Friday, 13 March 2015

The dirty language used in diabetes

It's been interesting watching the discussions about language coming from those attending the Diabetes Professional Conference this week. The use of the word "non-compliant" being a particular annoyance for both patients and HCPs alike. You can look back over the tweets from the conference by looking at the hash tag #dpc15 - there are lots of interesting tweets sharing information from the various sessions - well worth a read!

What really surprised me was how quickly the "non-compliant" word was used. Twitter was already talking about it at 8:52am on day one of the conference and exhibition only opened at 7:45!

Why is "non-compliant" such a dirty word?

Its definition in the Oxford Dictionaries is:

"Failing to act in accordance with a wish or command"

Ok, that's a loaded word!

In this debate about appropriate usage of words I have already used another contested word in this post. Have you spotted it?


What? Why? I hear you cry. Well in many ways it's linked with the non-compliance definition. Many see it as reinforcing the old view of the HCP-Patient relationship were a HCP gives "commands" and the patient duly "complies" - or "should" comply, otherwise they will be deemed "non-compliant" and poor outcomes will lie firmly at the patients feet.

Suggested replacements for the word patient include citizen or person. I remain to be convinced by these suggestions but I can understand why people are grappling with words.

Language and words evolve, times change, words take on new meanings and new words get picked up and spread so far they become part of the ever changing lexicon of the English language. As Laurie Anderson said: Language is a virus!

So the patient-HCP relationship should be one of equals rather than the paternalistic relationship of the past and "non-compliant" isn't a helpful phrase because it essentially puts the blame on the patient for less than ideal outcomes, without understanding the underlying cause for a patient not following the "commands" of the HCP.

Thankfully there are plenty who are thoughtful in their language and want to stop others from using unhelpful words and phrases, including Partha Kar who spoke about it in a conference session later in the week.

But "non-compliant" isn't the only dirty word used in diabetes healthcare.

Some will no doubt consider this discussion to be overly PC, but language is important. It can and does have an impact on the emotional well-being of people and so conveying the wrong meaning can leave lasting damage to a relationship and result in less than ideal outcomes. We have all heard the rhyme "Sticks and stones will break my bones but, words will never hurt me". Unfortunately judgemental words repeated over and over again do hurt no matter how much you try to ignore them and in turn they alter outcomes for the worse. So maybe it's time to be vocal about all of the language that isn't helpful.

What other dirty words exist?

I'm offering these as a starting point for discussion and I'd encourage you to share the words you believe are dirty or if you disagree with the ones listed here, please share your thoughts. If we don't have the conversation on how words are interpreted, how will people find out the true impact of the words they speak?

For the avoidance of doubt, the team I work with currently are most definitely in the enlightened camp and are very considerate when it comes to language (I wouldn't want to change them for the world and I'm not just saying that, I travel over 100 miles from my home because I believe they're worth it!) but unfortunately it hasn't always been the case.

Dirty Word Suggested Word Reason

management Usage: Do you have good control? Your control isn't as good as it could be.

When it comes to bg management there are lots of things outside of my control: illness, stress, hormones etc, but I can manage my bg levels. If you think about it, if I don't have good control then I must have bad control - it's judgemental and leads to guilt and frustration.

...and whilst I'm using phrases like "good" and "bad" (or "poor") control in this explanation, these are very judgemental words too... it is much better to talk about target ranges, high and low bgs etc
diabetic The persons name Usage: The diabetic in room A/bed 1

Please don't dehumanise me! Don't name people by the condition they live with, they have a name and they are human.
normal living without Usage: A normal person would have bgs in this range

Hang on, I'm normal too! Well as normal as anyone else is. If you call people without diabetes "normal" that makes me "abnormal", is that really what you are trying to say? A person living without diabetes is a better way to say it.

sufferer living with Usage: diabetic sufferer raises awareness

Usually the newspapers are the biggest offenders of this usage but unfortunately I see more and more healthcare organisations using the term too. One NHS diabetes service recently tweeted: "IS THERE A CURE TO STOP PEOPLE SUFFERING FROM DIABETES?!"

Sufferer implies a very negative situation, do I really suffer with my diabetes? Suffering sounds like I can do nothing about it. Yes, at times it can be tough but, I live with diabetes I'm not a "diabetic sufferer"!