Words fascinate, confound us
By Toni S. Adams, RDH, MA
My young son
Came through the door,
He was cryin’ like I’d never heard before.
His friend Tim
Had taunted him,
And the hateful words lay scattered on the floor.
-Lay It Down, lyrics and music by Linda Allen
“Language is what made us human. Everything we have ever achieved originates from it.”
G. Deutscher, Unfolding of Language
Words, words, words. They fascinate and confound us. They bring us together and keep us apart. They make us human but they also allow us to be inhumane. We may say, “Sticks and stones may break my bones, but words can never hurt me,” but we know that the truth is, “The pen is mightier than the sword,” and that words really can hurt a great deal. This is as true in health care as it is in life.
Language and the ability to use it are tools, parts of our armamentaria, and they are just as fundamental and essential to dental practice as a mouth mirror, compressed air, water, and suction. We cannot make the best use of our fancy, expensive, manufactured tools, not to mention our knowledge, unless we’re proficient with language. So it is important to understand how we use words and language to communicate.
Words as tools
Our words can be as frightening to our patients as some of our other tools, or our words can inform and comfort. I cringe when I hear a parent tell a child that their dental treatment “won’t hurt.” The child may never have considered the possibility of pain if he or she had not heard the word “hurt.” On the other hand, people may not take their conditions very seriously if we say, “You have a little bleeding.” But we get their attention if we tell them, “Your gums are hemorrhaging.” Similarly, I prefer the term reception area, with its welcoming connotation, to the term waiting room, and I like to say that the care we deliver is treatment instead of work.
Words have the power of suggestion, and we can use this in a positive way. Consider this anonymous quote, “The difference between crisis and opportunity is attitude.” According to this author, if we think of a challenge as a crisis, then it will be. If we call the challenge an opportunity, then we might change our view and create a positive experience.
When patients are tense and I see their shoulders moving toward their ears, I quietly and calmly say, “Relax your shoulders, relax your neck.” And they do! It works for them and it works for me as a self-suggestion. Admit it, many of you who read this just relaxed your shoulders and necks. It is amazing what a few words can do. A person’s name and label can influence our opinion of that person, and this is the basis of a long-standing debate in health care.
Patient versus Client
In the early 1970s, several nursing theorists suggested that the people who receive health care should be called clients rather than patients. They made two arguments. The term patient has a passive and dependent connotation that seems inappropriate for people who we hope will become involved in their own care, and the term client indicates a more equal relationship between caregiver and care receiver that reflects patient-centeredness. On the other side, those who advocate for patient contend that the word client has a financial, business, and impersonal implication and does not represent the special relationships that are formed in the provision of health care.
To this day nurses advocate the use of client, while physicians tend to side with patient. The discussion has expanded and researchers have surveyed the greatest stakeholders in the issue, the patients/clients themselves, but research findings have been inconsistent. Some people prefer to be called clients, some prefer to be called patients, and some don’t care. One Australian man may have spoken for many people when he said that he was more concerned with how he was treated rather than what word was used. He was happy with, “Any heading said politely.”1
This topic has been discussed in dentistry. Recent dental hygiene graduates I have met tend to use, or have been taught to use, the term client, but we seasoned practitioners, and most dentists and staff members I know, stick with patient.
The discussion on a dental hygiene listserv revealed a range of feelings about the issue. One discussion began with, “I learned in school that you are supposed to call your clients clients … (but the dentist says) that I am not supposed to call them clients but patients.”2 Typical responses were, “Calling patients clients makes the hair stand up on the back of my neck. It bothers me no end,”3 and “Regardless of whatever name is used they all still get the same treatment from me ... kindness, courtesy, professionalism, (and) knowledgeable, thorough care.”4
So the debate continues. What is the answer? That is a personal decision. Perhaps the most important thing is that there is a debate because we recognize the power that people invest in words. That power extends to diagnosis.
Patients crave information and often do not get as much as they want. Many come with lists of questions they composed from personal experiences, friends, television, publications, or the internet, and they seem to soak up the information that we share with them. One of their greatest desires is to know the names of their conditions or illnesses, their diagnoses. Dentists make their own diagnoses and dental clinicians care for people who have been diagnosed with a variety of other health problems. Many look to us for more information about all of their conditions, so it is important to consider the possible implications of speaking the words that surround them.
- Impact of what we say — People can have mixed feelings about labeling their illnesses. On the one hand, naming an illness validates it, organizes the symptoms, and defines a plan to deal with it. On the other hand, a serious diagnosis can be devastating.
For many people, it is shocking and upsetting to hear the words diabetes, hepatitis, or cancer applied to them, and some cannot even bring themselves to say the name of the illness out loud. However, one patient was actually relieved to hear that he had multiple sclerosis rather than the unnamed odd collection of symptoms that no one could define, and a young woman diagnosed with cervical cancer was thankful that she did not have the more stigmatized venereal disease.
