ON LANGUAGE; Age-Defying William Safire The New York Times August 20, 2006
Anti-wrinkle Vs Anti-aging Vs Age-defying
Reading Safire’s column on the emergence of Age-defying in the vocabulary of advertising prompted me to think about parallels with the ongoing Compliance Vs Adherence Vs Concordance et al controversy. The entire article is interesting and worth reading, but the sense of the piece, especially as it pertains to the “I say compliance; You say adherence” issue, can be extrapolated from this excerpt:
Compliance Vs Adherence Vs Concordance et al
Taking the marketer’s perspective, as Safire does in his column on the popularity of Age-defying, could be enlightening in considering the nomenclature of patient compliance as well. The chief criticism of compliance, adherence, and other terms designating the same phenomenon has been, after all, their connotations of patient subjugation to the demands of the clinician and the implicitly assumed but, as far as I can determine, unproven impact those connotations have on actual patient and physician behavior. In fact, given the interchangeability of these terms in the literature and, especially, the vernacular clinicians use among themselves,1 I suspect a linguist would be hard pressed to prove that a clinician’s or a researcher’s choice among these expressions corresponds to that professional’s predominate relationship mode vis-à-vis the patient (e.g., authoritarian, paternalistic, egalitarian, etc.). Nonetheless, it is clear that the consensus of the medical research community and perhaps the entire healthcare industry holds that the terminology of patient compliance should abstain from the appearance of evil (i.e., the language should not endorse the notion of a doctor-dominant physician-patient relationship), and, moreover, contends, at least by implication, that the semantics of the term used to designate patient compliance bears a portion of the responsibility for its achievement.2
That being the case, however, why settle for a non-offensive, scientifically oriented terminology? If there is a belief that the words will affect perception and performance, why not consider the problem from the point of view of professionals who persuade for a living? It seems to me that, for example, a results-oriented marketing specialist assigned to create an advertising campaign for the Patient Compliance Trade Group might have some useful insights about naming, with apologies to Prince, the entity formerly known as patient compliance.
~ Continued in tomorrow’s post ~
- The vocabulary of communications between clinicians and other clinicians and of the communications between clinicians and patients is not identical in this case. My own working assumption, for example, has been and continues to be that other doctors know the same code I do and translate the words, “patient compliance,” into approximately the same concept I have in mind. I don’t make that assumption with patients. I do not recall ever asking a patient if she has been “compliant with the medications.” I am more likely to ask about “How [has she] been taking the medications?” which may or may not avoid the problem.↩
- The transmutation of names of diagnoses or other medical processes is hardly unprecedented in healthcare. Examples follow:
- Some healthcare professionals have, for example, advocated replacing “hypochondria” with “health anxiety” specifically because the latter term has “fewer negative connotations.” A New Era in Treating Imaginary Ills. Mary Duenwald. New York Times, March 30, 2004. Accessed 11 September 2006
- Another article on hypochondria, this one from the professional literature, notes “Clinicians often use the word somatization rather than hypochondriasis when discussing the disorder with patients because this term is more acceptable to patients and families. Patients maybe offended by the terms hypochondriac or hypochondriasis, or believe that the clinician does not take their symptoms seriously. Use of these terms, which have a social stigma, may damage patient rapport and alienate patients.” Recognizing hypochondriasis in primary care Hardy, R Elaine, Warmbrodt, Lynn, Chrisman, Susan Kasal. L Nurse Practitioner, Jun 2001. Accessed 11 September 2006
- This excerpt from a discussion of the naming issue is from a journal review of the diagnosis and management of pseudoseizure and includes citations from two other sources:
- “Pseudoseizure is still the most recognized term, but may be considered derogatory, implying that the events are somehow fake and not to be taken seriously. Scull highlighted the difficulties and concluded that non-epileptic seizures (NES) was perhaps the least judgmental and would be more acceptable to patients as it describes the problem without implying causation. (Scull DA. Pseudoseizures or PNES (NES); 15 synonyms [letter]. J Neurol Neurosurg Psychiatr 1997;62:200) Stone et al found that the terms ’stress related’ or ‘functional seizures’ were more acceptable to a group of Scottish general neurology out-patients. (Stone J, Campbell K, Sharma N, Carson A, Warlow CP, Sharpe M. What should we call pseudoseizures? The patient’s perspective. Seizure 2003;12:568-72. )
- The diagnosis and management of pseudoseizures or psychogenic non-epileptic events. Russell AJ. Ann Indian Acad Neurol [serial online] 9:60-71 2006. Accessed 11 September 2006↩
