Some treatment decisions are straightforward: Avoiding gluten is the only way to manage celiac disease, and there’s nothing to do for a ruptured appendix except take it out. But in many cases, we have multiple ways to treat the same condition. Patients with torn ACLs, for instance, can opt for surgery followed by physical therapy — or they can skip the operating table altogether.
What motivates patients to go under the knife when they don’t need to, or take antibiotics for infections that will clear up on their own, or pursue other unsubstantiated or unnecessary treatments? A growing body of research suggests the specific language doctors use to describe health issues can play a role.
When doctors communicate health information, they often have leeway in deciding when to be clinically precise and when to favor less formal or traditional terms. For example, a doctor might say “Runner’s knee” instead of “patellofemoral pain syndrome” to avoid freaking a patient out, or use “fat” instead of “overweight” in an effort to be weight-inclusive.
These small choices matter. In one new study, an Australian-led research team ran an experiment involving 1,308 people from five countries. Study volunteers were asked to imagine they were seeking care for shoulder pain that started two months earlier and wasn’t caused by an injury. While everyone had identical pain symptoms, they didn’t all receive the exact same diagnosis.
Volunteers diagnosed with a rotator cuff tear — a tear in one of the shoulder tendons — were considerably more likely to believe they’d need surgery than those told they had bursitis, a type of inflammation that commonly affects major joints. The findings suggest relabeling rotator cuff tears might be a simple way to bring down the number of unnecessary shoulder surgeries performed each year, says lead study author Joshua Zadro, a public health research fellow at the University of Sydney.
Other research supports the idea that doctors’ language choices can influence whether or not patients pursue unnecessary or overly aggressive treatment; Zadro discussed some of it in a recent article for The Conversation. In one study, for example, parents who were told their kids had pink eye, versus a nonspecific eye infection, were much more eager for antibiotics, despite being told they wouldn’t work. In another study, women who were told they had symptoms of polycystic ovarian syndrome were more interested in follow-up testing, and perceived their condition as more severe, compared to women who’d been told they had a hormonal imbalance. And multiple studies have shown that patients who learn they have low-risk abnormal breast cells called ductal carcinoma in situ react differently when doctors describe the condition as “cancer” or “carcinoma” rather than just “abnormal cells.”
“Labels which suggest there is a structural or anatomical issue that can be fixed by surgery seem to encourage patients to consider surgery,” says Zadro. “Labels that are less specific about the structure or point to a structural issue that can’t be fixed by surgery seem to do the opposite.”
Collectively, Zadro’s work and similar studies also suggest that patients are more likely to go all in on testing or invasive treatment when their diagnosis has a formal name. “More complex or medicalized labels seem to encourage people to want unnecessary (or ineffective) care,” Zadro says.
Does that mean doctors should steer clear of precise or clinical-sounding terminology whenever possible? Not necessarily. For one thing, a diagnosis can offer validation. Avoiding one at all costs, Zadro says, isn’t the answer: “This can lead to patient dissatisfaction. Patients also see health professionals as being less credible if they are not given a diagnosis. I think the message the health professional provides alongside the label is far more important than the label itself.”
Ultimately, Zadro’s study demonstrates that doctors should always consider the effects of the language they use with patients. If certain clinical terms make patients overly anxious and lead to unnecessary tests or treatment, those terms need to be explained differently or contextualized further. The same logic applies to less specific labels. “Bursitis, low-risk cells and hormonal imbalance are still valid diagnoses,” Zadro says, “but health professionals might need to provide more explanation about these diagnoses so a patient doesn’t feel like they are being dismissed.”
On the flip side, if patients know that diagnostic labels can be surprisingly influential, they might be less likely to become preoccupied with scary-sounding terms. Still, the best thing patients can do to avoid ineffective or unnecessary care, Zadro says, is ask a lot of questions. For starters, he points to the five questions recommended by Choosing Wisely, a global initiative aimed at reducing unnecessary care:
- Do I really need this test, treatment or procedure?
- What are the risks?
- Are there simpler, safer options?
- What happens if I don’t do anything?
- What are the costs?
(Choosing Wisely fleshes out these questions in more detail.)
We still have a lot to learn about the ways diagnostic labels influence patients’ perceptions of care and treatment choices. For one thing, there’s no research on the combined impact of labels and the messages or contextual information shared alongside them. Zadro plans to tackle this issue next.
For now, remember that questions are your best defense against the sneaky power of a phrase like “pink eye.”