Has healthcare become infected with the wrong words?

Are health managers mired in management-speak? How good are clinicians at using language that patients can understand? The reform programme has introduced the language of the market, but for many it still sticks in the craw.

Nuffield Hospitals is initiating a debate about the vocabulary which has grown up around the delivery and management of healthcare.

Are there words and phrases you would like to see expunged from healthcare altogether?

Join the debate by clicking on ‘comments’ below. You don’t need a TypeKey or TypePad account to post a comment. The contributions will be reflected in a report to be published in November.

Comments

[David Mobbs]

I'm delighted Nuffield Hospitals has initiated this debate. In my view some very unhelpful words and phrases have become embedded in healthcare.

There are many challenges in the choice of words and phrases we use. At the very least they can convey hidden values that may impact on how we behave towards each other . At the other extreme they can control the agenda for what is actually discussed and how this takes place.

I'd like to kick the debate off by considering, arguably, the most entrenched word of them all - patient.

The word is Chaucerian in origin and means, quite literally, one who waits patiently for care. It comes laden with notions of helplessness and inertia. A patient is a recipient of care, not an active participant in it.

There’s no doubt that during treatment people do submit themselves to the expertise of clinicians. But the word patient has come to stand for anyone who comes into contact with the healthcare system at any point

Those who oppose choice often say that patients simply don't want it. They may be right about that. Patients probably don't want choice, but what about people? I think patient is an unhelpful way to describe people before they’ve got their pyjamas on.

They already make plenty of choices about their own health and many continue to make choices about what type of treatment is appropriate, who should carry it out, where and when.

Then of course there are variations, what does outpatient or inpatient actually mean today. We already have a replacement for this when people undergo a medical procedure in a day – they become a day-case, - described as a unit of production

So what are the alternatives? There is the term 'consumer'. Consumerism is a concept bound up with relative wealth and poverty, and the word is most frequently used by those with a distaste for it. However, it does more accurately convey the notion of choice as consumers are empowered to make choices and take control of the health.

I’m not going to propose an alternative. I hope that a better word will emerge from the views expressed in this debate, and I hope that many other words which need to be replaced or redefined will also come under scrutiny

[Annonymous from the South]

Surely we are living in a time of being over politically correct! What on earth is derogatory or negative about using the term patient?? The comment that it is submissive is utter pap! Just because individuals are being asked to take more responsibility for their health, doesn’t mean they do!

Soon we won’t be called nurses in case it implies too much of a dominant role. We’ll be Personal Rehabilitation Assisting Trainers!

However, on the subject of expunge certain language…..perhaps yes we do use too many complex and technical terms. Which do not include the layman! When looking after a patient one really needs to assess their understanding and use appropriate language. Something Surgeons certainly don’t often do!

Lets face it - whatever term is en vogue - there will always be those who are opposed!

[cheryl minto]

Perhaps if practitioners remember that we are all people first and patients second, the point would be simply made.

[Brian Clarke]

This is all rather silly. We know what we mean. Let's get on with looking after patients.

[Anonymous]

I would agree that there is often too much political correctness and concern about the labels that are given to people. However, how people are communicated to and when they are communicated to is critical in situations where they are feeling distressed or not feeling in control. In this context lack of control can be created due to uncertainty of the process that they are being taken through or lack of knowledge of what is wrong with them.

Brian, I would agree that 'Let's get on with looking after patients' is the right approach but all healthcare professionals can make a huge difference by treating people differently when they are customers compared to when they are patients. For me, it is an attitudinal difference rather than a language difference. The skill for everyone who is involved in customer / patient care is to be able to change the way that they interact dependent upon the way that a person that they are caring for is responding or acting.

The greatest skill is listening and not being judgemental rather than what is being said. Without this skill it is very difficult to adapt to each person that is being cared for. There is no set time when a customer becomes a patient. The ability to change behaviour often cannot be taught; instead it is dependent upon experience, time available and an inherent skill.

We can all improve our communication skills by listening more effectively and changing how and what we say. This does mean that we must view customers and patients differently, although they are the same person.

