Thursday, 16 August 2018

Re-writing the language.

   Here's a piece of 'educational research' that I  continue to get because  I  used to be a physician.    It is so tainted with 'political correctness' as to being  not only an opinion as to how a physician relates to  patients, but to suggest a whole new dictionary as to how physicians should record their interpretation of their interview with their patients.  George Orwell could hardly have dreamed up this piece.  
   Medical history taking is a highly skilled art, an art most physicians downplay today, because it is time-consuming and not rewarding.  Both the scientific community and the  masses grossly underestimate it, because in the long term, we all die.  History taking is not glamorous and much  of the time is routine grunt data collection, which is why in  our present health care system is almost exclusively done by medical students  and residents and even they realize that it is considered the 'scut work' and barely valued at all.  Although it is the bottom of the totem  pole, it holds the structure aloft.  I know the high tech stuff is much more exciting and achieves incredible results (sometimes!) but when the bottom of the pyramid is unstable, the whole damn thing is likely to topple.
   Remember, before Christ, the Romans were building bridges  that lasted a thousand years.  ( The Ponte Vecchio built in 1345 is still functioning today).


Stigmatizing language in chart notes creates negative impressions
Clinical question
Does negative language affect residents' and medical students' attitudes toward specific patients and influence their treatment decisions?
Bottom line
Think of how antagonistic common medical jargon is. Patients "complain." They "admit" or "deny." They "refuse" or are "noncompliant." The words we use can transmit, via a hidden curriculum, implicit bias to medical personnel in training. This study compared stigmatizing language with neutral language used to describe a patient with sickle cell disease that cast doubt on the patient's pain ("still a 10" vs "still a 10/10"), portrayed the patient negatively ("hung out at McDonald's" vs "spent the afternoon with friends"), or implied patient responsibility with references to uncooperativeness ("he refuses his oxygen mask" vs "he is not tolerating the oxygen mask"), Medical students and residents had more negative attitudes toward the hypothetical patient when described with stigmatizing language and suggested less aggressive management of the patient's pain. It's time to revise the medical scripts that convey negativity and bias about the patients in our care. (LOE = 1b)
Study design
Randomized controlled trial (double-blinded)
In this study, medical students (n = 233) and emergency or general internal medicine residents (n= 180) were randomly assigned, concealed allocation unknown, to read 1 of 2 chart notes with medically identical information about a hypothetical patient with sickle cell disease: one using neutral language (eg, "He has about 8 to 10 pain crises per year, for which he typically requires opioid pain medication in the ED") or stigmatizing language (eg, "He is narcotic dependent and in our ED frequently"). After reading the note, both the residents and medical students completed the Positive Attitudes toward Sickle Cell Patients Scale (range 7 - 35) and the residents selected a treatment for the patient from 4 options. Attitudes were significantly lower, on average, for participants presented stigmatizing language (25.1 vs 20.3; P < .001). Attitudes were progressively lower with years of training (correlation coefficient -.95). Residents were more likely to select less aggressive treatment (eg, a low-dose opioid or a nonsteroidal anti-inflammatory drug instead of higher dose opioid, along with less likelihood of redosing) if exposed to stigmatizing language (P <.001). Participants reading the stigmatizing note also were more likely to identify the physician who wrote the note as having a more negative attitude toward the patient.
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