Periodically, this newsletter serves as a vehicle for discussing how terminology inexactitudes can have a detrimental impact on health care quality. For example, the December 2023-January 2024 issue described how inconsistent use of terms, such as Alzheimer disease and dementia has compromised progress in clinical care, research, and development of therapeutics.
Also, from a much wider perspective, the October 2024 issue referred to how conceptual opacity characterizes the word “health.” Because of this opaqueness, health tacitly is defined narrowly as the absence of disease. The result is a perpetuation of a biomedical paradigm in health care with a focus on diagnosing and treating disease. This tacit definition yields poor investment in the inherent health potential of individuals relative to drugs and technology, thus fostering a misalignment between the goals of health care and the goals of individuals, communities, public health, and society.
A more recent example is provided regarding the term pain, a condition familiar to members of the entire human family irrespective of other demographic characteristics that differentiate them from one another. The March 2024 issue of the Journal of Pain includes a focus on the term “pain catastrophizing.” A paper by Sullivan and Tripp discusses how recent reports have pointed to problems with the term “pain catastrophizing.” Critiques of that designation have come from several sources including individuals with chronic pain, advocates for individuals with chronic pain, and pain scholars. Reports indicate that the term has been used to dismiss the medical basis of pain complaints, to question the authenticity of pain complaints, and to blame individuals with pain for their pain condition. These co-authors advance the proposition that problems prompting calls to rename the construct of pain catastrophizing have little to do with the term, and as such, changing it will do little to solve these problems. Moreover, they argue that continued calls for changing or deleting the term pain catastrophizing will only divert attention away from some fundamental flaws in how individuals with pain conditions are assessed and treated.
Conroy and Webster in their article in that journal issue underscore these views by maintaining that indeed, language does matter. The argument that the term itself is not problematic perhaps reflects an underestimation of the role of language in shaping understandings of the world. They posit that language not merely describes, but in fact shapes how objects become known. A survey they conducted pertaining to pain catastrophizing revealed how the term was understood to be problematic by many individuals living with pain insofar as they perceived it to invalidate their experiences and confer stigma. The issue is not confined to clinician education and the use of patient-centered language in the clinical visit. Rather, it extends to public education; media and press stories about scientific work; and social media visibility of scientific work where patients, scientists, and clinicians communicate in a public and open forum.