There is a growing awareness in health care education and practice regarding the use of written and verbal medical language that is appropriate and also not stigmatizing. The question, however, may exist as to what is "appropriate". Well-intentioned individuals may find themselves in the position of unknowingly using language that may not be optimal and can actually be considered disrespectful or inaccurate by the intended recipient. The question then arises as to how we can best ensure that we are referring to patients as per their individual preferences. The NIH Style Guide at https://www.nih.gov/nih-style-guide provides helpful guidance regarding medical language for those interested in learning more.
Destigmatizing Language and SUD/OUD
What has now led me to explore the topic of medical language is my personal exposure through my prior role as the PI of a HRSA grant focused on primary care and behavioral health integration with a focus on opioid use disorder (OUD). Through the grant, the importance of educating others regarding the destigmatization of substance use disorder (SUD) was highlighted. Creating awareness by sharing such changes in medical language as replacing "alcohol abuse" with "alcohol misuse" and "addict, junkie, or drug abuser" with "person with an OUD/SUD" was pivotal. If interested in learning more, resources specific to SUD/OUD are available through various governmental sites (e.g. National Institutes of Health [with links to the NIAAA and NIDA - whose titles still surprisingly contain the words abuse]).
Person-First Language vs. Identity-First Language
Having attended medical school in the 1990s, I had been trained at the time to refer to patients when presenting them by their disease process and/or disability as identifiers. For example, a patient who presented with a history of diabetes mellitus would be identified as a diabetic patient. Since this time, person-first language has been identified as an approach to focus on a person as a whole and not based upon their disorder or disability. Hence, the same patient is now referred to as a patient with diabetes mellitus and not a diabetic. Similarly, as described in the NIH Style Guide Section on Person-first and Destigmatizing Language), a patient with bipolar disorder replaces a patient who is bipolar.
When discussing person-first language, it is important to also emphasize the preference of some individuals and communities for identity-first language. Unlike person-first language, identity-first language is preferred by those who consider their descriptor to be pivotal to their identity and considered as part of their whole being. For example, individuals with disabilities may prefer to be identified by their disability (e.g. "autistic person" instead of "person with autism") and individuals in the deaf community may prefer to be referred to as a "deaf person" instead of "a person who is deaf".
With the distinct difference between person-first and identity-first language, it is important to identify individual preference in order to optimize communication. Of note, in addition to these two approaches, there is information regarding specific disorders or groups (e.g. age, race/national origin, sex, gender, disabilities) that may be found in the NIH Style Guide and other online resources.
Words Matter
Overall, in my eyes, the importance of the topic of medical language and general communication is to achieve the goal of expressing kindness, respect, acceptance, and understanding through words. Words matter, yet sometimes it is not what is said but how it is expressed. I just wanted to take a moment to say that, even with the best of intentions, there will be a time (or times) that we err in communication (I know that I have). However, I believe that if we are kind, compassionate, and open to learning about others and their preferences, we can continue to build strong, positive relationships with both patients and the people in our lives.
Wishing you success and joy in all of your endeavors,
Sincerely,
Rupal Vora, MD, MPH, FACP
Founder, MedStudentCoach LLC
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