In a recent BMJ Opinion article, Ian Hamilton expressed his scepticism that “adopting a new vocabulary to describe people who have problems with drugs will reduce the stigma they experience.” I agree that language alone cannot reduce this kind of stigma or prejudice, but it’s a good place to start.
As a final year medical student several years ago, I sat in a lecture theatre while a consultant used the phrase “dirty IVDU” to describe a patient to the entire year group. A lot of people laughed. And in one fell swoop, an ill judged (and offensive) throwaway comment propagated these prejudices among the next generation of doctors.
This group can be challenging and frustrating to manage, for many reasons. They become “heart sink patients,” receiving less time and attention—perhaps because many of us struggle to connect with the situation in which these patients find themselves. We find it easier to blame them, particularly when they have social problems that are beyond our control and that make them difficult to manage medically. It’s easy to find our compassion being ground away.
We sat in that lecture theatre, most of us both ill informed about this patient group and easily influenced by charismatic seniors, and it is unsurprising but depressing that these hundreds of soon to be junior doctors were, at worst, amused by and, at best, unable to contradict this consultant’s words. Herein lie the keys to addressing the issue: education and leading by example. Medical students need to learn, in a compassionate way, about the particular challenges of treating patients with drug addiction. And they need to learn from doctors who are tolerant and compassionate towards patients.
As Ian Hamilton points out, it is a fallacy to spout politically correct terminology while continuing to act or speak in other ways that are discriminatory. Yet phrases like “person that uses IV drugs,” in theory, should remind us that we are indeed dealing with a person and not a diagnosis—in the same way that my patient is a “person with schizophrenia” or “a person with alcohol misuse,” rather than a schizophrenic or an alcoholic, defined by their diagnosis.
It is suggested that tackling this stigma through the words we use risks simply changing behaviours, while failing to address the deeper issue they are symptomatic of. I disagree. Rather, it can help us begin the conversations we need to be having about the problem. Simply being mindful of our language in a system where these prejudices can be pervasive may not solve the problem itself, but by challenging the terminology we hear our colleagues use we can simultaneously challenge their prejudices.
Yes, seniors should lead by example, but juniors can equip themselves with the empathy and facts to question those seniors who do not. None of us put our hand up in that lecture to do this. Next time I will.
Elizabeth Romer is a foundation doctor in Leeds with an interest in patient and physician mental health. Twitter @emrmedic
Competing interests: None declared.