Abstract
In the context of health care professionals’ communication with individual patients, I’ve wondered if repeated usage of concise phrases like “COVID-19 patient,” instead of saying “patient with COVID-19” (the intended meaning of the phrase COVID-19 patient), might come across as offensive though no offense is intended. Though I have diabetes, I did not initially relish being called a “diabetes patient,” at least repeatedly. My reasoning has been that every patient is first and foremost an individual with a unique identity and story, and diseases or illnesses that affect individuals are part of them, and not the whole of them. Similarly, those affected by COVID-19 are not COVID-19 patients; rather, they are patients or individuals with COVID-19. In contrast, if my physician referred to me as diabetic (an adjective), I take it well, and take it that my physician intends to bring this aspect of my health to my attention.
Until recently, I believed that my not relishing phrases like “COVID-19 patient,” “diabetes patient,” and “hypertension patient” had something to do with my cultural background, and my being a non-native speaker of the English language. Now I’ve identified an additional precise explanation: COVID-19, diabetes, and hypertension are all nouns sounding like adjectives in the phrases “COVID-19 patient,” “diabetes patient,” and “hypertension patient,” respectively. Each of these phrases is a compound noun or noun string (1). I don’t relish noun strings because, as in the 3 examples above, some patients might perceive them as dehumanizing. Even if not dehumanizing, noun strings may cause ambiguity in communication. To give an example, a commonly used noun string “hypertension medication” may reasonably be interpreted as either medication to control hypertension or as medication that causes hypertension, by someone who is unfamiliar with the term hypertension, whereas health care professionals are unlikely to be misled by it.
A search for “COVID-19 patient” in the search engine Google (June 1, 2020) reveals numerous hits in the realm of scholarly literature, publications by professional organizations, and news media. In contrast, a search within the New England Journal of Medicine (NEJM) website (nejm.org) for the phrases “COVID-19 patient,” “hypertension patient,” “heart failure patient” yields zero results over the past 30 years though the journal has published numerous articles on these topics, and I really appreciate NEJM being sensitive to the issue I have highlighted here.
Advocates of plain English recommend avoiding noun strings when possible because otherwise the reader must reread the whole string to properly understand how modifiers relate to the main noun (1 -3). If the phrase “noun string” did not cause the reader any confusion, it is because the reader is familiar with it, since it too is a string of nouns. Schoenfield (3) has useful advice for tackling noun strings.
In conclusion, in communication targeted at the public at-large or patients, I recommend avoiding noun strings, especially when using technical terms, to minimize ambiguity. Additionally, it is helpful for health care professionals to be mindful of noun strings that might come across as insensitive to individual patients.
