Intended for healthcare professionals

Editor's Choice

Mind your language to catalyse the patient revolution

BMJ 2022; 377 doi: (Published 28 April 2022) Cite this as: BMJ 2022;377:o1071
  1. Kamran Abbasi, editor in chief
  1. The BMU
  1. kabbasi{at}
    Follow Kamran on Twitter @KamranAbbasi

Covid—wrongly—stalled the patient revolution. The voices of patients and citizens were lost amid responses to the pandemic that were too self-absorbed to consider the views of the people it affected the most. In one damning example, participants in unethical studies of ivermectin were exposed to its side effects without knowing that they were given the drug (doi:10.1136/bmj.o917).1 Covid was also a free pass to tighten, loosen, or avoid public health measures, with little consultation or input from the public. The wisdom of hastily assembled, and generally unrepresentative, advisory committees and advisers was never more important and the exact opposite of the patient centred logic of “nothing about us, without us.”

It’s easy to forget, in the heat of service efficiency and workload pressures (doi:10.1136/bmj.o945),2 that patients aren’t widgets or that, because evidence is rarely definitive, people’s preferences about their care matter. What doctors or other health professionals want isn’t necessarily what patients want. For example, a terminally ill patient might wish for assisted death, but their doctor might disagree (doi:10.1136/bmj.o1014).3 Or a woman might decline the offer of sodium valproate in pregnancy if sufficiently aware of the risk of birth defects (doi:10.1136/bmj.o1013).4

The BMJ has attempted to bridge these gaps in perspective and information by appointing patient editors. While we have much to improve on, we judge our patient initiative to be a success. We think it improves our decision making, as well as our published articles, and challenges our thinking (doi:10.1136/bmj.n1225).5 Unfortunately, where The BMJ has led on patient involvement, few other journals have followed. Change is hard, takes commitment, and is easy to obstruct (doi:10.1136/bmj.o949).6

But change is essential, and working with our patient editors has also helped us modify and adapt the language the journal uses. Our purpose is to empower patients, an ambition we don’t always achieve. However, medical training and clinical practice use—and have institutionalised—language that disempowers patients. Caitríona Cox and Zoë Fritz explain, with examples, how “some commonly used language confers petulance on patients, renders them passive, or blames them for poor outcomes” (doi:10.1136/bmj-2021-066720).7

To most clinicians, phrases such as “presenting complaint” and descriptions of patients “denying chest pain” are empty jargon, holding no more than functional meaning. But the danger is that hearing such words negatively affects patients and creates an environment in which people are seen as emotionless objects disinterested in their own care or unworthy of inclusion in management decisions.

We are at a time when differences in life expectancy between rich and poor people are widening (doi:10.1136/bmj.o1056),8 75% of patients admitted to hospital with covid report being unwell after a year (doi:10.1136/bmj.o1043),9 many people still avoid vaccination, despite the evidence of effectiveness of SARS-CoV-2 vaccines continues to grow (doi:10.1136/bmj-2021-069317, doi:10.1136/bmj.o867),1011 and incidents of sexual violence related to conflict continue, requiring a response that “increases the economic empowerment of women survivors” (doi:10.1136/bmj.o1016).12 In the face of such complex health challenges, clinicians should appreciate the power they hold in society, reflect on the language used in clinical practice, and lead change that ends the use of words and phrases that disempower patients.

If the patient revolution is to be accelerated, health professionals must be the catalyst.

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