Sign Out: Words hurt! What obstetricians can learn from Joe Biden

May 1, 2007

Words hurt! We need to choose our words carefully to avoid causing patients unnecessary pain and angst. Your patients will thank you!

Key Points

During a recent interview with Jason Horowitz of the New York Observer to launch his second run for the United States presidency, Senator Joseph Biden, Jr. (D-Del) made a number of candid comments. Most noteworthy was what he had to say about Barack Obama: "I mean, you got the first mainstream African-American who is articulate and bright and clean and a nice-looking guy," he said. "I mean, that's a storybook, man." What he meant to say, he later explained as he apologized for his misuse of the word 'clean', was that Mr. Obama was " . . . probably the most exciting candidate that the Democratic or Republican Party has produced . . . he is fresh, he is new, he is insightful." But the damage had been done. And, although Mr. Obama conceded that he was not personally offended by the comment, the resultant media frenzy has almost certainly ended Joe Biden's bid for the presidency. It's no coincidence that we refer to this concept as "political correctness."

A clear lesson

In the same way, the word 'retardation' has become synonymous with 'mental retardation.' With that in mind, describing a developing fetus as being 'growth retarded' is likely to conjure up a myriad of unpleasant images in the mind of the expectant couple. Replacing this term with 'growth restriction' allows clinicians to impart the same information while avoiding the unpleasant and unintended associations. The same can be said for the archaic term 'cervical incompe tence.' The term 'incompetence' refers to the inability to perform a given task. Exactly who was incompe tent? The cervix is not an autonomous entity but an integral part of the patient. Are we suggesting that the patient lost her pregnancy in the same way that some people lose their car keys? Use of the alternate term 'cervical insufficiency' will avoid any and all confusion and misinformation.

Not only do we need to choose our words carefully, but also our sentences. How do you politely explain to a morbidly obese woman presenting for a routine level II ultrasound that you are having difficulty visualizing the fetus because of her body habitus? How do you suggest to a noncompliant and poorly-controlled class RF pregestational diabetic that she may want to consider leaving her job at Dunkin Donuts? And how do you convince an expectant mother with poorly-controlled steroid-dependent asthma to stop smoking?

Psychiatrists tell us that, before we can affect their behavior and encourage lifestyle change, we first need to build an alliance with our patients. It is our responsibility, therefore, to develop our communication skills and avoid using words that may be offensive and alienating to some patients. And there are additional benefits too. Among others, Troy Brennan, MD, JD, MPH, from Harvard Medical School has shown that the likelihood of a physician being sued for an adverse event is related far more strongly to the nature of the doctor-patient relationship than to the presence or absence of negligence. So the message is clear: Choose your words carefully; your patients will thank you. And thank you, Joe Biden, for reminding us!