The Weight of Words in Healthcare Delivery and Equitable Outcomes

June 4th, 2024

Brunette female doctor is talking to African American patient Brunette female doctor is talking to African American patient

By Kimberly Brock, Executive Vice President, Health Equity Lead

We are told from an early age, “Choose your words wisely.” We’re taught that our words matter — they have the power to hurt, to inspire, to persuade. But what type of impact do words have on the delivery of healthcare and equitable outcomes?

As an agency, Golin Health is committed to health equity, which is why we were deeply concerned by the findings of a recent study published in The Journal of the American Medical Association (JAMA) Internal Medicine. In “Stigmatizing Language, Patient Demographics, and Errors in the Diagnostic Process,” a study authored by Katherine C. Brooks, MD; Katie E. Raffel, MD; David Chia, MD; Abhishek Karwa, DO; Colin C. Hubbard, PhD; Andrew D. Auerbach, MD; and Sumant R. Ranji, MD, researchers found that patients who experienced diagnostic errors were more likely to have stigmatizing language in their medical records. While the presence of stigmatizing language in patient medical records is not a novel issue, the study’s findings have brought light to this troubling reality and remind us of the efforts we must undertake to address health inequities.

The damaging language, which was more common in the records of Black patients and those with housing instability, was laden with stereotypes related to race and class, implications of patients being “difficult,” and phrases that questioned credibility. Additionally, patients with records containing stigmatizing language were more likely to have delays in care and communication.

Language has a lasting impact

The study’s findings further underscore the challenges and systemic change needed to address health inequities. A clinician’s choice of words holds immense power — it can shape a patient’s healthcare journey, influence treatment decisions, and significantly impact health outcomes. Beyond mere ink on paper, stigmatizing language can alter the quality of care a patient receives from subsequent clinicians who access their records. Word choice can exacerbate the negative effects of social determinants of health, heighten stigmas associated with underserved communities, and even delay diagnosis.

In addition to medical records, biased language has also been found in verbal communication in healthcare, which underscores the urgent need to put mechanisms in place to identify this issue in any area of health communication.[1]

Steps to address the use of stigmatizing language in health communication

As we continue to strive for health equity, it is critical to understand the implications of stigmatizing language and take action to stop its use by:

  1. Creating language guidelines: Creating and implementing standardized language guidelines across different areas of the healthcare industry is a critical first step. Adopting equitable language practices addresses bias, promotes equity, and fosters trust.
  2. Looking beyond words: Beyond language, the images we use in creative work can also reflect bias. To ensure that imagery goes beyond simple representation, work to develop creative that uses images and words together to create a meaningful feeling of representation and inclusivity.
  3. Collaborating: To create guidelines that accurately reflect the populations where people live, learn, work, play and worship must partner with community organizations that represent different groups — including race, ethnicity, and sexual orientation. This is essential to ensure the language we use in health communications reaches underserved communities.
  4. Measuring and monitoring: To assess if language guidelines are correctly used, ongoing monitoring and measuring is key. Tools to help flag bias and collect data on word choice will help give an accurate picture of adherence.
  5. Ongoing Commitment to DEI&A: A commitment to diversity, equity, inclusion and accessibility does not end with language guidelines. It is an iterative process that relies on ongoing education and training, observation, and monitoring to ensure the integration of inclusive work practices among employees.

The journey to greater health equity is a collective commitment that requires bold action, and we applaud the study authors for undertaking and publishing this important research We must be unafraid to draw attention to damaging stigmatizing language and raise the value of education, training and inclusive practices that address health inequities and drive patient empowerment. As much as words can hurt, they can also heal — let’s put them to work in our efforts to end health inequities.