Words Have Power
How language used in patient encounters can have an impact on diabetes care.
Melinda Maryniuk, RDN, MEd, CDE, shares her expert opinion from the joint American Association of Diabetes Educators/American Diabetes Association paper, The Use of Language in Diabetes Care and Education (PDF, 687 KB) .
Q: How can language that health care professionals use to talk about diabetes affect people with diabetes?
A: The language that health care professionals use with patients can have a profound impact, in both positive and negative ways. Much of this research is drawn from other arenas and suggests that language can have an impact on the patient-provider relationship. Many words that are part of our diabetes vocabulary can add to feelings of guilt, shame, embarrassment, and the stigma of living with a chronic disease. When health care professionals use language with their patients that is laden with judgment and blame, that can contribute to poor self-care, poor self-concept, not showing up for medical appointments, and poor diabetes outcomes.
On the flip side, language that health professionals use can add to people’s feelings of hope and positivity about themselves—and about their life with a chronic disease. This can translate into greater engagement in taking care of themselves, which can lead to better health outcomes.
Apart from its influence on patients, language can also influence how other health care professionals think about diabetes. For instance, if you’re going through nursing school and you keep hearing other professionals use language describing patients such as “uncontrolled and unmotivated,” it can perpetuate inappropriate and incorrect ideas about diabetes. Language forms impressions and could influence whether or not someone wants to go into a particular area of medicine that would have them care for people with diabetes; they may feel that it’s a somewhat futile area to work in. We feel like we don’t have enough diabetes educators and it makes you wonder: Is language part of the problem? This question certainly invites curiosity to explore more research in this area.
Q: The American Diabetes Association (ADA) and the American Association of Diabetes Educators (AADE) convened a panel of experts to look at the literature and identify recommendations regarding the use of language in diabetes care and education. What are the key recommendations?
A: The recommendations (PDF, 687 KB) can be summarized into five key areas:
- Use language that is neutral and nonjudgmental, and use language that is based on facts or actions. For example, instead of saying, “Your blood glucose is good,” “Your blood glucose is not great,” or “Your A1C is good,” use language based on the facts: “Your A1C is 7.2,” or “Your A1C is 10.1.” Then you can put context around that and say, “That’s higher than the target we talked about of keeping it at 7 or less.” Or “That’s a significant drop from your last visit at 13.1”
- Use language that is free from stigma. Try to avoid terms that are associated with guilt or shame. For instance, if a patient has been managing their diabetes with lifestyle changes and needs to start taking medicine, don’t make it seem like a failure on the patient’s part by saying “Since diet and exercise failed, we’ll have to start (or add another) medicine.” Explain that, over time, diabetes is progressive, and most people will eventually need to take medicine to help with the management of this disease.
- Use language that is strengths-based, respectful, inclusive, and imparts hope. “Strengths-based” means using language that focuses on what a person does well, instead of on what they don’t do well. Instead of saying something like, “I see you’re not checking your blood glucose regularly,” perhaps you could reframe that by saying, “I see you’ve been checking your glucose once a week. We had talked about doing it every day. Can you tell me what you could do to check it even more?” Focus on the fact that they’re checking it a little bit and invite them to problem solve for how to do more.
- Use language that fosters collaboration between patients and providers. Instead of having a conversation that has a lot of “you need to” or “you should” statements, try a “How can I help?” or “What can I help you with?” approach. In addition, instead of telling patients what they need to do, ask them for their action plan. For example, “So glad you’re interested in being more active. Tell me more about what you plan to do.”
- Use language that is person-centered. A good example of this point is to avoid labeling people with their condition or disease. Talk about a person with diabetes; not a diabetic.
Q: What other audiences might benefit from this information?
A: It’s important to remember that people get information and messages about diabetes from sources other than their health care providers. It can be something they read in a booklet, see on TV, or read in the paper or online. The medical and public health community, as well as industry professionals and the media, need to appreciate the power of language when talking about or reporting on diabetes. We’d like these messages to eventually reach a much broader audience than just the health care professional audience.
Q: What would you say to someone who might read this blog post and think, “Great! The Word Police have arrived.”
A: That’s not what we want. We’re not saying that there’s now suddenly a list of banned words that can’t be said and a list of okay words. We want this to be a way to increase awareness of and sensitivity to the impact that words can have. We’d love it if people took this to heart and were willing to talk with their colleagues and say, “Hey, can you give me some feedback on how I sound and write?” Perhaps have a period of time where we can collaboratively support each other and, in a friendly way, help each other be aware of some of our “blind spots,” where we might say things unconsciously.
The AADE created a handy guide that summarizes the main points of the joint AADE/ADA position paper. You can use the guide to stimulate discussion with your work colleagues and develop your own style guide for writing and speaking. If you work in a larger health care institution, share these messages with people in the communications and PR departments. It’s not supposed to be finger-pointing or a shaming thing, but just a gradual increased awareness.
Any words or phrases that you would toss into the mix for discussion?