We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Viewpoint |

Not Just Words Caring for the Patient by Caring About Language

Andrew S. Epstein, MD
JAMA Intern Med. 2013;173(9):727-728. doi:10.1001/jamainternmed.2013.365.
Text Size: A A A
Published online


I didn't flinch when a clinic assistant recently brought me intake forms on a patient I was about to see, matter-of-factly noting, “FYI, she refused vitals.”

“Okay, thanks,” I replied. Years of hearing and participating in conversations we have about patients, I later realized, had dulled my reaction. These conversations have become part of the fabric of our everyday work routines, whether on the wards, in team rooms, clinics, offices, and even outside hospital walls. To the layperson, a word like “refuse” might conjure up the notion of a cross-armed, defiant, and emphatic stance against something “reasonable” and “right.” In medicine,while patients rarely ever fit such a bill, the loaded label “refuser”—as well as other pejoratives—has entered our conversational medical lexicon. Even though this discourse (usually) takes place behind closed doors, it affects, in subtle but important ways, the manner in which we perceive and interact with patients and families. The subconscious neural circuitry might go something like this: If this patient is refusing to accept my recommendations, he must not only be wrong, but be pitted against me, and therefore I will similarly take a stance against him.



Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles

Users' Guides to the Medical Literature
An Illustration of Bias and Random Error

Users' Guides to the Medical Literature
Qualitative Research