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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.
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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.

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