Equitable Health Care Requires Inclusive Language

The words that clinicians use with their patients make a difference. They can help or hinder efforts to reduce the disparities in health care. Therefore, it is important for clinicians to strive to use inclusive language and avoid labeling people. To that end, this article offers six principles of inclusive communications that clinicians should keep in mind.

During my morning rounds, the patient, a 29-year-old woman let me know right away that she did not want to be called “hypertensive.”

“It makes me sound hyper, tense or both,” she said. “I prefer that people say I am a person with a history of hypertension.”

When patients are so forthright with their preferences, I listen carefully and make a note in their chart so that I and other caregivers can honor their wishes. Stronger connections with patients lead to better outcomes.

For clinicians, these notes serve as a reminder that the person before us is an individual with unique wants and needs that go far beyond their medical conditions. Using inclusive language and avoiding labeling that equates people with their conditions, such as “hypertensive” or “diabetic,” also reduces bias and disparities. Other examples include using “person with a disability” rather than “disabled person” and “person living with diabetes” instead of “diabetes patient” and avoiding “suffers from” when referring to people with chronic diseases.

The ancient Greek physician Hippocrates taught, “First, do no harm,” an oft-cited tenet of the medical profession. While physicians have sworn to uphold this value over the millennia, only in recent years have we begun to fully understand how the words we use with our patients can both help and harm them.

Numerous studies have shown that how health care professionals talk to patients — and about them — can affect their mental and physical health as much as the health care they receive. One recent analysis of more than 18,000 patients found that negative descriptors such as “resistant” or “noncompliant” were 2.5 times more likely to show up in the electronic health records of Black patients than white patients, raising concerns about stigmatizing language and its potential to exacerbate racial and ethnic health disparities. While such bias clearly can lead to discrimination in health care, research also shows that when doctors provide socially, culturally, and technologically appropriate information, outcomes often improve.

As physicians strive to address the disparities in U.S. health care that the Covid-19 pandemic revealed, they should focus not only on clinical quality, population health management, and appropriate technology but also culturally responsive care, including how they communicate with patients. Here are six principles of inclusive communications we should keep in mind.

1. Consider the impacts of discrimination.

Avoid perpetuating health inequities by considering how racism and discrimination unfairly disadvantage people; avoid implying that a person, community, or population is responsible for their increased risk. Instead of adjectives such as “vulnerable” and “high-risk,” consider descriptors such as “marginalized” or “under-resourced.” Instead of racially coded words like “inner city” or “urban,” describe the area itself (“city center” or “downtown”).

2. Address systemic health inequities.

Engage with communities to develop culturally relevant, unbiased communication strategies that promote good health and build trust through listening and shared decision-making. Instead of using words with violent connotations such as “target,” “tackle,” or “combat” when referring to health conditions in specific people, groups, or communities, consider words such as “address,” “treat,” or “manage,” which work just as well.

3. Remember intersectionality.

Many people belong to more than one group and may have overlapping health and social inequities; likewise, there is diversity within groups and all members are not the same. Kaiser Permanente research found that people from different parts of Asia had significantly different prevalence of chronic conditions such as diabetes, hypertension, and heart disease. For example, people of Filipino descent were twice as likely to have diabetes than those of Chinese descent.

4. Recognize diversity.

Use language that is accessible and meaningful to the community you are trying to reach and tailor interventions based on their unique circumstances. Emphasize positive solutions that highlight community strengths and recognize that some may not follow public health recommendations because of cultural norms, beliefs, or practices.

5. Promote health literacy.

Provide plain-language health materials in the languages that patients speak, train health professionals in best practices, and review health materials such as insurance forms and medication instructions with community members to ensure they understand the information and actions to take. To help communicate with patients in a respectful manner, the Centers for Disease Control and Prevention put forth health-equity guiding principles for inclusive communication, which the American Medical Association used as the framework for its comprehensive, evidence-based guide to equitable and inclusive language.

6. Keep in mind that context matters.

Language constantly evolves, and context always matters — what works for one physician and their patient may not work for others, and what works for a group of people may change over time.

We should always respect the preferences of our patients. This includes using their personal pronouns such as “they/them” when speaking with and about nonbinary patients and providing context for such usage in written materials.

In my own health care organization, we continuously review and revise our editorial protocols for internal and external communications, based on updated style guidance and the preferences of the people and communities we serve. Examples of terms we’ve recently changed include “Black” (now always capitalized) and “Latino/Latinx” (use “Latinx” only if preferred by a specific person). To promote gender-neutral language, we’ve also addressed the terms we use in our administrative roles — for example, “chair of the board” rather than “chairman.”

As we understand and address the inequities, structural racism, and injustices experienced by marginalized populations we serve, health equity has become a watchword of modern health care. With that comes a commitment to providing equitable — as well as high-quality and accessible — health care, and a responsibility to choose our words carefully when communicating with our patients. In doing so, we take giant steps toward helping, rather than harming, them.