Over the last few months, we’ve talked a lot about words in this country.
The Associated Press style guide now capitalizes Black to distinguish the ethnic group and identity from the color. Journalists are increasingly aware that the passive voice can imply racial bias, and influence the way readers interpret a story.
The software development community is exploring new ways to talk about servers without using the terms master and slave.
Words matter. They have subtle yet powerful ways of magnifying stereotypes, and persisting inequities and injustices. By changing them, we begin to dismantle the foundations of barriers to change. While I’m encouraged and inspired by this recent attention to language, there’s (much) more work to be done.
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We need to address a number of words that are part of our vernacular in the domain of health. By rethinking the words we use, we will improve our conversations about policy, care, inequality, and much more. And these conversations can facilitate real change.
Changing language to build connections
There’s no shortage of research that health is one of the strongest predictors of a person’s happiness. And happiness is something we are all striving for. What an opportunity, then, to improve happiness for everyone simply by changing the way we speak (and therefore think) about health.
Health conversations today tend to center on the traditional, yet asymmetric relationship between a physician and a patient. The physician, presumably all-knowing, provides a diagnosis and treatment plan. The patient complies (or does not comply) with the plan—and risks being labeled noncompliant (the 1980s term) or non-adherent (the “more sensitive” 2000s term).
Instead, we need to have collaborative discussions about health. A collaborative discussion values equally the knowledge, training and experience of a physician, and the individual’s own knowledge of their own body, preferences, beliefs and life experience.
I’m far from alone in calling for this shift. Dave DeBronkart (aka “e-Patient Dave”) and Daniel Sands are two founders of the Society of Participatory Medicine. In participatory medicine, “patients become potent agents in creating and managing their own health, in partnership with physicians.”
Alexandra Drane is another who (among many other things) is working to reframe our conversations about health to include things like finances and relationships, not just medicine. Zeke Emanuel advocates that we should consider physicians as part of a care team—an important part of that team, but no more so than a social worker, a food bank or the individual themselves.
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Getting people more involved and invested in their health is something even medical care providers are talking about. We call it patient engagement. But often, when those of us wearing the stethoscopes say engagement, we mean: "we need to get the patient on board with our plan for them."
So perhaps the intention here is good, but the words aren’t right. The patients still aren’t engaged. In one study, for example, 75% of physicians believed that they communicated well with people in their care—but only 21% of those people agreed. We tend to sound much more like Charlie Brown's teacher than we know.
How can we do better?
As I’ve already expressed, a first step is to cleave “healthcare” into “health” and “care.” Health is our shared goal. Let’s stay focused on that. Improve care? Sure! But what if we can achieve health without the need for care? Better.
Another is person—the word person is humanizing. Words like patient or case, or referring to someone by their diagnosis (e.g. diabetic, asthmatic), are dehumanizing. The word person encourages physicians to see someone in their care as a peer and interact with them in kind. Let’s practice: person with diabetes, person with asthma.
Hear the difference? The person has a condition, rather than the condition defining the person.
We also need words that remove some of the power attributed to physicians. Let’s have physicians give advice instead of orders, for example. This not only helps a person seeking care take a peer status in conversations about their health, but it also encourages physicians to practice humility. A little bit of humility goes a long way: humble physicians are more likely to thoughtfully collaborate and ask for help in support of each person’s health and happiness.
Let’s talk about provider engagement instead of patient engagement. Because we’re the ones who need to engage more and really listen to the people we serve. Patient engagement is exactly backwards. Provider, of course, refers to much more than just physicians: social workers, addiction counselors, housing providers, food pantry workers and many others are all connected to a person’s overall health. Physicians and hospitals are just one part of a community’s support infrastructure.
When we use these words, we not only rebalance the relationship between providers and the people we serve, but we also broaden our understanding of health. Health is more than measurements like blood pressure or weight. Health requires access to good food and housing. It requires a living wage and fulfilling relationships. With better conversations about health come better conversations about care—conversations freed from the walls of a hospital or a medical office. Imagine if, rather than looking to medicine to manage a person’s high blood pressure, we looked first to resources that mitigate the financial stress contributing to it. Wouldn’t that, ultimately, be better for their health and happiness?
There’s a growing body of research that says, yes. There is a strong correlation between factors (known in the industry as social determinants of health) like education or income and overall health. Higher education and income are associated with a reduced likelihood that a person is in poor health or is limited by a chronic disease. If our conversations about health include these factors, we suddenly have access to a host of resources to help people lead healthier lives.
Words matter. Let’s open the door to important conversations. Let’s change the way we think about care as an important, but ideally unnecessary, part of how we improve health—and ultimately happiness. These are not just words, they’re a movement.
Jacob Reider is the CEO of the Alliance for Better Health.