies”?
Complete neutrality is a fantasy. The best we can do is "own" what's going on under the hood when we use something like "diabetic" (e.g., what is diabetes and what are things that look like diabetes but aren't? Is A1c the best measurement of diabetes at this point or is it a construct of historical use and there's actually false positives? etc.) and be transparent about it.
Neutrality is a fool's game, but transparency and intellectual honesty can be practiced at any time.