Friday, June 15, 2012

Words mean what I say they mean

Apparently a few years ago someone decreed that “non-compliant” was no longer a politically correct term to describe patients who did not take their medicines or follow instructions. The newspeak to use is now “non-adherent.” This was recently brought to my attention by cardiologist-blogger Dr. John Mandrola, who humorously blogged about his own non-compliant-adherent behavior after a hand injury.

I googled “non-adherent vs. non-compliant” and found references to the former used in medicine from as far back as 1998 but most hits were from this century. I could not identify the origination of the switch or why the term non-compliant was perceived to be judgmental.

I suppose compliant has a more submissive connotation, and God knows, we should not consider patients as subjugated, but adherent really means sticky as an adjective and follower as a noun. Is a patient who takes his meds “sticky” or a “follower”? The difference between the two definitions, compliant and adherent, is minor at best.

Who decides these things anyway? I don’t remember this being discussed anywhere.

This phenomenon is not unique to the US. Public health workers in the UK were recently informed that the use of the word “obese” could be viewed as derogatory by obese people. The workers were told “that patients may respond better if they are encouraged to achieve a ‘healthier weight.’” The full story is here and is worth reading if only for this amusing mixed metaphor uttered by an opponent of the UK advice, “If you beat around the bush then you muddy the water."

There is research on this subject. A 2012 paper from the journal Obesity [soon to be renamed “Healthier Weight,” I guess] describes a survey of a lot of people whose weight formerly would have been termed obese but now should properly be called unhealthily weighted. The term fatness was rated as significantly more undesirable than all others and excess fat, large size, obesity and heaviness were rated as significantly more objectionable than the remaining terms, such as weight problem, BMI, excess weight and the best of all, weight.

It’s not clear how just describing someone as “BMI” or “weight” will get the message across, but then I didn’t perform the study.

Question: what do you do with a person who needs to achieve a healthier weight but is non-adherent?

This post appeared on Sermo yesterday and attracted 28 comments. As you might expect, most did not like the idea of politically correct terminology.


Tonja said...

Yep, sometimes being politically correct is a negative for unhealthy people. I don't think political correctness is good for medicine, it makes patients feel like the problem isn't as bad as it is, so they are less likely to be "adherent" as they might be otherwise. Better to "stick" to telling people what the deal is than tiptoe around it.

Skeptical Scalpel said...

Tonja, well put. Thanks.

Ruth Carver said...

The term "politically correct" is a right-wing ideological hat-trick. Considering ways in which language can reflect sensitivity to historically underserved factions — women, people of color, people with disease, and yes people of greater-than-perhaps-desirable-weight. I agree it lands us in comical situations with ever-shifting euphemisms, but it's no more "politically correct" than, say, ignoring such concerns. Which has been tacitly politically correct for centuries. And continues to be.

Skeptical Scalpel said...

Ruth, you make a good point.

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Skeptical Scalpel said...

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Tom B said...

Ruth - The problem with "political correctness" is that it subordinates the truth to a position of secondary importance. By controlling what is acceptable in the public discourse through the instrumentation of public disesteem freedom of speech is harmed. The remedy for speech you don't agree with is more speech. Not persecution.

Skeptical Scalpel said...

Tom B, give me liberty or give me (clinical, no make it brain) death.

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