Following the introduction of the 21st Century Cures Act and its ‘open notes’ provision, in which patients are entitled to almost instantaneous electronic access to their health records, it has become apparent now more than ever that the words we use to describe patients in our documentation and professional language matters. Survey data from Kaiser Permanente and the Department of Veterans Affairs, the first system to implement open notes across all disciplines, showed 85% of patients said they would choose health professionals based on the availability of open notes. This suggests patients are invested in reading about their care and will likely opt-in to reading their care providers’ documentation.
For a long time, physicians’ notes were viewed as the private thoughts of care providers. Soon-to-be-required transparency and availability of such notes has caused many practitioners and clinicians to take pause and consider whether they are documenting in a way that reflects respect and compassion towards their patients.
While patients’ increased access to their information is a practical reason to consider word choice within clinical notes, there are many more reasons to “watch your language.” The words we use, even when communicating to colleagues, reflect how we view other people. We all see the world through our own lens, and our own lens is biased. The way we think and speak subconsciously impacts the way we behave. Therefore, if you change the language you use to be person-centered, compassionate language, you will likely find yourself acting in more person-centered and compassionate ways.
One way to demonstrate respect and avoid stigmatizing, particularly when discussing marginalized populations, is to use person-first language. Put simply, person-first language puts the person before a diagnosis, describing what a person "has" rather than asserting what a person "is." For example, rather than “the diabetic patient,” you might say, “the patient is a 51-year-old male who has diabetes.” This shows that this is a person with an illness, not the illness itself.
Using person-first, compassionate language is especially important for populations that are heavily stigmatized, like individuals with mental illness. Many people reading “the schizophrenic patient,” might imagine someone who is chronically mentally ill, is actively hallucinating or acting erratically.
While we all carry our own biases related to words and diagnoses, the interpretation may differ, if instead the patient is described thusly: “Mary is a 25-year-old teacher diagnosed with schizophrenia. Mary has successfully managed her illness with medications.”
Similarly, consider what comes to mind when you read “the bipolar patient.” When you hear the illness first, you have your own ideas about the person based on what you know about bipolar disorder. But what if you read: “Jack is a 36-year-old husband and father of three diagnosed with bipolar disorder. Jack recently discontinued his medications due to weight gain and presents with manic symptoms.” You can see Jack is a person and not just “bipolar.” When we consider patients in the context of their humanity — rather than their illnesses alone — we can serve them better and empower them to achieve their goals
As we move toward goals of person-centered care, let’s focus on our patients’ strengths and treating the whole person. No one wants to be a label.
To help us all put forward our best efforts to adopt person-first language, Linden Oaks collaborated with the AHA to develop the first in a series of easy-to-read, digestible and downloadable posters designed to reduce stigma in health care settings. The first topic of the People Matter, Words Matter series is all about using person-first language. Watch for more topics to come over the next several months, and we hope you use these and share with your colleagues.
Kelly Ryan, a doctor of psychology, is director of social services and doctoral training at Linden Oaks Behavioral Health at Edward-Elmhurst Healthcare in Illinois. Gina Sharp is the president and CEO of Linden Oaks Behavioral Health.
Opinions expressed by the authors do not necessarily reflect the policy of the AHA.