It is estimated that over 26% of adults in America are living with disabilities, 45% have at least one chronic disease, and 22% live with mental illness (NIH, 2023). Phrases like “the diabetic patient in room 2,” “your cancer patient is ready to see you now,” or “a disabled student in class” are still commonly heard in today’s healthcare environment. What is inappropriate with these phrases is neglecting the importance of using person-first language. While person-first language is taught in most professional programs and required by academic journals, the gap between what is taught, and real-life application is significant.

What is Person-First Language?

The impact of person-first language in healthcare cannot be overstated. This communication approach, which places the person before their medical condition or disability, acknowledges individuals as multifaceted rather than defining them solely by a diagnosis. For instance, using ‘person with diabetes’ instead of ‘diabetic’ underscores the personhood before the condition. This shift in language is not just a matter of semantics; it is a crucial step toward fostering respect, reducing stigma, and promoting inclusive care.

Historical Context and Evolution

The concept of person-first language didn’t emerge overnight. It has a rich historical context dating back to the late 20th century, particularly within disability advocacy movements. The ‘People First’ movement began in 1974 during the first self-advocacy conference and was a significant milestone. In 1988, the term was officially introduced in a congressional act supporting people with disabilities, advocating for language that recognizes individuals before their conditions. This shift was a response to the dehumanizing effects of labeling individuals by their disabilities, which often led to marginalization. Over time, person-first language has been adopted by various medical and legal organizations, including the American Medical Association and the Centers for Disease Control and Prevention.

Examples of Person-First Language in Healthcare

Incorporating person-first language into healthcare practice goes beyond words; it reflects a cultural and systemic shift towards valuing patients as individuals. Some of the best practice phrases include: person or individual living with; people who are hard of hearing or use a wheelchair; the client who is experiencing unstable housing.

Below are more examples of how person-first language can be used effectively in various healthcare scenarios:

1. Mental Health Care

• Instead of saying, “You are bipolar,” a better way is “You are a person living with bipolar disorder.”
• Impact: This phrasing separates the individual’s identity from the condition, fostering a sense of autonomy and self-worth.

2. Substance Use Disorders

• Describing a “person with a substance use disorder” rather than “addict” or “substance abuser.”
• Impact: The language reduces stigma, encouraging patients to seek help without fear of judgment.

3. Chronic Illness

• Instead of referring to the patient as “obese,” try saying, “unhealthy weight” or “weight that exceeds the recommended weight for this particular height and body frame.”
• Impact: It empowers the patient to view their condition as something they manage, not something shameful or a defining characteristic of their identity.

4. Disabilities

• Referring to the individual as “a person who uses a wheelchair” rather than “wheelchair-bound.”
• Impact: This acknowledges the person’s capabilities and avoids language that implies limitations or negativity.

5. End-of-Life Care

• Saying, “Your father is a person receiving palliative care for terminal cancer,” rather than “a terminal patient.”
• Impact: This phrasing maintains the patient’s dignity, emphasizing their humanity over their diagnosis.

6. Pediatric Care

• Using “a child with autism” instead of “an autistic child,” unless the family explicitly prefers the latter.
• Impact: This respects the child’s individuality and avoids labeling them by their condition.

7. Behavioral Health

• Documenting “person experiencing homelessness” instead of “homeless person.”
• Impact: This shifts the focus from the condition to the individual, reinforcing that the situation does not define the person.

But Not Everyone Accepts this Approach

While the concept of person-first language is clear, it’s important to respect the preferences of individuals with disabilities, as not everyone accepts or recognizes person-first language terminologies. For example, many people who are deaf and hard of hearing may not accept the term ‘hearing-impaired.’ Likewise, many people in the autism community want to keep autism as an important aspect of their identity and, therefore, would prefer the term’ autistic people’ (NIH, 2019). Hence, it is helpful to ask first and be respectful and flexible of the individual’s preference, fostering a culture of consideration and accommodation in healthcare settings.

Final Thoughts

For the most part, people who use nonperson-first terms do not intentionally cause harm, but it does express insensitivity. It does not promote dignity and respect for people with chronic illnesses or disabilities. Person-first language reflects a deeper understanding of the practice of person-centered care. Healthcare leaders, nurse managers, and clinical educators are expected to exhibit a high level of proficiency in communication skills. They must set examples in practicing person-first language and seek opportunities to cultivate an inclusive culture of positive patient care outcomes and workforce relationships. Adopting this approach consistently requires a dedicated commitment to ongoing education, cultural sensitivity, and recognizing that each patient or client is an individual rather than their condition.

Author: Angie Jung, RN, BSN, CRRN, CCM

References:

Centers for Disease Control and Prevention (CDC). Person-First Language. 1-27-24. https://www.cdc.gov/nceh/clearwriting/writing-tips/2024/writing-tip-wed-01-17-2024.html

Crocker AF, Smith SN. Person-first language: are we practicing what we preach? J Multidiscip Healthc. 2019 Feb 8;12:125-129. doi: 10.2147/JMDH.S140067. PMID: 30799931; PMCID: PMC6371927. https://pmc.ncbi.nlm.nih.gov/articles/PMC6371927/

National Institutes of Health (NIH). Writing Respectfully: Person-first and Identity-First Language (April 12, 2023). https://www.nih.gov/about-nih/what-we-do/science-health-public-trust/perspectives/writing-respectfully-person-first-identity-first-language

Sara H Bares, Jasmine R Marcelin, Jill Blumenthal, Paul E Sax, Call to Action: Prioritizing the Use of Inclusive, Nonstigmatizing Language in Scientific Communications, Clinical Infectious Diseases, Volume 76, Issue 10, 15 May 2023, Pages 1860–1863, https://doi.org/10.1093/cid/ciad055