Recently I attended an education meeting in London titled Diabetes: Mind over Matter. I was there to speak about the GP view on how patients with type 1 and type 2 diabetes may be affected by mental health symptoms as well as how NHS services could be better integrated to offer seamless care for both the physical and psychological symptoms associated with diabetes.
There was a lot of discussion around the recent Language Matters paper. One of the patients who was speaking (Jen was phenomenal, as is her blog) said she didn’t mind whether she was referred to as a diabetic or a person with diabetes but was aware of many that felt strongly about not being referred to as ‘a diabetic’.
NHS staff and patients, here’s a question: if someone has type 1 diabetes do you call them a diabetic, if they have asthma would you refer to them as asthmatic, if a patient has psychosis would you call them psychotic?
I have asked a lot of my patients about this in the past and many aren’t really fussed either way as long as the clinician/staff member talking to them is compassionate, empathetic and ready to listen, some are very clear which words cause offence and upset. I think we really do need to think carefully about the language we use when referring to our patients. Next, I got thinking about how we talk about disease across the board. We don’t tend to describe someone as having a ‘physical health problem’ so why do we continue to use ‘mental health problem’. I think we need to stop drawing a line down the middle, most physical conditions have a psychological overlay and vice versa.
The power of words.
The words we use are important but i think the most useful thing to consider is how we use words. How are they delivered?…in a timely manner, not rushed, thoughtful and sensitive.
I don’t want my patients to feel less than an individual so am keen to use the terms above going forward – eg patient with asthma, rather than asthmatic but I think we, as clinicians, need to take things one step further and take more more in how we speak to our patients, be patient centred rather than take a ‘one size fits all’ approach. The Language Matters document details some phrases to avoid but usefully explores ways in which health professionals can improve their language in general and more specifically related to patients with diabetes.
Language is not only important when speaking to patients, but also our staff.
A lot of my patients struggle with a diagnosis of depression or anxiety, they worry about being judged or mocked. ’I don’t want to be one of those crazy people’, ’I’m not mental’ are common phrases I hear. The stigma surrounding mental health disorders is still ever present. Explaining your broken leg to your boss might appear easier than discussing a diagnosis of generalised anxiety disorder to your line manager. Patients with depression aren’t lazy or sloppy, they are suffering with symptoms that may include fatigue, poor concentration or lack of sleep and are trying their best through the fog and mental slowness.
It can make a huge difference to someones day to be asked how they are. Don’t shy away from family, friends or colleagues who you are worried about, talk, use words, communicate.
GPs, how often do you refer to the receptionists as ‘the girls’ or ‘the ladies’?
We need to move away from terms like these. I mentioned in a previous post about often being described as the young one and this follows that sentiment really. I was saying after the meeting last week that patients often refer to me as ‘love’ or ‘sweetheart’, mostly I think it is fine and just colloquialism but then I consider whether it is an element of gender bias and a lack of respect there?
#Hellomynameis is a phenomenon that was started on social media by the late Dr Kate Granger who shared her experience of being a patient with terminal cancer in 2013. She highlighted the importance of medical professionals introducing themselves at each consultation.
Every time I see a new patient I try to introduce myself and always will if I meet a new family member of a patient I know well.
‘Good afternoon, I’m Dr Brooks one of the GPs’…
Is how I introduce myself in the GP practice but often would refer to myself as ‘Abbie one of the junior doctors’ when i worked in the hospital. Why the difference? I don’t know to be honest.
Do we ask the patient what their name is? I don’t think I generally do, as GPs we have their name on the computer but maybe they use their middle name, do they want to be referred to as Matt not Matthew, Ms Smith not Sarah? Our 3rd year medical students ask every time, maybe something I need to change? I personally want to be ‘Abbie’ outside of work; not Mrs Brooks, Not Dr Brooks, just Abbie.
Something else that struck me recently, is the words (or lack of them) we use to explain tests, medication, diagnoses and ongoing plans. So often I see someone who has had contact with another medical professional, whether in my practice or at the hospital, that can’t tell me a summary of their last consultation. Maybe they didn’t know when to get their bloods or what to do after their scan and when to seek help again.
This is especially important in general practice when we are generally making a hypotheses about what the underlying condition is rather than a definitive diagnosis. It is rare someone walks in and I say – yes, you definitely have ‘x’ condition. Often, I need some time to pass to see if symptoms change or I request an X-ray or bloods to get more information. That first consultation is the time to be honest and say ‘I’m not 100% sure what is going on yet but we need to get some more information…’
Words. Time. They are intertwined.
If we had more time, I think the language we used in medical care would be so much better. Time is only going to get more pressured so we need to be efficient with it. One good conversation at the beginning can save so much time and stress for both the patient and the clinician going forward.
I think there are many reasons why communication can seem poor. Sometimes the issue is complex and difficult to translate into simple language and often the explanation part of the consultation is rushed towards the end. Frequently, a patient is discharged from hospital and has no idea what their diagnosis and plan is going forward. This might be due to poor memory, a lot of information given to them in hospital but possibly due to a lack of time spent explaining the situation to the patient. As GPs, we often translate discharge/clinic letters with the patient so they have a clearer understanding of their own health.
One of my current bugbears: comments made by clinical colleagues that can have huge consequences in primary care. As GPs, we are with that patient (potentially) for life. Other team members may only be involved for hours, days or weeks so saying something that may ruin the therapeutic relationship of patient and GP can have lasting effects. For example if a patient is admitted by their GP with abdominal pain, it is not useful for the admitted team to say to the patient how unskilled the GP is or how ridiculous the referral into hospital is. We are all on the same team.
I really feel sad when I see medical professionals putting each other down, we are all doing our best in increasingly pressured time. For the first time ever this week I have had to mute conversations on twitter. Seeing medical professionals against each other rather than rallying together and remembering they’re on the same team, there has been bitterness and comparisons of who has it harder. We all have it hard. The patients are in the middle. Think about your words (especially on social media!).
I have huge respect for those working on acute admitting wards but instead of assuming incompetence or laziness, consider why that GP felt hey had to admit that person (as a rule, we do not like sending people to hospital if we can avoid it). We’re all guilty of it, saying something without thought and in passing but language matters. One last plea, discharge letters – ‘I would be grateful if you would consider….’ is a better way of asking us to do something on discharge compared to ‘GP to refer to neurology out patients’ or ‘GP to chase potassium level’. Thanks 🙂
‘Safety netting’ is an important part of the clinical consultation – it is where we say ‘if you do not improve in ‘x’ amount of days do contact the surgery or 111’…or ‘if the redness starts to track up your leg seek urgent advice via 111 or -the emergency department’. The more specific the safety netting, the better. As a GP it can be easy to forget that patients don’t have background medical knowledge so they not link weakness in the legs and urinary incontinence to their back pain, it is our job to educate them where needed.
In summary, do consider both the written and spoken words, they can have a huge impact on the success of a clinical consultation and a patients long term relationship with healthcare. One bad experience can have lasting effects, if a patient feels listened to and part of the conversation, the benefits can be huge.
Have a look at the diabetes language matters document, it really is a good read.
Some questions for you all to consider, leave me a comment on the blog or via social media.
- What words do you hate seeing used in medical care?
- What do you prefer to be called – both patients and clinicians?
- Do you like the term patient, service user, client?