Inclusive Language for Medical & Health Education: An Evolving Guide

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July 27, 2021
What is inclusive language? It’s language that makes people feel included—language that doesn’t discriminate based on a person’s race or ethnicity, sexuality, gender, age, ability, or socioeconomic status.

In medical and health education, the way we discuss patients (even hypothetical ones) matters because all people deserve to feel seen, respected, and included. To address traditionally biased language in medicine, we’ve created this Inclusive Language Guide for Medical and Health Education to help keep wording consistent and respectful. This ever-evolving guide is available for anyone who finds it useful. After reading, if you’re ready to test what you’ve learned, check out the free Inclusive Language Qbank in your Rosh Review Boost Box.

The important work of improving health care education and patient interactions is not going to happen overnight, but with our combined commitment to doing better, we can make a difference. And please reach out with any comments or suggestions—much of what is included here has come from current best practices from expert clinicians and advocacy groups, updates released by major style guides, and YOU. Although old questions are continuously updated to address outdated wording, you may find something before we do!


Updated July 2021

This guide was originally created to address language used in Qbanks (i.e., regarding hypothetical patients), but conscientious wording is also essential in patient interactions and medical records. But keep this in mind: these guidelines will not pertain to every patient and every medical scenario, as individuals may have their own preferences about the language they use to refer to themselves or their loved ones. Often, the best solution is to directly ask the patient for their preferred terms.

Three basic principles have come out of creating the guide, no matter what you’re discussing:

  1. Be as specific as possible (e.g., NOT APPROPRIATE = foreign-born* and APPROPRIATE = from Nepal)
    *Foreign to who? Only you? Anyone in the US? This is why being specific is important

  2. Only use relevant details (i.e., no need to bring up a point, like sexual orientation, if it has nothing to do with what you’re discussing, like Lyme disease)

  3. When interacting with patients, never make assumptions; always elicit the pertinent information, whether it is a patient’s desired gender-affirming interventions or their decision to fast for Ramadan

It is important not to “other” (comparing groups to what you consider “normal”), so don’t use normal when describing the reverse of any of the categories listed below (e.g., normal vs disabled, transgender, gay), and be conscious of othering terms such as differently abled or at-risk.

Here are some of the resources the editing team referred to when creating these guidelines. Within the subsections outlined below, you’ll see links to more specific guides, as well:

18F Content Guide
The Diversity Style Guide
The Conscious Style Guide
Sum of Us: A Progressive’s Style Guide


Race and Ethnicity

There aren’t cohesive guidelines about how to use race in medicine (see this article in NEJM for some examples), and it’s a complex topic. On one hand, some common medical guidelines involve race, which may be important to know for the board exams. But on the other hand, these guidelines may be incorrectly equating race with issues that might be due to other factors, like social determinants of health. (Watch “The problem with race-based medicine,” a TED talk by Dorothy Roberts.)

To help highlight this, and in the hopes of teaching learners to think critically about how race is presented in medicine, we are starting to add this disclaimer in explanations where treatment may be affected by a patient’s race: 

The demographic information in the above explanation follows AMA Manual of Style terminology and may not match the language used in the references. Race is a social construct that is often correlated to certain medical conditions in the literature and evidence-based guidelines. Our hope is to inspire a change in the way race is used in the medical community.

Here are the basic principles we use when the team has decided race or ethnicity should be included in the Qbank:

  • When more specific terms can’t be used, we prefer using American Indian, Asian American, Black, and White based on currently accepted wording in major style guides. Rather than the broad and oft-confused terms Latino and Hispanic, we aim to use specific descriptors (e.g., Colombian, Mexican American).

  • Any term referring to race or ethnicity should be used as an adjective, not a noun (e.g., White men, patient of Korean descent rather than Whites or a Korean/a Korean American), and they are capitalized and do not use hyphens when more than one word (e.g., not Mexican-American woman, per major style guides).

  • It is important to refer back to the original categories used in studies to determine their relevance (e.g., when estimating glomerular filtration rate, it is suggested to multiply by “1.210 if African American” at sites like this, but the original study uses “Black”). It may be prudent to mention what terms were used in the original data.

  • Do not use the terms nonwhite, Caucasian, Oriental, or Brown.
    • Nonwhite indicates that White is the default and everything else is “other.”
    • Caucasian and Oriental are both outdated terms: Caucasian is commonly used interchangeably with White but specifically refers to the Caucasus region in Eurasia, while Oriental exoticizes and stereotypes the “East” relative to Europe.
    • Brown is a nonspecific term that is commonly used in casual language, but it’s best to be specific when describing a person’s heritage.

But remember, individual patients may have their own preferences about the language they identify with. For example, while the editing team chooses to use specific language such as Mexican American to refer to a hypothetical patient in the Qbank, an actual patient may identify as Latino, Latina, or Latinx.


Socioeconomic Status

Take care to avoid othering language or language that has a negative connotation, especially if it makes a person’s socioeconomic status sound permanent.

Instead of…Use…
the homelesspeople without housing, people experiencing homelessness
third-world, developing countrieslow-income, limited-income, resource-limited, resource-poor, transitional
the poor, the unemployedperson with low income, with no income, who is not currently employed
developed, first-world*, Western** countries/worldhigh-income, resource-rich, industrialized
at-risk***the specific descriptor being discussed

*Othering language works both ways (i.e., we don’t want to use “third-world” OR “first-world” countries, as first-world indicates there are other, lesser, countries).

**Western is traditionally code for predominantly White countries that were originally colonized by European countries. Try to be more specific about what you’re truly trying to say.

