By Joyce M. Vergili, EdD, RD, CDN, CDE, FAND
The words that healthcare professionals, including registered dietitians nutritionists (RDNs), choose when speaking about or with patients shapes the provider-patient relationship and influences clinical outcomes. Awareness of the power of language is why the American Diabetes Association recommends adopting a “communication style that uses person-centered and strength-based language.”1
When a practitioner states, “You’re a diabetic,” the labeling of the individual with a disorder of carbohydrate metabolism as “diabetic” reduces him to a diagnosis and is subtly dehumanizing. On the other hand, when the practitioner says, “You have a diagnosis of diabetes,” such patient-centered, respectful language positively changes the dynamics of the patient-provider interactions by reminding both parties that living with diabetes is only one aspect of that person’s multifaceted life.
We may hear individuals with diabetes being described as “noncompliant” or “nonadherent.” When healthcare professionals use such terms, it betrays their assumption that the role of the person with diabetes is to passively obey the “expert’s” advice, and sends the message that the individual is lazy, unmotivated, and simply doesn’t care. Though unspoken, that message is heard loud and clear. Indeed, studies show that the person with diabetes is less likely to keep follow-up appointments with such a provider.2 The role of the individual with diabetes is not to be deferential; rather, it is to collaborate with the provider to set personally relevant health goals and learn the skills needed to attain those goals.3 “Noncompliant” is meaningless in such a model. If discordance exists between the behaviors required to achieve certain outcomes and those that the individual with diabetes actually engages in, rather than putting the person with diabetes in the “nonadherent” box, the practitioner can focus on what the individual is doing. If, for example, a person with diabetes is eating more carbohydrates than is consistent with achieving blood glucose goals, a response such as, “I see you’ve started to keep a food diary” may invite discussion around any insights (perhaps regarding portion sizes) that keeping a diary may have led to.
Another commonly used term – “poorly controlled diabetes” – is inconsistent with the language guidelines.2 Typical reactions by a person with diabetes who is told her diabetes is poorly controlled include feelings of moral failure and shame. The term “poor control” implies that the individual with diabetes is in full control of her glycemic status. In fact, there are many factors affecting glycemia – illness, stress, lack of funds, lack of time, menstrual cycle, drug interactions, knowledge deficits, gastroparesis, denatured insulin – over which the person with diabetes may have little or no control. Nonjudgmental language that simply focuses on data, such as, “About 40% of your blood glucose readings are within the target, while 60% are above” opens the door to productive, meaningful discourse.
In summary, language that fails to demonstrate respect relegates the person with diabetes to a subservient role and may engender feelings of failure that can lead to a strained patient-provider relationship, fewer than recommended follow-ups, and poorer outcomes. Language that is respectful and neutral, invites discourse and collaboration, and celebrates incremental attainment of goals can lead to stronger patient-provider relationships and better outcomes.
Joyce M. Vergili is a doctorate-prepared registered dietitian and Certified Diabetes Educator, and a Fellow of the Academy of Nutrition and Dietetics. Her areas of expertise are diabetes and chronic kidney disease, and her experience spans the gamut of clinical, academia and research. One of her most notable accomplishments is creating the curriculum for the seminal online Master of Science program in Diabetes Education at Teachers College-Columbia University. Dr Vergili enjoys long walks and traveling with her husband.
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American Diabetes Association. Comprehensive medical evaluation and assessment of comorbidities: Standards of Medical Care in Diabetes – 2019. Diabetes Care 2019;42(Suppl. 1):S34–S45.
Dickinson JK, Guzman SJ, Maryniuk MD, et al. The use of language in diabetes care and education. Diabetes Care 2017;40:1790–1799.
Beck J, Greenwood DA, Blanton L, et al. 2017 National Standards for Diabetes Self-Management Education and Support, Diabetes Care 2017;40:1409–1419