The author Rudyard Kipling once said: “Words are, of course, the most powerful drug used by mankind.” And, we know that different ways of expressing things can have an impact on patients. It is said that ‘people experience diabetes and the language of diabetes in context.’ This goes for many acute and chronic conditions. We are moving more and more into the realm of patient-centered care, with the result being that we are (and should be) viewing patients more as individuals than in bygone days when patients in hospitals were often referred to by their disease…”the heart failure in 3B’ or the ‘lupus nephritis in 12A’. And while that has happened less and less over the years, there are still many communications with and about patients that are problematic. We often hear about what to do when patients ‘fail on metformin’, or during an office visit their diabetes is labeled as ‘uncontrolled.’ These labels of failure and lack of control when shared with or in front of a patient can have a lasting impact on their attitude and/or feelings of self-efficacy. A number of diabetes related organizations addressed the language of diabetes (1-3). Patients are decisionmakers in many medical interactions, and how the decision is framed can have a huge impact on those decisions. The words used can trigger biases, heuristics and affect the direction of therapy in nearly all medical decisions patients make (4). Community based Pharmacists continue to shift in their roles from dispensing to patient education and counseling. As community-based pharmacists and hospital or clinic-based pharmacists expand their education and counseling roles to increasingly involve, medication reconciliation, and even home visits the words used in various situations make a difference (5). This is true, of course for pharmacists practicing in the clinical environment as patient encounters related to drugs (MTM, Med Reconciliation, TCM, etc) are an ever-increasing part of the pharmacists role in clinics, hospitals and medical offices as well. Patient-centered communications or communications about patients should avoid labels either as a noun (eg “are you diabetic”) or an adjective (“that’s a diabetic foot ulcer”), should avoid designations related to control either as a noun or verb (“he has poor glucose control”). Communications of should avoid imperatives (“you really must take this medication each morning”), and should avoid terms like “non-compliant” or “non-adherent” (1). While these terms are applied to diabetes patients in these examples it is easy to see how they can translate to other conditions. In a recent study (5) that looked at home visits as a venue for patient-pharmacist communication, the most discussed topics aligned with the challenges found in other studies such as patients’ lack of knowledge about their medications and medication regimens. These discussions are potential entrees into the use of motivational interviewing as a tool to enhance patients’ motivation…key to many chronic conditions including diabetes [shameless plug: Motivational Interviewing in Diabetes Care. Steinberg MP & Miller WR. Available in the ACCP Bookstore]. Changing our words is hard, but being more conscious of how we speak to and about patients is vital to patient-centered care. Let’s all commit to making a conscious effort to observe the language we use and change it where we need to!
1) The Use of Language in Diabetes Care and Education. Dickinson J, et al Diabetes Care 2017;40:1790-1799
2) International Diabetes Federation campaign on the language around diabetes. https://www.idf.org/our-activities/advocacy-awareness/campaigns/language.html (accessed 12/12/18)
3) Diabetes Australia position statement: A new language for diabetes: improving communications with and about people with diabetes. Speight J, et al. Diabetes Research and Clinical Practice 2012;97:425–431
4) Cognitive biases and heuristics in medical decision making: a critical review using a systematic search strategy. Blumenthal-Barby JS, Krieger H. Medical Decision Making 2015;35:539-557
5) Patient‑pharmacist communication during a post‑discharge pharmacist home visit Ensing HT, et al. International Journal of Clinical Pharmacy 2018;40:712-720