Thread by @ColinWestMDPhD

1/ Welcome to another edition of West’s Well-Being Wednesday! Today as #SGIM22 begins: a 🧵 on language, respect in medicine, and how this relates to #burnout and #wellbeing. #wellbeingwednesday #medtwitter #meded (reposting due to upload errors yesterday, my apologies)

2/ Last week I tweeted about this paper @MayoProceedings:
Physician Identification Badges: A Multispecialty Quality Improvement Study to Address Professional Misidentification and Bias mayoclinicproceedings.org/article/S0025-…

3/ Role identification is an issue especially affecting women and URiM physicians, and can be an important reflection of workplace bias. Clear badging can help!

4/ Role misidentification is closely related to untitling and uncredentialing, described recently by @amydiehl @leannedz
fastcompany.com/90596628/we-ne…

5/ This is part of a larger issue relating to language and respect. See the editorial I wrote with @JuliaFiles @patmfriedrich @ChetRihal.
Language, Respect, and the Medical Profession mayoclinicproceedings.org/article/S0025-…

6/ Yes, the word #provider is part of this problem set. I’ve written on this before.

https://twitter.com/ColinWestMDPhD/status/1407091792554692612?s=20&t=oVYW_f-Ljp-jMblrLmSPgw

7/ From our editorial,
“Respect is a cornerstone of professionalism in medicine. The language we use is a critical medium through which respect is conveyed to colleagues and patients.”

8/ As highlighted in the study from @EmilyOlsonMD @AmyOxentenkoMD et al., we write
“medicine is afflicted with an insidious form of gaslighting within its ranks whereby the untitled are disparaged as entitled when they request the basic respect of proper role identification.”

9/ “#provider has never been an occupation or job title in medicine, so it is inaccurate and improper to use this word to describe individual health care professionals in their work roles.”

This word is another form of role misidentification.

10/ It’s also a problem beyond physicians.

“This applies to … every … group of professionals on the health care team. For some individuals, other language adds further degrees of disrespect, such as “midlevel provider” or “advanced practice provider.””

11/ Of #provider,
“It is diminishing and “inherently depersonalizing” and as such contributes to burnout, moral injury, and other forms of distress.”

12/ “Perhaps most important, it is a systematic untitling and uncredentialing term that communicates lack of respect for the individual, their training, and their expertise.”

13/ “Role misidentification, untitling, and uncredentialing, including use of the term provider, dishonor our commitment to respect as a cornerstone of medical professionalism.”

14/ “Language in medicine should be grounded in person-centered respect. To further this goal, we make several recommendations:”

15/ 1⃣ Medical organizations and professionals should prioritize use of individual descriptors and titles that precisely capture credentials and job roles. ➡️ reduce confusion and promote trust and transparency for patients and health care professionals across job categories.

16/ 2⃣ In referring to groups including multiple categories of health care professionals, terms without the negative connotations of provider should be used if individual job roles cannot be referenced. Examples include clinician, health professional, and health care professional

17/ 3⃣ Similarly problematic terms, such as midlevel, affecting key members of the health care team should be removed from usage to demonstrate mutual respect and to provide clarity in job roles.

18/ 4⃣ Language used to describe patients and their life experiences should be oriented to the person and demonstrate respect.

19/ Don’t think this really matters? See this perspective @JournalofGME for more reasons it does, including how it relates to #burnout and #wellbeing.
meridian.allenpress.com/jgme/article/1…

20/ Don’t agree with these recommendations? Let’s turn it around. If you are okay with (or even advocate for) #provider, what are your arguments in its favor? Any of these?

https://twitter.com/ColinWestMDPhD/status/1407091814297915396?s=20&t=V__GgeHrQWmDzNZcxcajCQ

21/ It seems clear that the arguments in favor of this term are very weak, and there are many reasons the word is problematic. There are also simple replacement terms we could easily use without this baggage: healthcare professional, clinician, and so on.

22/ I’ll be at #SGIM22 the rest of this week, where I anticipate seeing and hearing #provider many times. We can do better, but the first step is paying attention to the insidious creep of this term from outside of medicine to within our interprofessional norms.

23/ This is about values.
“inappropriate language can communicate lack of respect. Changing language to promote respect also promotes professionalism. In short, language matters to upholding the fundamental principles of medicine.”

24/ Its origins in the industrialization and commoditization of medicine, combined with the untitling and uncredentialing it represents, mean #provider does not properly reflect the core values of medicine and should be removed from our lexicon.

25/ I’ll return next week after #SGIM22 for more #wellbeing content! /fin #ProudToBeGIM