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Choosing words judiciously

by Rada Rouse

A recent Twitter discussion on the use of the term ‘patient compliance’ triggered some thoughts about the importance of language medical writers choose – and memories of ‘feminist studies’ years ago.

Use of ‘patient compliance’, rather than, say, ‘medicine adherence’ seems a bit top-down. It may imply ‘the patient is a slack person for not doing what the doctor says’.

Or, as doctor and writer Tim Senior suggested in a tweet, the phrase is health professional code for “this person hasn’t been able to do what we discussed and I can’t be bothered to find out why”.

Compliance and/or adherence seem to be tied to the concept of a pill having the power to deliver wellness, something which may fly in the face of social determinants of health.

As many feminist writers noted in the 1970s, language not only reflects society, it helps shape it.

According to linguist Robin Lakoff, author of Language and Women’s Place (1975, Harper & Row – which I climbed my bookcase ladder to retrieve from among yellowing university texts), it may be polite to call women ‘ladies’ but polite terms “used by and of and to women … are … stifling, exclusive and oppressive”.

Times have changed and few people today use epithets such as ‘spinster’ or so-called polite terms such as ‘lady doctor’.

Writing about medicine however, we might still have a way to go. Much of the mainstream media continues to define people by their disease: we read about patients who are ‘asthmatic’, ‘diabetic’ or ‘bipolar’ rather than people who have asthma, diabetes or bipolar disorder.  It is particularly jarring when the adjective is turned into a noun, as in this recent news story about the arrest of a “40-year-old schizophrenic”.

My favourite example of unfriendly medical terminology comes from a book on miscarriage and neonatal loss (Taking Control, 1997, Doubleday) by journalist Diana Plater, who asked: how does it feel to be told “your cervix is ‘incompetent’, your pelvis ‘inadequate’, your uterus ‘irritable’ or your mucus ‘hostile’?”

Plater cited work by Hilda Bastian who explained in an NHMRC guide (Options for effective care in childbirth 1996; rescinded 2005) how some medical jargon e.g. ‘confinement’ can have negative connotations for patients and be a barrier to good communication with health professionals.

Last week a web portal www.freepatientsupport.com  was launched. It is backed by key bodies such as the Heart Foundation and Prostate Cancer Foundation, and is described as Australia’s first national medicine compliance service.

To consumers, it offers ‘patient support’ but to pharmaceutical and other commercial entities, it offers a ‘compliance builder’.   Now, I wonder what might be deduced from these word choices?

Rada Rouse is the vice-president of AMWA, and clinical features editor of the Australian B2B magazine and website Medical Observer. Follow her on Twitter @radarouse

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