The End of Healthcare Consultese?

By Neil Seeman

A new motion passed unanimously by the British Medical Association urges the NHS to scrap management jargon. For example, physicians have been asked to use “patient” and ditch “client” and “service user.”

People who thirst for plain English in healthcare and in all service sectors – I count myself among them – have been losing this battle. In a journal article in 1994, Richard Peck described the then-“adjectival All-Star” of healthcare: “seamless.” He wrote: “Virtually no one attending a healthcare conference in the ‘90s will avoid hearing the word “seamless” at least a few times. It is the Holy Grail of would-be managers of the healthcare system, an ideal: patients moving effortlessly from one level of care to another, as necessary and without a hitch – without doubt, without misadventure …”.

Fifteen years later, “seamless” still reigns. According to the British Medical Association, management-speak dehumanizes health professions: “performer” (aka “doctor”); “efficiency savings and disinvestments” (aka “budget cuts”); and “service user” instead of “patient.” The UK-based Plain English Campaign promotes clear language in all public communications, noting that language confusion among doctors and patients can be a life-or-death issue.

The Plain English Campaign states: “Since 1979, we have been campaigning against gobbledygook, jargon and misleading public information. We have helped many government departments and other official organizations with their documents, reports and publications. We believe that everyone should have access to clear and concise information in plain English.”

Some NHS hospitals and trusts have received the Plain English Campaign’s annual Crystal Mark for clarity, while other institutions have been shamed with its opposite, the “Golden Bull” award. The Campaign’s medical writing course teaches “writing short sentences; using bullet points; being ‘active’ not ‘passive’; and using verbs to emphasize action.” Sessions feature lessons on how to craft hospital appointment letters and patient information leaflets.

What People Want

There are legitimate arguments against so-called “plain language”: sometimes what is straightforward to one is offensive to another (e.g., the word “blind”); hence words such as “non-sighted” emerge. Language, especially English, is like an arctic floe – slow and serene, and then disruptive. This year Miriam-Webster added many jargon-laden words that address concerns about the environment (carbon footprint), medicine (cardioprotective), pop culture (flash mob), and, in particular, online activities (sock puppet, vlog, webisode).

Given the natural drift of language, especially in healthcare, can we learn from patients to determine which words they prefer? I think so.

We can learn from online analytics – looking at the actual language people use every day – found in millions of postings scattered on the World Wide Web. When talking about their real healthcare experiences, people describe themselves as “patients” about five times more frequently than as “consumers”; and people call themselves “consumers” about seven times as much as they call themselves “clients”.

Most of the objections to the word “patient” seem to come from academics who decry the supposed paternalism associated with the word; or from those who prefer “consumer” on principle – they don’t like the “medical model” of health. My interpretation: Regular people overwhelmingly prefer “patient”.

This is just one example, and not scientific. (For what it’s worth, this approach seems to confirm small studies. In one such study, 75% of 133 people in community care preferred to be called “patient” by their GP – vs. “client” or “service user”. In another study, the author surveyed 101 people attending a back-pain clinic and found that 74 preferred “patient.”)

Words such as “client” and “consumer” and “service user” have been thrown about in conferences and vision statements for many years, but they don’t stick with the public. When a word doesn’t stick, we should shelve it.

It would be helpful if dictionaries would expunge stale meanings with the same vigour with which they embrace new ones year after year. Then, perhaps, the experience of patients everywhere might be a bit more seamless.

About the Author

Neil Seeman is a writer and Director and Primary Investigator of the Health Strategy Innovation Cell at Massey College at the University of Toronto.

Bird Flu, Mad Cow Disease, and other Biological Plagues of the 21st Century

Andrew Nikiforuk

On October 17, 2004, a Thai smuggler wrapped the two small crested eagles from Tibet in cotton cloths. Then he placed each bird into a 60-centimetre (24-inch) wicker tube, making sure the raptors had room to breathe. With the tubes hidden in his hand luggage, the avian transport boarded Eva Airways Flight BR0061 from Bangkok to Vienna, along with 128 other jet-setters.

The smuggler was on a business trip. A Belgium falconer had ordered the birds for $17,000 and the avian entrepreneur had promised to make the delivery in Antwerp. But a random drug check at Zaventern airport in Brussels uncovered the illicit cargo. Given that bird flu had already killed 32 peasants and chicken handlers that year as well as millions of chickens and 83 tigers at Thai zoos, customs officials quarantined the birds and tested them. When both eagles proved positive for H5N1, authorities slaughtered 700 parrots and canaries in quarantine facility. Authorities then tracked down the smuggler (importing diseased species is not a crime) and put him in an isolation ward at the Antwerp University hospital for four days. The veterinarian who tested and killed the infected eagles developed conjunctivitis, a common flu symptom, just two days later. Doctors put his entire family on anti-viral drugs. "We were very, very lucky," admitted Renee Snacken at Belgium's Scientific Institute of Public Health in Brussels. "It could have been a bomb for Europe."

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