25 August 2021

Labels make us lose sight of the patient

Comment Patients Psychology

During my 20-year career, I have often reflected on the language we use towards and about our patients.

Guilty of using less-than-acceptable words and phrases in the past, I now strive to improve my own communication habits and model appropriate behaviour for the junior staff I work alongside.

“Frequent flyer”, “self-harmer”, “GOMER”, “the miscarriage in six” – if you have worked in an emergency department for more than five minutes, you will have heard these phrases being tossed around.

Whether we like it or not, the words we use and the attitudes we bring to our patients can set the tone for how we are going to manage their conditions, queries and concerns.

Canadian emergency physician Dr Brian Goldman, author of The Secret Language of Doctors, says some slang is not witty at all but “simply objectifies and stereotypes patients, and strips them of any kind of individual identity”.

As a senior clinician, I field stories about patients in my department as gathered by our junior staff. It’s my job to filter through the information, search for red flags and to make sure life-threatening diagnoses are considered and excluded.

I heard one such story recently: a young man who presented with abdominal pain. The words I heard were “excruciating pain” and “peritonism”; however, they were accompanied by the words “marijuana” and “mental health issues”.

The resident was reluctant to perform a blood test, let alone any advanced medical imaging. It took a lengthy discussion and advice born from years of experience, and a smattering of gestalt, for the resident to consider the signs and symptoms in a context devoid of mental health issues and drug use. A diagnosis of ruptured appendicitis was eventually made.

There are patients that come into our emergency departments that are simply triggering for many health care professionals. They are generally the ones who seem to have made a lifetime of poor choices. The patient who drinks too much. The patient who eats too much. The patient who does too many amphetamines. The language we use about the patients in our care can reveal the frustration and even apathy we feel in the practice of modern medicine.

Workload, burnout, bureaucracy – among others, these factors contribute to clinician fatigue and the occult bias which clouds our clinical acumen. We often fail to accurately diagnose and manage the medical illnesses of the patients that make our hearts sink.

These patients, who are more than their presenting complaint, have a history of prejudicial life events that have led them to this exact point in time. In my own experience, it has helped to acknowledge that presenting frequently to an emergency department is hardly the definition of an idyllic lifestyle and it has become easier to bring empathy and curiosity to my consultations.

Despite the hustle and bustle of a modern emergency department, it is startling to realise just how much our patients glean from our work-station conversations. Hospital curtains do not conceal the colourful conversations staff have at clinical desks.

Patients with sensitive health and mental health issues have reported feeling “patronised, punished and humiliated” in healthcare settings. Demeaned by the very people from whom they seek help, these patients may then be less willing to share relevant, intimate details of their lived experience, or ask questions about the specifics of their investigations and treatment. What do we get? Poor health outcomes for all. And many more presentations to the emergency department.

A friend once described my job to me as “ordinary people having an extraordinary day meeting extraordinary people having an ordinary day”. Some days, we meet people at the very nadir of their life, and it is our calling to make their very worst day just a fraction more tolerable.

It takes just a moment more to say “the patient having a miscarriage in six” instead of “the miscarriage in six”.

Consider your turn of phrase as if it were your loved one in the cubicle and they could hear every word you said. Take just a moment to ponder what lies below the tip of the iceberg of your patients’ lives. As Maya Angelou said: “Try to be a rainbow in someone’s cloud.”

Dr Bethany Boulton MBBS FACEM is an emergency physician working on the Sunshine Coast. She is a founding member of WRaPEM (Wellness Resilience and Performance in Emergency Medicine), dedicated to bringing the non-technical skills of medicine to the fore

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