Lewis Katz School of Medicine, Temple University, 3500 N Broad St, Philadelphia, PA, 19140, USA.
Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02110, USA.
J Gen Intern Med. 2022 Aug;37(10):2533-2540. doi: 10.1007/s11606-022-07609-y. Epub 2022 May 6.
A growing body of literature demonstrates that healthcare providers use stigmatizing language when speaking and writing about patients. In April 2021, the 21st Century Cures Act compelled clinicians to make medical records open to patients. We believe that this is a unique moment to provide clinicians with guidance on how to avoid stigma and bias in our language as part of larger efforts to promote health equity. We performed an exhaustive scoping review of the gray and academic literature on stigmatizing medical language. We used thematic analysis and concept mapping to organize the findings into core principles for use in clinical practice. We compiled a list of terms to avoid and seven strategies to promote non-judgmental health record keeping: (1) use person-first language, (2) eliminate pejorative terms, (3) make communication inclusive, (4) avoid labels, (5) stop weaponizing quotes, (6) avoid blaming patients, and (7) abandon the practice of leading with social identifiers. While we offer guidance clinicians can use to promote equity through language on an individual level, health inequities are structural and demand simultaneous systems and policy change. By improving our language, we can disrupt the harmful narratives that allow health disparities to persist.
越来越多的文献表明，医疗保健提供者在与患者交谈和书写时会使用污名化的语言。2021 年 4 月，《21 世纪治愈法案》要求临床医生将医疗记录向患者开放。我们认为，这是一个独特的时刻，可以为临床医生提供如何避免语言中的污名化和偏见的指导，作为促进健康公平的更大努力的一部分。我们对关于污名化医学语言的灰色文献和学术文献进行了全面的范围审查。我们使用主题分析和概念映射将研究结果组织成核心原则，以便在临床实践中使用。我们编制了一份避免使用的术语清单和促进非评判性健康记录保存的七种策略：（1）使用“先人物，后疾病”的语言；（2）消除贬义词；（3）使沟通具有包容性；（4）避免标签；（5）停止引用的武器化；（6）避免指责患者；（7）放弃以社会标识符开头的做法。虽然我们提供了临床医生可以在个人层面上使用的指导，以通过语言促进公平，但健康不平等是结构性的，需要同时进行系统和政策变革。通过改善我们的语言，我们可以打破允许健康差距持续存在的有害叙事。
