The words we use when interacting with people living with diabetes can be perceived as judgmental and stigmatizing. Language use can impact patients' self-confidence and motivation, and thus influence health and well-being (Speight et al., 2012). It is observed that individuals with diabetes, clinicians, and the public at large often use negative words/phrases when communicating about diabetes. Counseling patients with clear, motivationally minded language about their diagnosis and progress might reduce barriers between providers and patients, and allow patients to make decisions about their health.
According to Speight et al. (2012), negative words can create a power imbalance between clinicians and persons with diabetes. Relying on patients to "follow the physician's advice" or suggesting via subtle judgment that we clinicians "know best" is not a patient-centered approach, but rather an approach aimed at compliance-oriented care. Patients would be more motivated if goal setting and treatment plans were seen as collaborative partnerships. People with diabetes are experts about their own lives and experiences. Therefore, using a patient-centered approach would facilitate patient motivation and empowerment that could lead to more effective diabetes self-management.
The case was made by Dickinson and Maryniuk (2017, p. 51) that "people with diabetes experience abundant guilt, shame and blame." Negative words can make patients feel frustrated and dissatisfied, especially if they feel they are being judged and blamed for their inability or unwillingness to achieve goals. Using words such as "control/uncontrolled," "poorly controlled," and "fail" implies a lack of willpower and may result in patients feeling irresponsible for not "complying" with their treatment plan. Moreover, persons with diabetes might interpret words such as "non-compliance" or "non-adherence" as suggesting they are uncooperative, weak, and difficult. Such words may give patients a feeling of failure (Speight et al., 2012).
Dickinson and Maryniuk (2017) contends that negative words activate the hypothalamic-pituitary-adrenal axis, which is triggered by the stress response, causing a release of corticosteroids leading to elevated blood glucose. These stress hormones can also promote inflammation and decrease immune-response protection, leading to infection and poor wound healing, thereby compounding the effect of the underlying diabetes condition.
Be very careful with the terms you use. See the Box for a list of commonly used negative words along with suggestions for language that could be perceived as empowering for people living with diabetes. Putting people first by including careful use of language when engaging in dialogue and treatment can be instrumental in improving self-care behaviors.
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