How the language we use can drive overtreatment

If a doctor told you that your baby had gastroesophageal reflux disease, would you want to give her medication? What if the doctor said she was spitting up and crying? As it turns out, they are the same thing, and it should come as no surprise that more parents would opt for drug treatment when their baby is given a clinical diagnosis. 

This phenomenon of clinical or “scary” language leading to patients choosing more care is common. In a recent literature review in The BMJ, researchers looked at five examples of medical conditions that can be described in either technical or everyday language. When asked about their preferred treatment in hypothetical scenarios, patients in the studies generally wanted more invasive treatment when the condition was described with a “medicalised or precise term.” 

Here are a few examples from the study:

  • When women were told they had “polycystic ovary syndrome,” they were significantly more likely to ask for an ultrasound than when they were told they had a “hormone imbalance.”
  • When patients with ductal carcinoma in situ (abnormal cells in the milk duct) were told they had a “non-invasive cancer,” 47% wanted surgery, but when it was described as a “breast lesion,” 34% chose surgery, and when it was described as “abnormal cells,” only 31% wanted surgery.
  • Parents were significantly more interested in medicating their infant when told he/she had “gastroesophageal reflux disease,” compared to parents who were not given a medical diagnosis.

In a counter-example to the “clinical = scarier” rule, parents who were told their child had “pinkeye” were more likely to want to give them antibiotics, even when the doctor said that antibiotics would be ineffective. Whereas parents who were told their child had an “eye infection” were less likely to give their child antibiotics when the doctor said that antibiotics were ineffective. In this case, it seems the connotation parents had with “pinkeye” was scary enough to override the power of more clinical language. 

Medicalization of common or relatively harmless conditions in the medical world abound. Dentists call crooked teeth “malocclusion”; menopause is a “hormone deficiency.” Of course, there’s the flip side of making the harmless sound ominous, and that’s making the serious sound benign. Adverse events are “complications.” The families of patients who are in the terminal stages of disease are told that the patient’s condition is “serious,” or “it’s not looking good.” Maybe medical school should offer courses in communication.

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