Words can shape or reinforce a patient’s understanding of their problem. Words and concepts can reinforce cognitive errors and biases, thereby reinforcing common misconceptions. Given the strong influence of thoughts, emotions, and behaviors on musculoskeletal symptoms and limitations, it’s important that both scientific and lay writing use the most positive, hopeful, and adaptive words and concepts consistent with medical evidence. The use of words that might reinforce misconceptions about preference-sensitive conditions (particularly those associated with age) could increase symptoms and limitations and might also distract patients from the treatment preferences they would select when informed and at ease (1). 

One study found that some common hand surgery words have a relatively negative emotional content (2). The use of questionable words and concepts is common in scientific writing in orthopedic surgery. Given that psychological distress is an important predictor of pain intensity and disability, clinicians should be motivated to use optimally hopeful and adaptive language for describing musculoskeletal pathology.  

Patient interpretation of advice from hand therapists may be related to cognitive biases in response to nociception. A recent study suggested that hand therapists should be mindful that nonadaptive pain thoughts are an important determinant of disability and that such thoughts can affect and be affected by their recommendations (3). Nonadaptive pain thoughts exacerbated by psychological distress were found to be related to participants’ hand therapy goals, interpretation of advice from hand therapists, and upper extremity-specific disability. 

Diagnostic MRI reports can also be distressing for patients with limited health literacy. Humans tend to prepare for the worst, particularly when we are in pain, and words like “tear” can make us feel damaged and in need of repair. A study showed that emotional response, satisfaction, usefulness, and understanding were all superior in MRI reports reworded for lower reading level and optimal emotional content and optimism (4). Given that patients increasingly have access to their medical records and diagnostic reports, attention to health literacy and psychological aspects of the report may help optimize health and patient satisfaction.  

Our research on optimal words and concepts is focusing on several areas:

1. We are researching the influence of words used in provider-patient interactions on response to treatment and effectiveness of cognitive coping strategies. 
2. We are developing hopeful and adaptive language for describing musculoskeletal pathology. 
3. We are investigating patients’ less adaptive thoughts associated with nociception.

References

1. Connor CM, Menendez ME, Hughes K, Ring D. Questionable Word Choice in Scientific Writing in Orthopedic Surgery. Arch Bone Jt Surg. 2017 Jul;5(4):231-234. PubMed PMID: 28913380; PubMed Central PMCID: PMC5592364.
2. Vranceanu A, Elbon M, Adams M, Ring D. The emotive impact of medical language. Hand 2012; 7:293-296.
3. Bekkers S, Becker SJ, Bossen JK, Mudgal CS, Ring D, Vranceanu AM. Relationships between pain misconceptions, disability, patients’ goals and interpretation of information from hand therapists. J Hand Ther. 2014 Jun 20. pii: S0894-1130(14)00058-1. doi: 10.1016/j.jht.2014.06.003. [Epub ahead of print] PubMed PMID: 25064147.
4. Bossen JK, Hageman MG, King JD, Ring DC. Does Rewording MRI Reports Improve Patient Understanding and Emotional Response to a Clinical Report? Clin Orthop Relat Res. 2013 Jun 13. [Epub ahead of print] PubMed PMID: 23761176.