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Words Mean What I Say They Mean

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Skeptical Scalpel

Skeptical Scalpel is a practicing surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For almost 2 years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 200,000 page views, and he has over 2,900 followers on Twitter.

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Skeptical Scalpel (click to view)

Skeptical Scalpel

Skeptical Scalpel is a practicing surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For almost 2 years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 200,000 page views, and he has over 2,900 followers on Twitter.

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Frustration over semantics in medicine: Why words like "non-compliant" have fallen out of favor.

Apparently a few years ago someone decreed that “non-compliant” was no longer a politically correct term to describe patients who did not take their medicines or follow instructions. The newspeak to use is now “non-adherent.” This was recently brought to my attention by cardiologist-blogger Dr. John Mandrola, who humorously blogged about his own non-compliant-adherent behavior after a hand injury.

I googled “non-adherent vs. non-compliant” and found references to the former used in medicine from as far back as 1998 but most hits were from this century. I could not identify the origination of the switch or why the term non-compliant was perceived to be judgmental.

I suppose compliant has a more submissive connotation, and God knows, we should not consider patients as subjugated, but adherent really means sticky as an adjective and follower as a noun. Is a patient who takes his meds “sticky” or a “follower”? The difference between the two definitions, compliant and adherent, is minor at best.

Who decides these things anyway? I don’t remember this being discussed anywhere.

This phenomenon is not unique to the US. Public health workers in the UK were recently informed that the use of the word “obese” could be viewed as derogatory by obese people. The workers were told “that patients may respond better if they are encouraged to achieve a ‘healthier weight.’ ” The full story is here and is worth reading if only for this amusing mixed metaphor uttered by an opponent of the UK advice: “If you beat around the bush then you muddy the water.”

There is research on this subject. A 2012 paper from the journal Obesity (soon to be renamed “Healthier Weight,” I guess) describes a survey of a lot of people whose weight formerly would have been termed obese but now should properly be called unhealthily weighted. The term fatness was rated as significantly more undesirable than all others and excess fat, large size, obesity and heaviness were rated as significantly more objectionable than the remaining terms, such as weight problem, BMI, excess weight and the best of all, weight.

It’s not clear how just describing someone as “BMI” or “weight” will get the message across, but then I didn’t perform the study.

Question: what do you do with a person who needs to achieve a healthier weight but is non-adherent?

Skeptical Scalpel is a practicing surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For almost 2 years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 200,000 page views, and he has over 2,900 followers on Twitter.

2 Comments

  1. I’m glad to see I’m not the only one who finds this a bit ridiculous. Of course now in the name of political correctness we can’t tell patients much of anything but rather guide them to make proper decisions.

    The patient with the 500 blood glucose and the burning pain in the feet needs to ‘explore all the options’ and not be pushed about controlling blood sugar, about not finishing off the 2 pounder of potato chips and 3 liter sugared soda. Oh no. It has to be a guided journey.

    The HIV patient who persistently takes medication holidays and blames it on us that his viral load can’t come down: The patient who demands a Jazzy (motorized wheelchair) because the legs won’t support the elevated BMI (see even -=I=- can get in tune with the new speak.

    I realize that we as physicians are rapidly downgraded from learned teachers (a role I thought my mentors passed on to me) to ‘providers’. Sometimes I want to ‘moo’.

    I’m rather glad you brought these issue forward. I suppose next that patients will be making the decisions on where the scars go.

    Irv Buchbinder, DPM
    Community Health Services INC
    Hartford CT 06120

    Reply
    • It’s nice to hear from a kindred spirit.

      I have bad news for you. With the advent of single-incision laparoscopic surgery, patients are requesting that technique even though it has not been shown to confer any advantage (including cosmetic) over standard 4-port surgery.

      Reply

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