What word do you wish we would delete from use in medicine and why? What would you replace it with?

Noreen Mirza, Medical Educator, National University of Medical Sciences, Pakistan

I would replace the words “low intelligence,” with “limited experience.” They may just have limited exposure in life, they are not dumb!

Leslie Ordal, MSc, Genetic Counselor, Toronto, Canada

We’ve really got to ditch “compliance.” The paternalistic and judgmental overtones have no place in a time when we’re moving more and more towards shared decision making.

“Adherence” can be unwieldy but so far seems to be the best replacement.

Colleen Christmas, MD, Johns Hopkins University School of Medicine

Our medical language is filled with negativity, dehumanization, and fixing broken things. I wish our language and our actions better facilitated working with humans to achieve their own health goals.

Replace “problem list” with “categories of health addressed.”

Replace “the patient” with said person’s name as he or she would prefer to be addressed.

Replace “denies” with “doesn’t have.”

Replace “refuses” with “chooses not to,” or “declines the offer of.”

Replace “history or present illness” with “story,” or “experiences”; replace “social history” with “description of person’s life.”

Never, ever, ever, ever refer to a person as a disease, a body part, or an inanimate object (“rock”). Ever.

Replace “withdrawal of care,” with “removal of X device.”

Replace “code status” (those two words don’t even make sense together) with “views about attempts at resuscitation.”

Remove “drug abuser” and replace as “experiencing substance use disorder.”

This one will get you in hot water but I’ll say it anyhow: remove “clinician” and “provider” and replace with the more accurate titles, “doctor”, “nurse practitioner”, etc. I think it is deceptive to laypersons who believe they are coming to see a physician but instead sees the physician assistant and blurs the lines of role definitions in a dangerous way.

Margaret Chisolm, MD, Johns Hopkins University School of Medicine

Addict – it dehumanizes people, by defining them by their illness. I would replace the word “addict” with “person with a substance use disorder” or “person with addiction” or the like. Anything that puts the person first and the illness/behavior second. I also dislike the word “clean” to describe a person in sobriety/abstinence.

Also, “borderline” – it has no inter-rater reliability and is essentially what my mentor terms “sophisticated name-calling.”

And what about “difficult patient” and “uncooperative with the history” – I was taught to say, “I was unable to win the patient’s cooperation with the history,” shifting the responsibility to me as the physician instead of blaming the patient.

Finally, let’s retire “committed” suicide – like it’s a sin or a crime.

Rachel Salas, MD, Johns Hopkins University School of Medicine

Obese. Although being overweight has negative health consequences, there may be a better way to state it than the negative word, “obese.”

Instead, I say or write, “BMI is ___,” and list the NIH BMI scale with the ranges. If obesity is a risk factor, I say or write, “per BMI,” so that it is not subjective.

Sam Kant, MD, University of Maryland Medical Center

I would delete ‘poor historian’ – there’s a always a history to be elicited if we persist. Stories reveal so much about a patient.

Flora Smyth Zahra, Dentist, Kings College, London

”Soft skills” or ”non-technical skills,”  i.e all the multi- perspective elements of being a clinician other than the doing.

Like U2, “I still haven’t found what I’m looking for,” even “humanistic” sounds a bit clunky.

Elizabeth Dougherty, MSW, Burlington, Ontario

It’s always upsetting when the reference is made that a patient with a life-limiting illness “failed” treatment – like one can somehow study and pass?

This is evidence of yet another burden placed on the individual… #MedEd #Healthcare #hpm

Anisha Gupta, Dentist, United Kingdom

I’m not a fan of “patient complains of.” It’s very negative, maybe replace it with “patient concerns” or “presenting symptoms.”

Sawsan Razig, MD, Cleveland Clinic

“Orders,” propagates hierarchical care models. Perhaps replace with, “recommendations.”

J. John, Healthcare Agent of Change, Boston, Massachusetts

Replace “instruct patient”  to “ask patient.” We are partners with our patients.

Shoba Stack, MD, University of Washington Medicine, Seattle, Washington

Refused —> Declined. Refused carries an unfair undertone.

Eileen Barrett, MD, MPH, University of New Mexico School of Medicine

Uncooperative – usually patients are unable to participate due to acute illness or confusion.

Stuart Ray, MD, Johns Hopkins University School of Medicine

I would eliminate all words that we would not say with our patient listening.

Many are obvious, but a subtle example is “denies,” which is strongly pejorative when heard by patients.

Bedside (patient present) presentations teach us the power of words, the wisdom of patients, and the fragility of trust.

Megan Hosey, PhD, Johns Hopkins University School of Medicine

Delete – “manipulative.” Add – “scared,” and/or “frustrated.”

Amita Sudhir, MD, Charlottesville, Virginia

“Claims,” or even, “states.” As in “the patient claims,” or “the patient states.” This makes it sound like we don’t believe our patient. Just report their history as fact (and editorialize if necessary in the assessment if you really think it’s not true).

Jill Murphy, Physical Therapist, Neenah, Wisconsin

Patient “refused” a bath with cholorohexidine. Only 1 of 10 entries mentioned that this is because the patient is allergic to it!!!

Also, the words “proper” (according to who?) and, “tolerate,” are such junk words. “Pt tolerated __ well.” What does that mean? They lived? They survived?

As I teach in documentation seminars – words have meaning and weight – stop throwing your patients needlessly under the bus!

Shmuel Shoham, MD, Johns Hopkins University School of Medicine

“Frequent flyer” should never be used except in relationship to an airline program.

Diana Anderson, MD, Quebec, Canada

“Difficult patient” and “difficult family.”

Often the clinicians and/or the circumstances can create barriers to effective communication.

If we use these terms then we should also reserve space for a “difficult clinician” term too! 🙂

Madhu Singh, MD, Veterans Hospital

Delete “poor historian.” I would replace it with “an incomplete story,” and remove the blame aspect.

Also, if I never hear the term “provider” again, I will be happy. I understand the need for such a term, and I am so much happier with the term “clinician.” Provider is a strange, impersonal term that is like nails on chalkboard for me.

Randy Barker, MD, Johns Hopkins University School of Medicine

I would delete the use of “case” when referring to a patient. It turns a person into an object, and can insidiously foster thinking “thing” not “person.”

I would also delete the use of “endorses” when we mean “reports a symptom.” Endorsing means a public announcing of one’s support or to sign a check. It does not apply when a patient says something like, “yes, I have had some shortness of breath.” I have not idea how the incorrect use of “endorse” got so ensconced in our lexicon!