By Kiana Birge, The Seattle Medium
The words healthcare professionals choose to use with patients are not only the key to better health outcomes, but are a crucial component in generating trust.
Healthcare experts across Seattle are drawing from their own experiences and research in order to train healthcare workers and raise awareness about how language matters when working with patients and other citizens in need of care. According to the National Library of Medicine, 21% of U.S. adult survey respondents in 2019 reported they had experienced discrimination in the healthcare system, and 72% of those respondents experienced discrimination more than once.
Sachita Shah is an associate professor of emergency medicine at the University of Washington. She is also an emergency-department physician at Harborview Medical Center. She explains that the first step towards better health outcomes starts with the language we use with one another.
“It gives us the ability to connect with our patients,” said Shah. “The most important thing is to not alienate our patients. I train my students and residents to always be thoughtful with every patient we interact with.”
Shah said, for example, that it may take several visits for patients’ who have experienced domestic violence or trafficking to open up about their physical and mental health experiences.
“We have this unique opportunity to interact with people and help them. We must cement trust with our patients so that we can deliver better patient care and better health outcomes,” said Shah.
Marsha Williams is a volunteer with NAMI South King County and has been involved with this nonprofit organization since the early 2000s. First, she was a client there, and she now serves as president of the affiliate board of directors. NAMI is an acronym for National Alliance on Mental Illness.
Over 600 NAMI state organizations and affiliates across America offer free support and education programs online and in person. Their mission is to improve the quality of life of those affected by acute and chronic illness through advocacy, support and education. They work to end stigma and advocate for access to quality healthcare, education, housing and employment for people experiencing mental illness.
NAMI South King County office is in Kent and local affiliates can be found on the Nami Washington state website.
“My early experience with NAMI was life changing,” Williams said. “I want to help other people and get the kind of help that helped my family and I. They were not judgmental and did not treat me with any stigma.”
Williams explained that NAMI has free educational programs available to families, peers, schools and healthcare providers. Each program is led and taught by NAMI members who have undergone intensive training for certification.
The NAMI Provider Education program is for healthcare professionals who work directly with people experiencing mental health conditions. NAMI Provider is a 15-hour in-service training taught by a team led by an adult with a mental health condition, a family member of a person who is experiencing a mental health condition, and a mental healthcare professional. NAMI Provider offers unique perspectives of people who have experience with mental health conditions.
One aspect of this course aims “to teach providers how to not use specific language that may be triggering or inappropriate for patients,” said Williams. The goal is to expand participants’ compassion for clients and patients through their verbal and nonverbal communication. NAMI teaches participants’ how to strengthen their nonverbal communication skills, such as actively listening and using an appropriate and respectful tone with others.
NAMI also teaches its participants’ to avoid any term that uses an illness as an identifier. For example, rather than saying “a patient is schizophrenic”, say “a person living with schizophrenia”. The term “disorder” or “substance abuse” can also be triggering for a patient.
“We see the person and not the illness,” said Williams.
Robin Hinz, the NAMI Ending the Silence program coordinator for the South King County affiliate, expressed her own triggering experiences as a patient in the healthcare field.
Hinz was seeing a sports medicine doctor who gave her a cortisone injection into her knee. She was deciding whether to get a knee replacement and this doctor said she was “too fat to have the surgery and no orthopedic surgeon in Seattle was going to take her Medicare insurance for this surgery.”
Hinz was appalled at his response. She said the word fat is a derogatory term that was inappropriate and triggering. She was in the thick of her eating-disorder treatment program when he said that.
After her session with that sports medicine doctor, she found a more compassionate surgeon and he had no issue with conducting the surgery or taking her Medicare health insurance. The surgery was successful, but had she listened to the previous doctor, she may have never pursued this option for care.
“If my sports medicine doctor had gone through the NAMI Provider Education Program at https://namiskc.org/support-and-education/mental-health-education/nami-provider/, then maybe he would have been more empathetic towards my situation,” Hinz said.
June Strickland is a retired nursing professor at the University of Washington who supports the advancement of American Indian, Alaskan Native and Native health. Strickland is Cherokee Indian and has had multiple experiences in which healthcare workers made her feel uncomfortable with invasive remarks and actions.
One time, “I was there to see a gynecologist, and a nurse practitioner came in to take my information before I could see the doctor,” she said. “I was wearing a decorative medicine bag and she grabbed it, saying, ‘Oh cute’.”
Strickland responded to the nurse practitioner, “‘I am Native and we are very private people and it makes me feel uncomfortable if you touch something on me’.”
A different time, Strickland was wearing traditional Native jewelry and braids and the gynecologist said, “You look so Indian!” to her during the checkup.
Since then, Strickland has designed women’s health screening programs in Washington state specifically for American Indian and American Native women. She has designed culturally appropriate interventions and believes that respectfully interacting with and building trustworthy relationships with other people from other cultures will help the healthcare system advance.
Strickland worked with a tribe to adapt a program designed to increase the number of Native women receiving Pap tests and mammograms. The program centered around patients making a pledge to get health screenings. Previous research showed that in mainstream culture, women are more likely to get these services if they sign a commitment paper.
When Strickland took this intervention to a tribe of Native women, they said the women would need to stand and make a verbal commitment to their people, elders and aunties, promising that they will take care of themselves for their tribe and their family members. This tribe was oriented towards their families, the tribal elders and the spoken word when committing to taking health screenings.
“We all have our own power and people can choose to use it in a positive or negative way. We are all related. We are all connected,” Strickland said.
