Leeches in our language

Sept. 1, 2001
Precision is something that hygienists deal with daily.

Precision is something that hygienists deal with daily. Sharpening instruments, for example, is a precise exercise. The angles have to be right or the instrument won't work. In dentistry, precision is a requirement to every procedure.

Somehow, that precision doesn't transfer to our use of language. It must. In order for our patients to benefit the most from our knowledge, hygienists are compelled to develop a communication style to reflect the precision of the science of dental hygiene.

The use of qualifying words has been a problem in our language for a long time. An entire book, titled Elements of Style (Strunk and White) was written about effective communication in 1869. It is currently in its fourth edition, and the intent is to serve as a resource for writers. But the book is beneficial for communicators of all types.

In the chapter of "Principles of Composition," Rule #16 is, "Use definite, specific, concrete language. Prefer the specific to the general, the definite to the vague, the concrete to the abstract." Rule #8 in the chapter "An Approach to Style" is, "Avoid the use of qualifiers. Words such as rather, very, little, pretty are leeches that infest the pond of prose, sucking the blood of words."

Whoa! Probably, maybe, and can are other qualifier words that diminish the impact and urgency of a message. Can you hear yourself telling a patient that it's pretty important to floss? How about, "It's pretty important that you brush daily. Flossing can probably help the little bleeding I'm finding?"

The word "probably" is a fat leech sucking the blood out of entire conversations. After spending a good part of the appointment discussing the importance of periodontal therapy to a patient, the whole heart of the conversation flies out the window when probably enters the picture. "Yes, periodontal therapy would probably get that bleeding under control" — not much motivation there for treatment. In this context, the word "bleeding" is not as precise as necessary. Rewrite the sentence, eliminating probably, and change bleeding to infection. "Yes, periodontal therapy could get that infection under control." Most people would be more offended with the first sentence than the second because the second is truthful.

From an information sheet from the U.S. Department of Health and Human Services, we find this impassioned sentence sucked dry by the word may. "The oral health of children and adolescents with special health-care needs may be affected negatively by the medications, therapies, or special diets they require, or by their difficulty with cleaning teeth thoroughly on a daily basis."

The purpose of the information sheet is to motivate legislators to act on the dental-access crisis. Why would any legislator act if health-care needs may be negatively affected? Those things do negatively impact a person with special oral health care needs.

"It wouldn't be a bad idea to consider quitting smoking." Huh? Qualifiers do not necessarily have to be a single word. What impact does that sentence have? None. While a super direct approach may alienate patients ("Quit smoking or you'll start coughing up blood and die a long, agonizing death"), there is a middle ground. Most patients respect directness; they become confused if too many words are padding the message. Does smoking aggravate periodontal disease? Yes!. Does it possibly increase the chances of losing a tooth? No, it does increase the incidence of tooth loss. Our professional obligations do not end at the mouth anymore. Fidelity in the language we use to speak to our patients and professional peers is important. Qualifiers have no place in that setting.

A good example of how dental professionals use qualifiers to the detriment of their patients was an article in JADA earlier this year. In "Perspectives of Maryland Dentists on Oral Cancer," the results of research done with focus groups of dentists were reported. One thing that came to light during the conversations is that many in the group were uncomfortable performing an oral cancer screening. They were especially uncomfortable palpating extraorally on young women.

When the discussion moved to informing patients that an oral cancer screening procedure was accomplished, many in the focus group admitted using vague phrases. They made comments that were even designed to distract the patient from the procedure, certainly avoiding the word cancer.

In this example, imprecise language gives patients the continual impression that dentistry is about fixing what's broken. When confronted with nonhealing soft-tissue lesions in the mouth, patients go to their physicians. This, coupled with the hesitancy on the part of many dentists to provide oral-cancer screenings, explains why dentists rarely see oral cancer in their practices.

The small state of Maryland has two oral cancer deaths per day — a statistic the focus groups would not believe! When using qualifiers in their conversations with patients, a cycle of unproductive misinformation begins. The dentists in the study will not see the need for changing their screening practices for oral cancer due to a spuriously fabricated "low incidence" of the disease in dental-practice settings. Until the language used to communicate with patients changes, they will not get a meaningful grasp of the enormity of the problem in their clinical domain.

As professionals, people look to us for answers to their questions, and there are definitive answers to questions. It may be that the clinician does not know the answer or where to find it. That should not interfere with direct language. Say it with precision. Use language to emphasize the true meaning of what you are saying. Do not let those leeches suck the blood out of what you are trying to achieve in your clinical practice.

In the following months, this column will continue to incorporate research into critical rethinking of how we practice dental hygiene. You can count on sharp thinking about evidence-based dental hygiene practices, new ways of thinking about old practices, and insights from unconventional sources.

Thank you for letting me into your head!

Shirley Gutkowski, RDH, BSDH has been a full time practicing dental hygienist in Madison, Wis., since 1986. Ms. Gutkowski is published in print and on Internet sites, and speaks to groups through Cross Links Presentations. She can be contacted at [email protected]