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Healthcare Lingo Hobbled by Political Correctness

Cheryl Clark, for HealthLeaders Media, April 28, 2011

"I like calling them 'patients,' and I don't like calling them 'consumers,' " he says. "It feels like we're selling cars, and we don't have a fiduciary duty. Like we're a vendor. And if we can trick them into buying a fancier car, we do. That's not the way we or other physicians think about what we do."

This new kerfuffle, he says, represents "the reflection that this healthcare universe, metaphorically, is like a bunch of plates and utensils on the table and someone just pulled the tablecloth out. And they're all flying in the air and it's not clear what will land upright and what will tumble to the ground and break. During stages like that, people essentially juggle for power in the realization that the status quo is not going to be the future."

"No one pays attention to words when attitudes toward the words, or power or politics or money that flow around those words, are unimportant," he says.

Paul Levy, former CEO of Beth Israel Deaconess Medical Center in Boston, weighed in last week on his blog, "Not Running a Hospital," (when he altered his blog profile. Instead of being an advocate for 'patient-centered care,' he now is an advocate for 'patient-driven care.'

What's the diff?

He says it's to reflect the idea that "clinicians should do their best to collaborate with patients to understand their needs and desires and to jointly design plans of care that are as consistent as possible with those needs and desires."

Wachter took issue with that. "We have to be so careful we don't go so far in the other direction that in fixing one problem we're creating another. 'Patient-driven' feels like it's too far in the opposite direction, and diminishes and marginalizes the role of healthcare professionals, who spent a lot of time trying to gain a kind of expertise and experience that is there to benefit the patient. It makes it appear that they almost have no role."

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3 comments on "Healthcare Lingo Hobbled by Political Correctness"

Milt Hammerly (4/28/2011 at 6:38 PM)
Cheryl, I enjoyed your article on the hobbling effect of political correctness. I've never been a fan of politically correct language, the inappropriate chastising that occurs for "transgressions" and the repressive effect this has on an open exchange of ideas. However, I think there are times when linguistic precision is both desirable and necessary. Two adages come to mind: "Say what you mean and mean what you say," and "If you don't know where you're going any road will get you there." Hybridizing these two we end up with, "If you don't what you mean or where you're going, any words will do and good luck getting anywhere." The operational reality is that organizations or systems can't effectively [INVALID] a plan without unambiguously defining and articulating the plan. Using imprecise wording that is subject to multiple interpretations will hobble execution because the lack of shared understanding will result in inconsistent and incompatible actions. Shared understanding (based on precise, unambiguous language) must precede shared behavioral responses. Therefore, words really do matter if we want to [INVALID] a plan that moves us from a current suboptimal state to a future, more desirable, state. There is plenty of room for debate and discussion as to what a future desired state for health care should look like. Your article validly points out that giving full control to patients and making providers passively sit on a shelf (as commodities to be consumed at will) doesn't make sense. I don't think that anyone really supports that extreme position. In that sense, I agree with you that "patient-driven" care may not be the best language to convey cohesive movement toward a future desired state. I think the intent of Paul Levy was to illustrate the inadequacy and imprecision of "patient-centered" language. Some people (like Dr Don Berwick) say "patient-centered"and link it inseparably to the concept of "nothing about me without me." In other words, health care providers don't just put their heads together to figure out what's best for patients without getting their input in some way. Many, if not most, health care providers still think "patient-centered" is just about providers doing what's best for patients. The latter group doesn't actively seek patient input and may even belittle it as uninformed, trivial and a waste of time. With both groups using the same imprecise "patient-centered" language, cohesive movement toward a future state with greater patient involvement has been hobbled. Catholic Health Initiatives (CHI) had been struggling with advancing a more progressive view of patient-centered care until we recognized we were getting in our own way with imprecise language. The dictionary definition of "patient" makes it clear they are defined by their illness and/or their relationship to a health care provider. There is absolutely no autonomy, individuality or control in the definition of a patient. They are passive victims of illness and at the whims of providers. In this sense, "patient-centered care" is doing what's best for the pancreatitis in room 615 (and oh, by the way, there's a person attached to that pancreas). The definition of "person," on the other hand, is all about individuality, autonomy and control. If you ask a large room full of people to tell you who they are, it is extremely unlikely a single one will answer "I'm Dr Smith's patient." That's not how people think of themselves. Typically they'll describe who they are by speaking of relationships, family, vocation, avocation, religion, politics, etc. We should not limit their identity to their pathology and their passive relationship with us. No one should be required to give up their personhood to become a patient. Are there times when the patient is horizontal in an ambulance or the ICU where we have to act without their input? Absolutely! On the other hand, if the patient is vertical a collaborative dance can take place between two autonomous persons. Sometimes the provider will lead and the patient will follow and at other times this is reversed. When CHI made a conscious effort to consistently communicate our desire to deliver person-centered care (rather than patient-centered) we were able to get out of our own way. Consciously and explicitly shifting the locus of control towards patients (not complete control by patients but a shared decision making model) with more precise language has allowed us to have much better organizational traction in moving toward a vision of greater patient involvement. This is not just some touchy-feely humanistic aspiration[INVALID]we believe there is evidence this improves outcomes and is also more cost-effective. Yes, person-centered care is more humane towards patients but it is also more humane towards health care providers who (as persons) are not commodities to be consumed. As a result of the greater linguistic precision used to "say what we mean" CHI is making great strides in "meaning what we say." Patient and Family Advisory Councils (PFACs) have been established at all the hospitals across our entire system. The PFACs review safety and quality data as well as HCAHPS scores for our hospitals and are asked to make a list of prioritized recommendations to the hospital boards yearly. Each hospital is expected to identify at least one of the recommendations from their PFAC and develop an action plan to implement over the coming year. If the status quo is OK then words and plans are not so important because there is no vision. I don't think there are many people, patients or providers (anyone who has actually had to use or work in the current system), who sincerely believe the status quo is acceptable. That being the case, I believe we do need a vision and a plan that can be clearly defined and precisely articulated if we aspire to a better future in health care. This is not about political correctness. It is about thoughtfully and carefully choosing words that allow us to get out of our own way so we can collectively move in a desirable direction. One final, adulterated adage: "A vision without a plan is just a dream. A plan without a vision is just drudgery. But a vision with a (precisely articulated) plan can change the world." Milt Hammerly, MD VPMA, CHI Institute for Research and Innovation 198 Inverness Drive West Englewood, CO 80112 303-383-2668

bob (4/28/2011 at 4:19 PM)
Cheryl Clark correctly focuses on increasing discussion of the changing meaning of key words and phrases, reflecting the ever changing health care system in this country. Like almost all of the literature on the meaning of the patient/physician relationship during the past decade, she does not include explicit reference to the legal reality that the patient, rather than the physician, is responsible for sensitive decision making. Everyone know that is the case, reflected in all of the burdensome requirements concerning "informed consent", except for most physicians and almost all patients. Clearly, in the period ahead, it will be important to explore more exciting and dynamic concepts of guarantees of effective patient/professional relationships than patients simply consenting to professional decisions.

Bruce McLaughlan, CCS (4/28/2011 at 2:15 PM)
Insightful article, Cheryl. At some point in an acrimonious debate such as this you have to wonder how much the argument over semantics is being used as misdirection in order to avoid dealing with the real issues. Talk, talk, talk instead of do, do, do. Perhaps it's a natural reaction to feeling powerless.