The Power of Words: Using Language to Support Collaborative Provider–Patient Relationships

Laura M. Cascella, MA, CPHRM

The impact of language — both written and verbal — can be profound. Words create meaning, which can shape individuals’ understanding, feelings, interactions, decisions, and so forth. In healthcare, written and verbal communication are the crux of the provider–patient relationship, and they are paramount to patient outcomes and experience.

Much emphasis has been placed on the magnitude of verbal communication in relation to engaging patients, improving quality of care, and creating collaborative care models. Yet, on the heels of the 21st Century Cures Act and its information blocking rule (also known as open notes), the significance of clinical documentation has come to the forefront. As patients gain wider access to their health information and providers’ clinical notes, the importance of written language has become increasingly evident.

Documentation Challenges

Research and experience have identified a number of issues that have surfaced as a result of patients having broader access to their clinical notes. Not surprisingly, one of the main issues is inadequate health literacy, which has consistently been a problem with both verbal and written communication in healthcare. Only a small percentage of adults have proficient health literacy skills, and most adults have difficulty using the everyday health information that is routinely available in healthcare facilities.¹ Thus, it logically follows that patients also will struggle to understand clinical documentation, which historically has not been written with the patient as the intended audience.

Similarly, medical jargon in health records can create confusion and misunderstanding for patients. A 2022 study in JAMA Open Network notes that although practitioners acknowledge that they should avoid medical jargon, they still frequently use it. The study authors caution that although “this medical language may facilitate communication between health care professionals, its use with patients can introduce confusion that may have serious consequences.”²

Another troubling issue in clinical documentation is the use of language that patients may find derogatory. Although some of this language might be ingrained in the medical lexicon and providers may intend no harm or offense with their wording, research has shown that certain words, phrases, and descriptions can have negative effects on patients. The consequences of patients feeling disparaged by their providers can seriously harm provider–patient relationships. Patients might feel alienated, inferior, stigmatized, and distrustful. As a result, they may delay or avoid seeking medical care, which may lead to suboptimal outcomes and reinforce health inequities.³

Documentation Strategies

To address documentation challenges and help avoid misunderstanding, healthcare providers can employ various strategies to improve clinical documentation and patients’ comprehension of it. Experts note that changes to documentation do not need to be burdensome, but might involve some tweaking to help make information more understandable and to address language that might be problematic.⁴ Following are some examples of strategies providers can implement:

• Consider explaining the rationale and concept of open notes to patients and discussing some of the challenges related to documentation as well as how you’re making changes to help them better understand their health records.
• Invite patients to look at and review notes during the clinical encounter to ensure accuracy and create a collaborative process. Encourage them to also review their notes after the encounter as a reminder of important information and instructions and to catch any potential discrepancies.
• Only document the current clinical encounter and pertinent information related to it; avoid pulling in lengthy amounts of data from other parts of the record that might confuse patients or be irrelevant to their current situation.
• When documenting clinical care, consider how you would communicate the information to the patient during a face-to-face encounter. The sensitivity used in verbal communication can help guide written documentation.
• Refer to patients in documentation in the ways in which they prefer to be addressed in person, including their preferred pronouns.
• Use plain language and layman’s terms when possible, and — to help save time — consider developing boilerplate plain-language text for common explanations or guidance.
• Try to avoid confusing medical terms and medical jargon, such as words that have a different meaning in common usage than in the medical context. Examples include “negative,” “unremarkable,” “progressing,” and “impressive.”
• Define abbreviations and acronyms at first use and try to avoid using them excessively, particularly if they might be misunderstood or interpreted as insulting (e.g., follow-up [FU] and shortness of breath [SOB]).
• Use person-first language to describe patients rather than leading with their conditions (e.g., “patient who has diabetes” rather than “diabetic,” or “patient experiencing alcohol use disorder” rather than “alcoholic”).
• Be aware of language that patients might find offensive, such as terms or words that are:
  • Belittling — examples include words and phrases that might cast doubt on the patient’s truthfulness or authenticity (e.g., “the patient denies” or “the patient claims”)
  • Demeaning — examples include words or phrases that patronize or infantilize patients (e.g., “the patient is not allowed” or “the patient is noncompliant”)
  • Incriminating — examples include words or phrases that place blame on patients (e.g., “poorly controlled asthma” or “failure to progress”)
  • Stigmatizing — examples include words or phrases that have negative connotations in modern society (e.g., “morbidly obese” or “substance user”)
• When patients do not follow their care plans, document the nonadherence using subjective statements from the patient or others and objective information obtained through patient encounters. Avoid disparaging remarks or editorializing in the health record.
• Try to determine the factors that lead to nonadherence and document accordingly (e.g., rather than “patient refuses to follow medication regimen,” document that “the patient hasn’t been taking all medications because of concerns about cost”).
• Include and discuss lab and test results in your notes to help provide context and clarify important information about the patient’s condition and treatment regimen.
• Include links to credible patient education materials within your documentation to help patients better understand key terms, conditions, treatments, and more.
• When patients identify incorrect information in their records, acknowledge the errors and correct them. Be aware of how to appropriately amend electronic health records to avoid allegations of fraud and misconduct.⁵