[garth]

Management in the UK health care system has become infested by waffling words that mean nothing as the powers that be are forcing through a series of antidemocratic reforms that are privatising and wrecking the health service.

As managers are rarely interested in listening to clinicians and other staff on the ground, they make no progress. They are not interested as they have their orders from above which they bust obey or else, the Department of Health is a cruel authoritarian master.

This culture of top down centralised authoritarian management is the reality of the NHS. The rhetoric of 'choice', 'better care', 'patient safety' et al is simply a disingenuous smokescreen to take attention away from the reality of the reforms.

The reality of the reforms is a top down centralised system that provides a shoddy standard of care for all, a system that ignores valid concerns on the ground, a system that stifles progress, a system that has fostered an unpleasant culture of bullying and intimidation rather than a culture that reqards success.

People do not care what words are used, people care that they get a good standard of care. As the government's reforms are intent on cheapening medicine and reducing the quality of care, no matter what words are used, people will not be happy with a shoddy dumbed down service.

People want better actions, not bad actions wrapped in waffling propaganda.

[Dr Blue]

In medicine we are developing some nice new words. I'm glad Nuffield Hospitals are opening up this lexicographer's delight.

Firstly to correct a poster above a patient is one who is sufferring, not one who is waiting patiently.

Now some new words:-

GANFYD- Get a note from your doctor- a regrettably common instruction to too many patients for no good reason.

Twaterati- a group who once might have looked like doctors but who are now so far removed that any resemblence is lost.

Probophilia- The excessive need to prove oneself again and again and again- Look I didn't murder all those patients. Shipman did. I don't see why I should lead my professional life as an expiation of his crimes.

Some words have become position stating rather than meaningful. "Patient centred" is very rarely said by anyone who is. "Holistic" is a badge of belonging, not a statement about medical treatment.

The more talk there is of clinical engagement the less of it is happening.

The language around healthcare is changing. Harry Cayton described "The alienating language of healthcare" I think the language of healthcare management is at least as alienating.

In NHS politics reform, modernisation and progress simply mean "change" There has actually been very little progress in NHS over last ten years.

[Martin Staite]

I've always been puzzled by the term contestability; the word is used as a substitute for competition in healthcare but as I understand it the term actually refers to the illusion of competition in public services. Is this really the sense in which it's being used by the Dept of Health?

[Brian Fishleigh]

I don't think there is anything wrong with 'patient' but I am amused and bothered in equal measure by the notion of 'patient centred care'. What other type of care is there for goodness sake!? It's disturbing that we have a need to coin such a term. What does it say about us?

[sandra sedgwick]

I would like to thank Nuffield Hospitals for developing this communication opportunity.

I like the word patient. It may be that it is conveys waiting impassively, it may come from suffering, but it conveys a concept that one is receiving medial treatment and is understood by those receiving or hoping to receive medical care.

Patient centred medicine is the current focus of educating doctors & nurses. We do not need to change the nomenclature, let us change our focus on sharing and communicate with our patients to the extent that they wish and in a way that they are able to understand. This requires us to listen carefully as part of the process, an activity that many clinicians find a challenge in our “efficient” service.

I empathise with the posting 13 August. I think the government agenda is about power and there has been a dumbing down of healthcare professionals, which is greatly to the disadvantage of all patients. I have over the last 10 yrs been a GP with an interest in education, a patient and now a patient’s relative and a GP once more. I feel embarrassed & frustrated by the service which NHS is currently offering.

Please can we concentrate our efforts on making choice truly available not just a concept that is much talked about, but in reality hardly exists within the NHS in 2007? Until then I think the word choice should be banned!

[Michael Chick]

I don't much really care what terms and phrases are used. Lets just have some honesty. My local hospital wrote to me to say that they would write to me in 12 weeks time to confirm that I would then be put on the waiting list and that I would then expect to wait six weeks before my appointment. Marvellous - brought the waiting list down to six weeks even though I had to wait 18 weeks for my appointment. I expect they got a Gold star for meeting government targets to reduce waiting list times.

