Semiotics has a focus on the study of signs and symbols. Failure to interpret them correctly in interactions between patients and clinicians may lead to unfortunate consequences that compromise health care quality. For example, touching a patient may be considered a sign of caring whereas a failure to touch may be perceived by a patient as a radically different kind of unwelcome symbol.
The study of linguistics indicates that a single word may have several referents. According to the June 2023 issue of the Journal of Applied Gerontology, the term ageism initially was coined in 1969. Since then, it has gone through numerous transformations, reflecting different nuances. Similarly, other “ism” words are used currently to characterize the interaction between patients and clinicians, such as racism, sexism, and ableism. It also is possible to be affected by more than one ism. Ironically, someone who is both an ageist and an ableist eventually will enter old age cohorts and be affected by one or more disabilities.
Until recent years, it was common to refer to an individual as being disabled or handicapped. The emphasis presently is on the employment of person-centered language (PCL) in health care. For example, it is preferable to refer to a patient with cancer instead of using the expression a cancer patient. The June 2023 issue of the journal Obesity discusses a study in which of the 991 articles examined, only 24.02% of publications adhered to PCL. Non-PCL in reference to obesity is widely evident, however, in weight-focused periodicals despite recommendations for adherence to PCL guidelines. It is believed that continued use of non-PCL in reference to obesity in research inadvertently may perpetuate weight-based stigma and health disparities in future generations.
Racism also may occur alone or with ableism. The June 2023 issue of the American Journal of Psychiatry refers to an investigation in which Black and Hispanic veterans were more likely than White veterans to have an alcohol use disorder (AUD) diagnosis despite similar levels of alcohol consumption. Ableism would be applicable had they been classified as alcoholics rather than as individuals with an AUD. The difference was greatest between Black and White men. At all but the lowest and highest levels of alcohol consumption, Black men had 23%–109% greater odds of an AUD diagnosis. The findings were unchanged after adjustment for alcohol usage, alcohol-related disorders, and other potential confounders.
Moreover, schools in the health professions may constitute a highly competitive environment where the most accomplished students are able to obtain the most prestigious and best selective post-graduation placements for internships, residency positions, and employment. Students with a disability may be reluctant to disclose that they have a particular condition, especially one that is invisible such as social anxiety disorder, fearing that doing so may hurt their future prospects, an outcome of structural ableism. The same holds true in workplace settings where seeking any special accommodation, such as needing more time to complete assignments, has the potential of triggering stigmatization by co-workers and employers.