I spend a lot of time talking about diabetes. Over the years, I’ve become more conscious of the words I use. Language shapes how we think about illness, how patients feel about themselves, and how we relate to each other in the clinical encounter.
Uncontrolled. Pasaway. Matigas ang ulo.These words slip out, and they carry weight. They assign blame. They reduce a person to a diagnosis. They can make someone feel like a failure when they’re actually doing their best under difficult circumstances. I’ve written before about how I used to slip into scare tactics when talking about diabetes complications:
Sige kayo, pag hindi po natin naayos ang blood sugar ninyo, baka ma-dialysis kayo. Mahal po yun!
I’d say this with an apologetic smile, but the message was still fear. In that same post, I shared what one patient told me: “You are different from my other doctors. You don’t get mad when my blood sugar is not controlled.” I told him I don’t get angry because this is not about me — it’s about him. And besides, getting angry will only increase my wrinkles!
What I’ve come to understand is that scare tactics don’t work. I’ve had to unlearn words and find new ways of saying what needs saying without being threatening. It’s an ongoing process.
The CDC notes that more than half of people with diabetes report experiencing stigma — and this stigma exists in healthcare settings, not just in families or workplaces.
Diabetes stigma can be experienced internally or externally. Internal stigma is a belief that a person with diabetes has about themselves. It can include feelings of self-blame, shame, and guilt. External stigma is blame and judgment that comes from other people and society. It can include awkward or mean looks, rejection, exclusion, and difficulty maintaining relationships and friendships.
https://www.cdc.gov/diabetes/articles/diabetes-stigma.html
The person-first language movement emerged from disability rights advocacy decades ago. Person with diabetes. Person-first language acknowledges what a person has, not what a person is. But the conversation has become more nuanced. I find that many of my patients don’t mind being called “diabetic” though online in the Philippine Diabetes Support Group, the term used is “mga ka-sweet.” Ang sweet nga!
Beyond labels, there are other words worth examining. “Non-compliant” implies the patient is at fault, when often they’re facing barriers we don’t fully understand, like the cost of medications, competing life demands, mental health struggles. My residents and fellows know this. I always remind them to use “adherence” instead. “Control” sets up blood sugar management as a test that can be passed or failed. Sometimes a patient will blurt out, Pasaway talaga ako, Dok! And I reply, Ikaw ang nagsabi niyan ha, hindi ako.
Tonight, let’s talk about the language of illness at the #HealthXPH chat, 9 pm Manila time on BlueSky. Whether you’re a healthcare professional, a patient, a caregiver, or simply someone interested in how words shape health, I hope you’ll join us.
T1. What words or phrases commonly used in healthcare do you find problematic, stigmatizing, or unhelpful?
T2. As a healthcare professional, how conscious are you of the language you use with patients? As a patient, has a physician’s choice of words ever affected how you felt about your condition?
T3. How can we collectively shift toward more empowering, person-centered language in healthcare? What practical steps can we take in clinical practice, medical education, and in everyday conversation?
[AI Disclosure: This is the first blog post I have written with assistance from Claude. It helped me decide on a topic, outline the blog post and draft the questions. I take full responsibility for this post.]