Apart from gestures and semiotic influences, such as wearing a white coat and having a stethoscope, communication between a health professional and a patient relies heavily on language in the form of words—whether spoken or written. As stated in Lewis Carroll’s Alice’s Adventures in Wonderland and Through the Looking-Glass, "The question is," said Alice, "whether you can make words mean so many different things.” Along with person-to-person interaction, the widespread use of the electronic medical record and text messages provide ample opportunity for communication miscues to occur. Not only do words count heavily in deciding how to interpret what is being conveyed, the order of those words also can play a substantial determinative role.
Two decades ago, the federal Agency for Healthcare Research and Quality (called AHRQ) was known as the Agency for Health Care Policy and Research (AHCPR). The acronym was pronounced akper. Until an alert staff person spotted the problem immediately prior to launching the new name, this entity barely missed being labeled the Agency for Health Care Research and Policy (AHCRP) and the acronym would be pronounced ahcrap. To cite another example, consider the word only and how its placement affects the meaning of the following sentences:
The doctor only gave her the pill today.
The doctor gave only her the pill today.
The doctor gave her only the pill today.
The doctor gave her the only pill today.
The doctor gave her the pill only today.
The doctor gave her the pill today only.
Only the doctor gave her the pill today.
Several journals have wrestled with the issue of whether the individual or a health condition that identifies a person should be placed first. For example, should it be An individual with a disability or should it be A disabled individual (noting that critics prefer to use the term differently-abled)? The preferred order usually is individual first, condition second. Yet, there are some naysayers who believe that using this sequence of words accentuates stigmatization rather than attenuates it.
Metathesis is a term describing how sounds and letters are transposed. The word ask was pronounced aks in New England early in the 19th century, which usage then died out there and migrated to states in the south where it can be heard to the present day. Stigmatized in some places as substandard English, that critique can be considered invalid. For example, in Middle English, the word bird formerly was pronounced brid during the 1400s. Usage obviously can change over time. So, it may help to keep in mind that language is a metaphorical gun and words basically serve to pull the trigger. Proper aiming represents a way of ensuring that the outcome between health professionals and patients will be a satisfactory interaction as opposed to becoming an unfortunate and ill-advised collision.
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