Most people bringing claims against doctors do not want money. That may be surprising, but research suggests that only 20% of people (1 in 5) are seeking compensation. Those of us who act for patients hear people telling us daily, ‘It is not about the money.’ Most have other reasons. For many, it is the response to being made to feel small, unimportant or that no one has listened.
I am sometimes asked to speak to doctors about how to avoid claims. I tell them that the most important factor is their relationship with their patient. Patients who feel valued and respected are unlikely to criticise their doctors even where things go wrong. Doctors need to pay careful attention here.
Language plays an important role. Doctors can use language that undermines, belittles or blames patients or sounds controlling[1]. They may not mean to do this – they are just using the terms they have heard other doctors use since they were at medical school. But the wrong words undermine the doctor-patient relationship. Patients feel dissatisfied and are more likely to bring claims.
My father-in-law once read a letter from his GP which said he had pain in the hypochondrium. He was furious. He thought his doctor was saying he was a hyperchondriac – imaging his symptoms. In fact, the hypochondrium is the area under the ribcage, which is where his gallbladder was causing him pain. In this case, the right language had confused him. But in many cases, using the wrong language creates the problem.
Belittling patients
Doctors may use language which belittles patients or misrepresents them. The often talk of patients having ‘complaints’ rather than concerns. But patients may not be complaining. They may just want to know why they have a lump and whether they should worry about it. Patients may read in their records that a patient ‘denies’ having symptoms. Doctors use this term frequently. To most people, it implies they may not have told the truth. This is not what doctors usually mean. Why then use the term?
Being authoritarian – treating patients as childlike
Some language is unnecessarily authoritarian. It paints a picture of the doctor as active and the patient as passive. Doctors ‘take’ histories, ‘send’ patients home, ‘allow’ them certain foods and describe them as ‘compliant’ or ‘non-complaint’.
Blaming patients
Other language can be moralistic and blame patients for poor outcomes. A patient may ‘fail immunotherapy’. A mother in labour may ‘fail to progress’ or, worse, show ‘poor maternal effort’. Another patient may ‘not be able to tolerate chemotherapy’. None are at fault.
Many people with diabetes feel stigmatised by being described as ‘poorly controlled diabetic’. Aside from the implied criticism, it is better not to categorise people as ‘diabetic’, ‘amputee’ etc. These terms define people by their medical condition – but we are all much more than that.
Does it matter?
A young client of mine failed to follow advice on how to control his diabetes. After unfortunate negligence in his care, he ended up with a lower leg amputation. He lacked self-confidence and felt as though doctors were always telling him off. So, he missed some appointments to avoid being made to feel bad. Their advice was right; the way they gave it was wrong.
He is not alone. Studies suggest that language really matters. It harms patient care and outcomes.
- It affects how doctors think about patients and how they treat them. One study of patients looked at patients not able to cope with an oxygen mask. It found that doctors who used language blaming them were less likely to prescribe them medication than those who used neutral language. In another, 19% of overweight patients said they would avoid appointments if they were described as ‘fat’ or ‘obese’.
- The wrong words draw attention away from the barriers patients face. Knowing what those barriers are is important. If we know what they are, there is a better chance of finding ways to overcome them. Just describing someone as ‘non-complaint’ fails ask the question ‘why’. What is holding them back? Is it (like my client) a lack of self-confidence? Does the task seem too complicated? Do they actually understand? Does life at home or at work seem overwhelming? Does the cost of a prescription leave too big a hole in the budget? We need to understand these barriers to support patients properly.
Some may think that changing language is trivial. They are wrong. Small changes can be important. They can shape the way doctors think about patients. That enables them to provide better care. They can also change the way patients feel about doctors. That may change patient response to medical advice. It can also take away one of the factors leading patients to bring claims.
[1] This article is based on the work of Cox and Fritz, ‘Presenting complaint: use of language that disempowers patients’ BMJ 2022; 377.
