Abstract
We all believe that we place our patients are at the centre of our care models, but do we also practise patient-centred language? Careful use of language will make a person feel recognised and supported, whilst the use of diagnostic, socioeconomic, gender or even ethnicity terminology may make them feel alienated, disrespected, stigmatized or even harmed. And while providers must sometimes use diagnostic labels and clinical language for clear communication, overreliance on such language can unintentionally but negatively impact relationships.
Utilising person-centred language emphasizes the person first rather than the illness, for example, ‘a woman with diabetes’ rather than ‘a diabetic woman’. When we use diagnostic labels, we depersonalise the individual and this creates cognitive bias that may impact our interactions and their care. Person-centred language is part of a person-centred model of care that shifts our focus toward an individual's unique needs and abilities.
At the recent ISOM conference in Sydney, an invited speaker pointed out her displeasure with the terms ‘vulnerable’ and ‘disadvantaged’ when referring to the First Nations women for whom she was advocating. They did not consider themselves vulnerable or disadvantaged; they were pregnant women, who, like all women, deserved culturally appropriate services to meet their needs. Such expressions have been termed ‘deficit-based’ language.
In the health care context, vulnerability and disadvantaged are terms commonly used to denote a specific potential for harm or inability to protect one's own best interests. They are often coupled with ‘social inequality’, ‘marginalized’ or ‘special needs’ implying impoverishment, low health literacy, geographical remoteness, homelessness, immigrant or refugee status and frequently First Nations groups. Populations and individuals may also be considered vulnerable or disadvantaged because of an inability to communicate due to language barriers including visual or sign language. The impact of these social determinants on maternal health and issues has been repeatedly demonstrated in a variety of settings.
In the recent biannual report of the Confidential Enquiry into Maternal Deaths and Morbidity, the MBRRACE-UK committee once again identified elevated rates of maternal mortality amongst women from Black and Asian ethnic backgrounds as well as those from deprived areas and those with ‘severe and multiple disadvantage’. 1 The main elements of multiple disadvantage were a mental health diagnosis, substance use and domestic abuse. In their detailed discussion of respectful care for migrant women, they highlighted an ‘appreciation of vulnerabilities’.
Health care providers, as well as researchers, have used these terms with the best intentions. However, this language also has patronising overtones that imply the problem lies within the individual or group and may be considered pejorative and discriminatory. Alternatives to these insensitive and triggering terms have been suggested which recognises that challenges in health care delivery and uptake are systemic and not the ‘fault’ of any specific individual or group. Terms such as ‘underserved/underserviced’ shift the focus to the inadequacies and inflexibility of the health and political systems rather than to the individuals being impacted by discrepancies in health care provision or outcomes.
As described at a 2001 conference addressing access and inequities in health care in Canada: ‘underserved’ refers to ‘an increased likelihood that individuals who belong to a certain population (and people can belong to more than one) may experience difficulties in obtaining needed care, receive less care or a lower standard of care, experience different treatment by health care providers, receive treatment that does not adequately meet their needs, or that they will be less satisfied with health care services than the general population’. 2
The MBRACE report clearly identified the need to aim for ‘equity in outcome rather than equality in care’. Along with this, reframing our language presents an opportunity to create and implement pathways and resources that recognise culturally appropriate and safe services that meet the needs of all pregnant people and their families. As clinicians we pride ourselves on our communications skills. Being aware of the impact of our language on those we are communicating with, and about, requires as much consideration as the medical care we provide.