The words we use and diagnostic naming can vary among generations and cultures. My mother grew up in the 1920s and ’30s, and remembers when it was improper to say underwear; they said unmentionables instead. It is only in the past 20 to 30 years that it has become acceptable to speak the names of certain parts of the human anatomy out loud in polite company.
I grew up in the 1950s and ’60s when people did not say the word cancer; we called it The Big C. To this day in the Navajo tradition, “The word is equal to the thing,”5 and “speaking a thought into the air gives it more power.”6 This is also true for other American Indian and Alaska Native cultures, and is the reason why only a handful of their existing 250 languages even have a word for cancer.
They are not alone. Doctors from many places do not want to say the “C” word. Oncologists from Africa, France, Hungary, Italy, Japan, Panama, Portugal, and Spain reported that they preferred not to say the word cancer when making a diagnosis. They substituted it with words like swelling or inflammation.
An interpreter, in the course of doing his job, said the word cancer and revealed a Russian man’s diagnosis to him. The man’s son was furious and “stared daggers” at the interpreter. “Do you understand what this means to a Russian man? It means you’ve just given him a death sentence. He is going to lose all hope, he’s going to stop eating, he’s going to stop drinking, he’s just going to curl up in a corner and die. You’ve just ruined two years of us carefully hiding this from him.”7
- Impact of how we say it — On the other hand, sometimes we must say a word in a certain way to get someone’s attention. I once found a lesion on a 40-year-old mother of three. She had an unusual bump of bone on the buccal aspect of her maxilla around the area of teeth Nos. 12 and 13. The dentist had referred her to the oral surgeon, but she postponed going, no matter how much we both explained how important it was to go in every way we could think of over a period of several months. Finally, a new dental hygienist who observed me with this patient blurted out, “But it could be cancer!” Though both the dentist and I had informed the patient that the lesion could be cancer, we had not said it with such emphasis, but it was what this particular woman needed to hear.
She saw the oral surgeon, was diagnosed with osteosarcoma (bone cancer), received treatment, and was able to heal. She was well when I left that practice about six years after her original diagnosis. She thanked me for saving her life every time I saw her after she completed treatment, and the experience became one of the most meaningful in my 26-year career. However, I felt that the credit and responsibility were shared. I first noticed the lesion and the dentist referred to the oral surgeon, but my colleague said the word in just the right way to finally prompt the patient to do something.
The lesson I took from that experience was that sometimes we need to approach certain words with caution, and sometimes we need to be blunt and forceful, and it isn’t always easy to know which is which. One researcher summed it up well. “When physicians name illness, it is helpful for them to give due philosophical consideration to the possible effect of that name on their patients. It would also be wise for them to critically appraise their communication style and the many extraneous pressures that influence their use of words.”8 In dentistry we discuss intimate and potentially devastating diagnoses, so we must be aware of what we say and how we use the words that surround those conditions.
Toni S. Adams, RDH, MA, combines 26 years of clinical dental hygiene experience with her BA and MA education in Communication Studies to specialize in communication issues in health care and dentistry. Toni has won awards for writing, speaking, scholarship, leadership, and mentorship, including being honored as the 2009 Philips RDH Mentor of the year.
(For direct quotes, contact author for full reference list.)
1. Nair BR. (1998). Patient, client or customer? The Medical Journal of Australia, 169, p. 593.
2. Fkitten (April 23, 2005). Clients or patients. Message posted to Amysrdhlist.com: A unique dental hygiene community at http://www.Amysrdhlist.com
3. Ranno SG. (April 23, 2005). Clients or patients. Message posted to Amysrdhlist.com: A unique dental hygiene community at http://www.Amysrdhlist.com
4. Goldman J. (April 23, 2005). Clients or patients. Message posted to Amysrdhlist.com: A unique dental hygiene community at http://www.Amysrdhlist.com
5. Bulow E. (1991). Navajo taboos. Gallup, New Mexico: Gallup Medicine Books.
6. Alvord L, Van Pelt EC. (1999, 2000). The scalpel and the silver bear: The first Navajo woman surgeon combines Western medicine and traditional healing. New York: Bantam Books.
7. Donan D, Levintova M. (2007). Barriers beyond words: Cancer, culture, and translation in a community of Russian speakers. Journal of General Internal Medicine, 22(Supp.2), 300-305.
8. Wood ML. (1991). Naming the illness: The power of words. Family Medicine, 23, 534-538.
This reprint was adapted for RDH magazine from Book 3 of the Dental Communication Brief Book Series, Verbal Communication in Dentistry. The author wrote the seven-volume Dental Communication Brief Book Series for anyone interested in improving communication skills in dentistry, including practicing clinicians and staff members, students, instructors, researchers, managers, trainers, and company representatives. Books 1 to 5 are in print, books 6 and 7 are in production. Adams welcomes input and inquiries at [email protected]. For more information, or to order, go to toniadams.com–>Brief Book Series.
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