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The Weight of Our Words

February 3, 2022

Blog: Family Connections with Pediatrics

“The difference between the almost right word and the right word is really a large matter. ’Tis the difference between the lightning bug and the lightning.” –Mark Twain

This month’s Pediatrics article (10.1542/peds.2021-054296),The Weight of Our Words: How Medical Communication Perpetuates Bias’ by Taneja et al talks about the difference between lightning bugs and lightning in the language used daily in health care. The authors spotlight how labels given to patients and families in the health record or in health care discussions can create bias and judgment that harm care. The article is honest and real; the words and cases are likely to prompt memories: “parents tend to be absent”, “hysterical” and “needy”, “aggressive”, and “make poor choices”. The weight of these words may not be heavy as they sit on this page, but the authors take great care to look at how these labels can lead to bias.

The article begins by talking about how to prevent medical error with good communication. Daily use of tools such as rounds, handoffs, and huddles now ensure safety. However, adding terms like those listed above into these tools can cause bias and ingrain that bias into the system of care. While the tools may have prevented error, they are now vehicles that can spread biased views of a patient or family and could affect every person reading this patient’s health record moving forward. This process, in turn, can create or increase distrust between patients and healthcare teams, especially for diverse and minority groups. The article shares research, with supporting references, that shows that biased communication can lead to less pain support, adverse attitudes that dismiss and view patients as less than human, and choices in care that may punish rather than treat.

Our country is at a point in time where we are very focused on words, how they are delivered, and by whom. Social media, politics, COVID-19, and a sea of injustices (racial, disability, environmental, economic, social) beckon us to listen, reflect, absorb, and speak out. How do we disrupt bias in the care of children? The authors suggest that healthcare teams focus on: how communication matters, how existing power structures impact our communication, and how we have the power to reframe our judgments.

How can you use this article?

  1. Take this article to talk with one of your child’s trusted doctors at their next visit. You can discuss the words or labels used in your child’s health record in the past or concerns that this article brings up for the future. Talking and listening matter and can lead to change, one person at a time.
  2. If you partner with healthcare teams in advisory, quality improvement, or public health roles, think about sharing this article. Culture and systems change are a process and require ALL of us to acknowledge the weight of words, bias, and their impacts to be able to transform.
  3. The following are just a few tools that can help groups take steps to change:
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