As Canadian hospitals evolve with the COVID-19 pandemic and elective surgeries resume, it is a timely opportunity to reflect on the power of language in health care.
An “elective” medical procedure is one relating to, being, or involving a nonemergency that is planned in advance and is not immediately essential to the survival of the patient. This may include anything from hip replacements, a subset of cardiac bypass and stent procedures and pre-emptive cancer surgeries.
There is no doubt that the pandemic has required hospitals to make difficult decisions in terms of balancing surge capacity with the continuation of urgent and life-saving treatments. But what are patients hearing when the invasive and potentially frightening procedures they have consented to are labelled as “elective,” when they were previously told they were likely necessary.
It is time that we rethink this term and the message it is conveying to our patients.
It is well established that poor communication in healthcare settings leads to worse health outcomes, decreased patient satisfaction, decreased compliance with treatments and increased malpractice risk.
In the past few decades, medical schools and other health professional programs have responded by beefing up training in professionalism, ethics and communication skills. As early as at the admission level, future doctors are evaluated on their communication skills and ethical approaches.
The effort is there but the culture hasn’t completely changed. “Bounce back” is still often used instead of “readmission.” “Frequent flyer” refers to a patient who seeks care often. And “Indian file” continues to be a descriptive term used to describe the appearance of certain breast cancer cells in pathology textbooks, referencing the way First Nations were described as having walked in single file by settlers.
The disclosure that physicians use inappropriate language about patients is not new. The highly successful novel The House of God introduced the concept into the popular mainstream more than 40 years ago.
But good communication goes beyond socially appropriate communication. After all, healthcare providers need to be precise in their language when conveying complex medical information in an easily understood way.
This point was solidified for me many years ago when I saw fear in my Polish-speaking immigrant grandmother when she left her family doctor’s office thinking she had cancer. Her well-intentioned family physician was able to communicate with her in Polish but had used a Polish term that, in translation, lost the essence of reassurance that comes with what turned out to be a pre-cancerous diagnosis.
Precision of language is extremely important in health care. Not only is it important that we avoid using judgmental or culturally insensitive terminology but when we can, we should anticipate the interpretation of well-intentioned benign words.
What we really mean by “elective,” is in fact “scheduled.” This subtle word difference avoids the confusion and cognitive dissonance patients face when they are told that their hip pain, occluded heart vessels and pre-cancerous lesions are thought of as “elective” by their healthcare providers.
Patients want to be heard and have their symptoms acknowledged. Hospitals need to be able to schedule care in a prioritized way with finite resources.
Let’s call it what it really is.