***See principle 1 about being specific—this term is vague in the sense of socioeconomic status. For example, if you write “at-risk youth are susceptible to self-harm,” what exactly makes these youth at risk—economics, exposure to violence, poor nutrition, another factor? Be specific, such as “Youth residing in foster care are at higher risk of [or have higher rates of] self-harm compared to youth in the general population.” This specifies the factor that puts these individuals at risk.

APA Guidelines for Socioeconomic Status


Sex and Gender

In Qbank and other hypothetical content, avoid reinforcing gender stereotypes (female nurse vs male doctor, a mother always accompanying a child to doctor visits, assuming that all relationships are heterosexual).

  • fe/male = sex (biological classification), wo/man = gender (a person’s personal and social identity)
    • Therefore, correct usage is transgender wo/man (not transgender fe/male)
    • Note: transgender is an umbrella term that is not limited to binary sex and gender. Some terms you may encounter include MTF (male-to-female), indicating a transgender woman who was assigned male at birth, and FTM (female-to-male), indicating a transgender man who was assigned female at birth
  • When applicable to acknowledge nonbinary gender identity or if sex or gender needs to be anonymous, is unknown, or can be used in nonpreferential general terms, use “they” as a singular pronoun
Instead of…Use…
opposite sexdifferent sex
hermaphroditeintersex
gender-neutralnonbinary, gender nonconforming
born a boy/girl, biologically fe/maleassigned fe/male at birth
sex change, sex reassignment surgerygender confirmation surgery
normalcisgender
identifies as a wo/man, nonbinaryis a wo/man, nonbinary

Clinicians should be familiar with community resources where they can refer transgender patients for any care that can’t be obtained in the office and should also familiarize themselves with the unique physical and mental health care needs of transgender patients. 

UCSF Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People


Sexuality

A person’s sexual orientation describes who they are romantically, physically, or emotionally attracted to. It is separate from one’s gender identity, which is how a person sees themselves (e.g., transgender, nonbinary, cisgender). Defer to the language that a person or group prefers. For example, some may consider “queer” offensive while others identify as queer.

  • Do not use nonstraight, homosexual, or queer (unless this is how a person or group refers to themselves)

  • Use sexual orientation, not sexual preference, lifestyle choice, or sexual identity

  • In hypothetical situations, unless knowing a patient’s sexual orientation is necessary to understanding something about them, referring to their spouse or partner is preferred to husband, wife, boyfriend, or girlfriend
    – In clinical situations, nonbinary language (spouse, partner) is appropriate when the sex or gender of a patient’s partner is unknown
  • Wo/men who have sex with wo/men is acceptable terminology when discussing behavior

  • Instead of identifying sexuality (e.g., gay man), it might be better to describe their partner (e.g., has a male sexual partner).
    – Think about principle 2: what is important to the topic? Does it matter whether the patient is gay, straight, or bisexual or what behaviors they engage in (e.g., sex with partners of the same or a different sex)?

GLAAD Media Reference Guide


Disability

As with other categories, avoid othering language, and use the language that a person or group prefers.

  • Most of the time, person-first language is preferred, but some people (including many in the Autistic and Deaf communities) prefer identity-first language because they feel the identity is an inherent part of their being
    • person-first: man with diabetes
    • identity-first: autistic man
  • Beware of othering language that implies 100% healthy is normal (e.g., “differently abled”—different from what?)
Instead of…Use…
differently abled, challenged, handicap(ped)disabled
normal, able-bodiedwithout disabilities
suffers from, is a victim of, is afflicted by [disorder, disability, disease]has [disorder, disability, disease]
wheelchair-bound, confined to a wheelchairuses a wheelchair
mental retardationintellectual disability, developmental disability
obese/overweight patientpatient with a history of obesity, with obesity/overweight, with elevated BMI, with a BMI of [X] (for adults)
substance abusesubstance use, substance use disorder
alcoholismalcohol use disorder, chronic alcohol use, excessive alcohol use
alcoholicpatient with alcohol use disorder, person who excessively uses alcohol
[patient] is [bipolar, schizophrenic,…][patient] has, with [bipolar disorder, schizophrenia,…]

National Center on Disability & Journalism’s Disability Language Style Guide
APA Guidelines for Nonhandicapping Language


Other Terms

Some things don’t fall neatly into categories, and as you may have noticed, language is full of exceptions. Here are some other outdated terms and their suggested replacements.

Instead of…Use…
provider*clinician, be specific (e.g., physician, PA, NP)
prostitutesex worker
elderly, senior, aged, geriatricolder, age range (e.g., patients ≥ 65 years)
admits (e.g., patient admits to drinking two glasses of wine per day)reports (e.g., patient reports he drinks two glasses of wine per day)
deniesreports no
complains/complaining ofhas, notes, reports 
patient failed [treatment]patient refractory to, who did not improve from, who didn’t respond to, did not derive benefit from [treatment]
noncompliant [with medication]discontinued the medication [due to…]
committed/completed suicidedied by/due to suicide
un/successful suicidesuicide attempt/suicide

*There are a few reasons this term is problematic. As with most topics, it’s better to be specific.


Remember to test your inclusive language knowledge with the Inclusive Language Qbank—free in your Boost Box.

This guide was developed by Melinda Campbell and Laura Wilkinson with the editing team: Lisa Alchier, Gina Jansheski, Grace Satterfield, and Kristian Savic with the help of Morgan Leafe, MD, MHA; Melinda Chen, MD; Charmian Lewis, MD; and Adam Rosh, MD.


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