In the fi rst installment of this series of articles, we discussed how types of bias such as information bias, misclassifi cation bias, observer bias, recall bias and selection bias can cause errors and inequities in medical research that can have ripple eff ects on eff ective care.4


While bias may manifest in myriad ways, the bias expressed through language used by healthcare professionals is especially impactful. To deliver equitable, anti-oppressive, compassionate care, providers should be highly aware of the language we use with our patients.


Language of the medical environment Every outward-facing aspect of a medical practice informs the messaging delivered to patients—from the website and advertising to the institutional signage, consent forms, and pre- and post-op instructions. For IRs, one of the most frequent ways language-based bias may exert itself is in the process of informed consent. Such bias may occur during the exchange of information between the physician and patient as they discuss a potential future procedure and in the physical, printed documentation that formalizes that conversation.


Established partly by the Nuremberg Code and later codifi ed in the Declaration of Helsinki, informed consent has become a standard practice in procedural medicine.5


Twenty-fi ve million people


in the United States are not fl uent in English.6


Throughout the United


States, laws require licensed hospitals to implement policies to provide language assistance services to patients to eliminate communication barriers. Federal law also requires hospitals that receive federal fi nancial assistance via Medicare, Medicaid and grant funds to ensure equitable language access.


Providers at all practice levels and types should ensure their marketing and consent forms are available in multiple languages. Further, the onus is not on the patient or their family members to provide translation services. Providers should also ensure that the documents are created at an accessible reading level and avoid common phrases


of biased patient descriptions (as discussed below).


Accessibility is limited not just by what is on the page, as some patients may have hearing and visual impairments. Having supplemental reading implements such as a magnifying glass and voice amplifi ers to enhance communication and mitigate liability risk is good practice.


By ensuring that all medical documents intended for patient usage are translated upon implementation, providers can ensure that accessibility is a key tenant of the consenting informed consent process. In hospital- based practices, start by engaging the Policy Committee and encourage them to hardwire a process for translating patient-consumed documents in the predominant languages of the community being served.


The language of patient descriptors Word choice matters when communicating with patients and family members. Unconscious usage can have substantial implications. How often have you heard a colleague describe a patient in person as “a great case?” How we utilize language to obtain a past medical history can also be impactful. For example, “Are you a diabetic?” versus “Are you being treated for diabetes?” or “Have you ever been diagnosed with diabetes?” is an easy example of shifting emphasis. The former question—Are you a diabetic?—may be considered disrespectful by dehumanizing a patient into a disease. The latter choices preserve their humanity and are a nonjudgmental inquiry regarding their medical history.


In addition, patient-blaming medical jargon can impact your relationship and bonds of trust with your patient. These terms often blame poor health on the patient rather than acknowledging the social determinants of health and systems that may have contributed to their health outcomes. Consider whether you have ever used the following terms in conversation or notes:


• Noncompliant • Drug-seeking behavior • Diffi cult, combative, abusive patient


• Minority patient • “Right off ‘The Boat’” • High-risk patient • Non-English-speaking • Elderly • Psychosomatic • Uninsured


One of the most common areas of bias involves weight. The language surrounding how we describe weight is often stigmatizing and fraught with bias. Such bias may reinforce negative perceptions, discrimination and health disparities. Intentional shifts toward more respectful, nonjudgmental, objective and patient-centered language promotes eff ective communication in healthcare.


Conclusion How we utilize language in engaging our patients is fraught with potential hazards. Even long-accepted practices may need to be reconsidered. A fundamental strength of interventional radiologists is our instinct to strive to see things clearly so we may deliver eff ective treatments. None of us want to be an impairment to delivering eff ective solutions. By providing intentional, language-concordant, human-centered care focusing on dignity, respect and empathy, image-guided healthcare providers can help humanize the medical experience and promote positive health outcomes.


References


1. USAGov. Offi cial language of the United States. usa.gov/offi cial-language-of-us.


2. Bischoff A, Denhaerynck K. What do language barriers cost? An exploratory study among asylum seekers in Switzerland. BMC Health Serv Res 2010. Aug;10(1):248. 10.1186/1472-6963-10-248.


3. Cohen AL, Rivara F, Marcuse EK, McPhillips H, Davis R. Are language barriers associated with serious medical events in hospitalized pediatric patients? Pediatrics 2005. Sep;116(3):575–579. 10.1542/peds.2005-0521.


4. McGinnis, HD. The language of bias. IR Quarterly. 2023. irq.sirweb.org/advocacy/ the-commitment-bias.


5. Bazzano LA, Durant J, Brantley PR. A modern history of informed consent and the role of key information. Ochsner J. 2021 Spring;21(1):81–85. doi: 10.31486/toj.19.0105. PMID: 33828429; PMCID: PMC7993430.


6. United States Census. What languages do we Speak in the United States? census.gov/library/ stories/2022/12/languages-we-speak-in-united- states.html.


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