It’s not only what you say; it’s how you say it. Just ask the AMA.
By Louis Greenstein
Illustration by Joey Guidone
Illustration by Joey Guidone
anguage is dynamic, not static. Yesterday’s accepted terminology may be today’s pejorative. A century ago, physicians used words like “idiot” and “moron” as scientific terms to describe a person with intellectual disabilities. “Those words were not derogatory then,” said Jeffrey P. Brosco, M.D., Ph.D., professor of clinical pediatrics at the Miller School and director of the four-year, longitudinal Medicine as a Profession (MAP) curriculum, covering race, ethics and professionalism. By the mid-20th century, however, those words were viewed as offensive by family advocates, he said, and were replaced by terms like “mentally retarded.” But as society began to look at the person first and the condition second, gaining appreciation for the full human potential of all people, those descriptions became highly inappropriate, as well.
The American Medical Association’s new language guidelines underscore the trend. Advancing Health Equity: A Guide to Language, Narrative, and Concepts suggests using person-first language, avoiding dehumanizing expressions, and eschewing adjectives such as “vulnerable” and “high-risk” to describe populations. It encourages clinicians to describe people as having a condition, not being a condition. Instead of describing a patient as “a 40-year-old diabetic, medically noncompliant female,” for example, call her “a 40-year-old female with limited medical literacy and a diagnosis of diabetes.”
The AMA guidance aligns with MAP’s goals. “We’re trying to teach students to use identifiers as they are appropriate,” Dr. Brosco said. “Language helps us interpret the way we see the world, but by itself is insufficient. It’s not only about the words. It’s a conceptual shift that reflects a deeper understanding of the drivers of health.”
Teshamae Monteith, M.D., associate professor of clinical neurology and co-chair of the Dean’s Diversity Council’s Subcommittee on Curriculum, developed guidance to improve racial justice and reduce bias in the medical curriculum. She said the council’s Curriculum Action Team is “combing through the curriculum to see where race is inappropriately regarded as a biological factor for disease and assuring racism is eliminated in clinical presentations.” The team is integrating anti-racism in the clinical, basic sciences and social sciences curricula.
“We’re asking how and when to use race in a presentation,” Dr. Monteith said. For example, when a person of Ashkenazi Jewish ancestry presents with symptoms of Tay-Sachs disease, ethnicity matters for genetic counseling. When an African American presents with hypertension, race is typically not a factor, but poverty and limited access to social services may be. “There is a place to talk about race,” Dr. Monteith said. “But many times there is not a place for it.”