Finally, it is important to note that although word choice and language are important considerations in documenting clinical care, patients’ access to their notes should in no way diminish accurate and thorough documentation of their diagnoses and care plans. If patients complain about or request the removal of objective clinical information, providers should listen empathetically but explain that the information is medically accurate and will remain in the record. They can offer to note the patients’ concerns or objections in the record as well.⁶

In Summary

Awareness of how language can shape the clinical experience and affect the overall provider–patient relationship can help practitioners think critically about how patients might interpret the information in their health records, particularly as more information becomes available to them. Making an effort to address issues related to health literacy, remove medical jargon, and avoid language that patients might find offensive or hurtful can help healthcare providers reinforce important information, build trust, increase transparency, and support patient-centered care.

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¹ U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National action plan to improve health literacy. Washington, DC: Author. Retrieved from https://health.gov/our-work/health-literacy/national-action-plan-improve-health-literacy; Centers for Disease Control and Prevention. (2013). The state of aging and health in America 2013. Atlanta, GA: Author. Retrieved from www.cdc.gov/aging/pdf/state-aging-health-in-america-2013.pdf

² Gotlieb, R., Praska, C., Hendrickson, M. A., Marmet, J., Charpentier, V., Hause, E., . . . Pitt, M. B. (2022). Accuracy in patient understanding of common medical phrases. JAMA Network Open, 5(11), e2242972. https://doi.org/10.1001/jamanetworkopen.2022.42972

³ Putka, S. (2022, April 28). ‘Belittling, doubting, or blaming’: Outdated medical language may harm patients. MedPage Today. Retrieved from www.medpagetoday.com/special-reports/features/98443

⁴ Health, S. (2021, June 28). How to write open clinical notes for a good patient experience. PatientEngagementHIT. Retrieved from https://patientengagementhit.com/features/how-to-write-open-clinical-notes-for-a-good-patient-experience

⁵ Putka, ‘Belittling, doubting, or blaming’: Outdated medical language may harm patients; Cox, C., & Fritz, Z. (2022). Presenting complaint: Use of language that disempowers patients. BMJ, 377, e066720. https://doi.org/10.1136/bmj-2021-066720; Gotlieb, et al., Accuracy in patient understanding of common medical phrases; CRICO. (2021, April 2). Opening your notes: Patient care recommendations. Retrieved from https://www.rmf.harvard.edu/Risk-Prevention-and-Education/Article-Catalog-Page/Articles/2021/Opening-Notes-Patient-Care-Recommendations; Hsieh, P. (2023, January 27). The power of ordinary English to improve healthcare. Forbes. Retrieved from www.forbes.com/sites/paulhsieh/2023/01/27/the-power-of-ordinary-english-to-improve-healthcare/; Health, How to write open clinical notes for a good patient experience; Klein, J. W., Jackson, S. L., Bell, S. K., Anselmo, M. K., Walker, J., Delbanco, T., & Elmore, J. G. (2016). Your patient is now reading your note: Opportunities, problems, and prospects. The American Journal of Medicine, 129(10), 1018–1021. https://doi.org/10.1016/j.amjmed.2016.05.015

⁶ Health, How to write open clinical notes for a good patient experience.

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