Banish These Five Terms From Medicine?

Ariel Harsinay

Disclosures

September 26, 2018

No matter how skilled a physician is with patient care, using the wrong language when speaking with patients or families can derail the whole process. Studies have shown that patient parameters such as blood pressure, for example, are affected by doctor-patient communication,[1] as is overall patient health.[2]

In fact, a clinician's specific choice of words can influence a patient's medical decisions.[3] And patients are becoming more vocal about which terms they prefer to describe the conditions they have.

The following terms have already been scrubbed from the lexicons of many healthcare professionals. After you review each one, answer the poll to share whether you think the language shift is justified, then click on "comments" to add any other changes that you want to propose for the medical lexicon.

1. Heart Failure

(noun): inability of the heart to function properly

Due to the imprecise nature of the word "failure" and its inability to describe the full spectrum of cardiac complications, Dr Lynne Warner Stevenson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital, advocates using alternative terms such as "heart dysfunction" or "cardiac insufficiency." Stevenson suggests that the label "heart failure" is hindering effective care.

"This stigma has consequences not only for self-image and personal goals but also for families, employment, and insurance," she said. "Clinics labeled as 'heart failure clinics' and the linked attachment of heart failure diagnostic codes may discourage entry of those patients who could benefit the most."[4]

Dr Richard Lehman, professor at the University of Birmingham (United Kingdom) shares the view that "heart failure" does not adequately represent the variety of heart illnesses that are lumped together under that term.

"For doctors, 'heart failure' covers a confusingly wide spectrum of illness, whereas for patients it has a deadly ring of finality," said Lehman. "Failure means the end of hope, and many patients who have been told they have heart failure prefer not to remember the term or let it dominate their lives. This partial denial may have damaging consequences, both psychologically and in terms of adherence to treatment."[5]

On the other hand, Dr John McMurray, professor of cardiology, University of Glasgow, said that he believes using the term "heart failure" is fine as long as you explain what this really means to your patients and their specific condition.

"When I tell patients that I have diagnosed 'heart failure,' I explain that this is the description that doctors use when referring to the symptoms patients experience when their heart isn't pumping normally—ie, breathlessness and ankle swelling," said McMurray. "I point out that it doesn't mean a 'heart attack' or 'cardiac arrest' or that I expect them to drop dead in the near future."

"If they have HFrEF [heart failure with reduced ejection fraction], like most of the patients I see, I go on to say that we have many effective treatments, that I expect to have them feeling better in a few days or weeks at most, and that as I introduce these new treatments slowly over the next weeks and months, I expect that there will probably be some improvement in their heart function."

In fact, some physicians are adamant about keeping the term "heart feature" in use. Dr Barry Borlaug, a cardiologist from Mayo Clinic, believes that it would be a huge detriment to remove the term from clinician vocabularies. "To change the term runs the risk of trivializing what is in fact a significant and lifestyle-altering medical condition," Borlaug said. "The job of the heart is to pump blood to the body at rest and during exercise without an untoward increase in heart filling pressures. If the heart fails to do this, and that causes symptoms of effort intolerance or shortness of breath, then we call that 'heart failure.' That is its very definition. To pretend that this is not failure of the heart is dangerous in that it may lead to ignorance in both patients and caregivers about the magnitude and scope of this problem."

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