Words are important

This is a guest blog written by the wonderful Cathryn Brown (@cathrynjbrown). Not only is Cathryn is an amazing community pharmacist, she's also involved in teaching pharmacy students at the University of Lancashire. She's smart, brave, honest, and a great friend. It's a pleasure to host her writings here. Hope you enjoy:

We were tidying up the office at home again the other day when I happened across an old Medicines, Ethics and Practice Guide. Flipping through the index, “Addicts” struck me as odd. There was no “see also: Drug misuse, drug misusers, or “people who misuse drugs and other substances.” Instead, a whole, diverse, nebulous group of people and stories, from all sorts of backgrounds, we summed up with one stark word: Addicts.

This got me thinking about how the use of language within pharmacy has changed since I qualified, and how we can make even more positive changes.

I've spent a lot of time over the past few years thinking about how I refer to people and patients. I've carefully avoided labelling people as “asthmatics” or “Epileptics”, preferring “people with asthma” etc instead. I assumed that this people-first language would apply across all groups. But my assumptions were challenged when I happened across an article which suggested that the opposite may be for the best for some autistic people. It made me realise that a blanket approach doesn't work, and that it is important to ask the patient themselves how they would like to be described. (As an aside, I found that article through the Emergency Chat app, which is amazingly helpful for anyone who sometimes feels overwhelmed.)

When I first started teaching on the UCLan MPharm course, we used to ask our students to identify “what a patient might be suffering from” in dispensing classes. Just that one little question presents so many problems. Labelling people as patients, assuming that they are suffering, that their illness defines them. Nowadays, we ask “what might the medicine on this prescription be used to treat?”. My hope is, that by changing the words, we can also change our students' perception about the people they will go on to look after. I'm hoping that they'll start to see people less as suffering patients, and more as fellow people with individual needs.

I also wonder sometimes whether our approach as a profession to patient and public involvement creates a barrier between them and us. Does the way we act cause our students to think of patients as exhibits? “These are the patients we’ve brought you to meet with today, none of the rest of us are patients, oh no…” And do these barriers affect our students, do they see patients as “other” and think that they themselves should never be unwell?

When I refer to my own mental health, I will refer to myself as “bonkers” or “crazy in the head”. That's okay for me to say about myself, but I would hate to think that a health professional would refer to me like that. I know that’s odd, and maybe if we discussed it, then I would let them join in with me, but I would hate to see a consultant’s letter that went to my GP saying “Thank you for referring this bonkers lady to me”. I think it’s easier for me to think about myself as a person with depression, rather than a depressive.

When a friend of mine visited his GP for depression, the doctor described him as “feeling a bit down”. Now, perhaps his Doctor was too scared to use the “D” word. Perhaps he thought he would be resigning the patient to a life of darkness and gloom. But instead, all it did was dismiss the hell he was going through, and on a practical level it also didn't look great on his sick note.

I guess I'd like asking how a person would like to be described to become as ubiquitous a question as “do you take any other medicines?”. Whether someone is gay, trans*, black, a person of colour, a person of faith, Christian, a diabetic, a person living with epilepsy or all of the above, we should be able to ask them who they think they are and respond appropriately. We also need to start being truly patient centred, and let our patients lead the conversations where they want them to go, and if that’s hard to begin with – let’s start a conversation within the profession and see where it goes. Don’t forget there’s lots of help out there, and lots of ways to improve the way we communicate with patients, the public, and other health professionals.


Cathryn xx