The Words We Choose


In this issue of the Journal of Midwifery & Women's Health, Lichtman[1] proposes alternative language for what midwives do at births. The language surrounding birth, including the debate between birth and delivery has been addressed in this Journal before.[2, 3] Some might say these language discussions are merely arguments about semantics, but I believe the words we choose are an important way in which midwives and other clinicians express our philosophy about our work and profession. This editorial focuses on some of the words the Journal's editors find ourselves changing frequently in an effort to have the language in the Journal show respect for the women midwives provide care for as well as our profession and colleagues.

A commonly debated word choice among midwives is whether to use woman, patient, or client. In this Journal, the term woman is preferred whenever possible. When patient or client is the better term for a sentence, authors can choose either as long as they are consistent. Personally, I am not a fan of the term client because it seems more applicable to business relationships; however, I recognize that there are many midwives who feel strongly that patient is not the best word for the women we care for because many of them are not ill.

Whether you choose woman, patient, individual, person, or client as the noun, it is important not to use diseases as adjectives. Referring to a “diabetic patient” or “HIV-infected patient” identifies the woman by her condition rather than as a whole person. Saying “woman with diabetes” or “individual with HIV” places the focus on the woman instead of the disease.

Sometimes word choices can appear to reflect negative clinician attitudes toward patients. Three words that often stand out in this respect are admits, denies, and refuses. The word admits is commonly used in sentences such as, “The patient admits she has not taken her medication for the past 2 weeks.” This has a connotation that the patient is guilty of something. While this may be the clinician's perception, it is more neutral to use states or notes. The word denies is used both to describe undesirable behaviors, such as, “The patient denies illicit drug use,” and symptomatology, “Patient denies history of similar abdominal pain.” Denies suggests (especially with the first example) that the client is not telling the truth and would be better replaced with reports. The word refuses indicates the patient is not following the clinician's recommendation. While this may be the case, individuals maintain the right to make choices about their health care. Replace refuses with declines when referring to whether someone chooses a health care intervention or participates in a study.

In addition to the language we use when referring to women, their lives, and their experiences, it is also important to consider words we use that relate to our profession. As health care becomes increasingly multidisciplinary, it is important to choose words that are inclusive of midwives as well as the other clinicians who might be involved in the same health care delivery. Medicine is still often used as the frame of reference even when one is not referring to services exclusively provided or used by physicians. For example, the terms health care home and electronic health record are preferable to medical home or electronic medical record. Along these same lines, there are many professionals, including midwives, who are doctors because they have advanced degrees. It is always better to use the term physician, rather than doctor or MD, when referring to medical doctors. Finally, Ob/Gyn is not an acceptable abbreviation for obstetrician-gynecologist. We should honor the profession's preference for the full spelling using a hyphen.

Word choices are important for editors and authors, but they are also significant for all of us in our daily conversations. I hope thinking about some of these words will motivate you to reflect on the words you speak and write, whether they are in a woman's health care record or a journal manuscript. Words can convey intended and unintended meanings. Let's choose ours carefully.


Thank you to all of my colleagues who have shaped my thinking around word choices especially Tekoa King, CNM, MPH, FACNM, Patricia Aikins Murphy, CNM, DrPH, FACNM, Kerri Schuiling, CNM, NP, PhD, FACNM, FAAN, Mary Brucker, CNM, PhD, FACNM, Kathryn Osborne, CNM, PhD, FACNM, and Robin Jordan, CNM, PhD, FACNM.