More Clinicians Say Human-First Labels Are Preferred: Poll

Marcia Frellick

October 31, 2019

Terms for patients such as "diabetic," "alcoholic," "addict," and "depressive" were deemed more problematic among nurses than physicians in a recent Medscape poll.

However, physicians in psychiatry and mental health were considerably more likely than physicians in general, along with nurses and advanced practice registered nurses (APRNs), to find those terms and others objectionable.

Table. Percentage of Clinicians Who Find Terms Problematic

Term Physicians Nurses/APRNs Physicians in Psychiatry/Mental Health
Addict 60 73 86
Alcoholic 55 66 76
Depressive 45 53 72
Diabetic 29 38 60
Hypochondriac 68 80 92
Neurotic 69 78 96
Noncompliant 43 64 62
Obese 44 52 62
Schizophrenic 47 50 80
None of the above 13 7 2

The poll, first posted on July 10, reflects responses from 316 nurses and 489 physicians.

It followed publication of a perspective piece in Medscape by Don Dizon, MD, professor of medicine at Brown University and director of women's cancers at Lifespan Cancer Institute in Providence, Rhode Island, and Tatiana Prowell, MD, associate professor in the breast cancer program at Johns Hopkins Kimmel Cancer Center in Baltimore, Maryland, who discussed the language clinicians use around cancer patients.

Prowell said in the commentary, "[A] lot of the language that's baked into medicine reflects a time when medicine was more paternalistic, when patients were not equals or partners. That time is still reflected in our language, and I worry that it has the ability not only to make patients feel disrespected, but also to influence our own thought patterns."

The poll asked, "Is it time to rethink some of the old phrases, or is this just political correctness run amok?"

Few of the poll respondents (10% - 13% overall) said they had been accused by patients of insensitive or gendered phrasing, but many more said they see problems with using certain terms.

And most clinicians agreed that they are currently weighing their words more carefully than they have in the past (73% of physicians, 75% of nurses/APRNs, and 76% of physicians in mental health).

"Diabetic" Brought Widely Varied Opinions

"Diabetic" was one of the labels that elicited very different levels of comfort.

A general practice physician commented, "The word diabetic simply means 'a PERSON with diabetes.' Schizophrenic means '... a PERSON with schizophrenia' etc, etc, etc."

A registered nurse (RN) commented that the label is necessary, given limited time: "A charge nurse has 30 minutes to give report on 32 patients, review assignments, the latest 'pass down' from above and any and all other information that needs to be shared with the oncoming shift. '32yr old male diabetic last BG 200, transitioned to sq insulin, stable' is about all I have time for."

However, in the poll, 60% of physicians in mental health thought the term was problematic, twice as many as did general physicians (29%), and more than nurses/APRNs (38%).

A pediatrician commented on the poll that it's dehumanizing to use the labels and says a child should not be labeled autistic, for instance, "but instead as a child with autism; the same with all (disabilities), even if the parents don't do that. First it is a person, a child; second, a child with this or that disease."

Age May Also Affect Answers

The word "addict" seemed to hit a nerve with physicians 1 - 5 years post residency: 71% said it was problematic compared with the 58% - 59% of physicians who said it was problematic and listed their experience as 6 or more years postresidency.

However, those with 1 - 5 years of experience were less likely to say that the term "obese" was problematic. While only 34% of the newer physicians said it was problematic, the numbers agreeing with that statement by age group were 55% of those with 6 - 10 years' experience, 51% of those with 11 - 20 years of experience, and 43% of those with 21 or more years of experience.

Ask the Patient?

A couple of responders said that even patients differ on what they want to be called and maybe providers should ask them.

An RN wrote, "I have several grandchildren on the spectrum. I used to say a 'child with autism,' meaning the term does not define the child. But I became active on an autism site. Many preferred being called autistic. I guess it depends on the person. Ask them their preference."

An internist agreed and added this example: "A large number of people refer to themselves as deaf and reject the term 'hearing impaired' because they consider themselves to have alternative senses rather than a disability. It might be good to support patients with medical conditions to assert how they prefer to be identified on an individual basis."

A pain management physician didn't weigh in on which language to use but was glad for the discussion the commentary and poll raised.

"It is about time that the medical profession put a spotlight on the imprecision of medical language and the negative effects that it can create for those in need of empathetic and compassionate care," he commented.

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