[Fender]

Why use the term "private" for the independent sector. You are not private, but open to anyone who can fund your charges!

Also, in medical insurance, how can a medical condition be "pre-existing"? It either exists or it doesn't and it can't exist before it exists!!

[Zed]

The problem is that no matter how hard you try you can not avoid this verbal excreata spoken by a species of work inhibiting drones that have parasitically attached themselves to the NHS. I have to now use the "KNOWLEDGE TO SKILLS FRAMEWORK" for a "Personal Development Planning" which in effect means I have to translate something I would do normally on an informal basis into a quagmire of stalinist management speak with the result that my blood pressure goes up and communication is rendered impossible.
Here is a classic example:

The NHS KSF has been based on the following principles:

* simple, easy to explain and understand
* operationally feasible to implement
* able to use and link with current and emerging competence frameworks.

They can not even manage to remember what they said two bullet points earlier.

Emerging competence frameworks are what exactly, in fact not only do I not know or care but I never want to know and will go to my grave happy not knowing.

[Max Patrick]

"Patient" derives from the Latin "patiens" meaning "sufferer" or "suffering".
I think it is the ideal word to describe our clients.
(By the way, "patient" in the sense of waiting, is a much later indirect derivation of the oroginal meaning).

[Max Patrick]

"Patient" derives from the Latin "patiens" meaning "sufferer" or "suffering".
I think it is the ideal word to describe our clients.
(By the way, "patient" in the sense of waiting, is a much later indirect derivation of the oroginal meaning).

[Kathryn Delaney]

I have been working in the Healthcare sector for 15 years and I have seen numerous attempts by different organisations to stop 'putting a label on people', the word 'patient' crops up frequently. I do not find the word 'patient' as at all derogatory, as I am sure most people don't. Why can't we just leave things be? Do we need a new word for this group of people at all? Surely anthor word, be it 'Client' or 'Consumer' is still a 'label'.

What I do find highly irritating are those Healthcare Professionals who cannot put medical language into plain English. I have often been privy to consultations whereby the patient has been given his results in pure medical speak...only to leave the poor soul sitting there looking confused, bewildered and a little frightened for something that was a minor condition that was easily treatable that probably sounded to the recipient of the diagnosis that he had some hideous illness that was incurable. The patient then turns to me looking for a translation!

This inconsiderate use of language is used in many instances, not just the delivery of results. I can think of one particular example of a patient who was undergoing a barium enema (an examination that is quite stressful not-to-mention embarrassing for the patient) when the Doctor who was performing the examination said 'You have voluminous bowels'. The patient went from being quite chipper to looking quite scared. When the Doctor left the room, the patient turned to me and asked what the Doctor had said and if it was bad (please bear in mind that you don't have these examinations unless it is suspected that there may be a problem with the bowel and the patient is already quite anxious at this stage). When I explained that all the Doctor meant was that the bowel was quite large, the reply was 'Phew! I thought I was a gonner!'.

When I did my training it was drummed into us from the very beginning that we had to be cautious of the language that we used. That where possible we should make our explanations as simple as possible, regardless of who we were dealing with and to treat everybody the same. This is because that a trip to hospital, for most people at least, is time of high anxiety. When people are anxious, no matter how educated, intelligent etc that person may be, they are less likely to take on board everything that they are being told.

I guess the point that I am really trying to make is that it is not so much the words that need to change, more that they way in which we use them. We need more awareness of the impact that our words have. I undertook a course in NLP (Neuro Linguistic Programming) and in this course one of the 'Presuppostions' we were taught was 'We are responsible for the meaning of our communications'. Maybe there should be elements of NLP taught to all Healthcare Professionals.........just a thought!

[Alex]

Was there ever a report published on this? (As per the opening statement: "The contributions will be reflected in a report to be published in November"

I suppose it would have been quite a short report :-)

[Dr Blue]

I don't think we have ever had a meaningful metric by which we could scope out the answer to your question.