NATA Now

March 26, 2018 by JordanG
compassionate language in health care

From the editor: This blog is the last entry in the weekly series we’re running during National Athletic Training Month to highlight different aspects athletic trainers should consider as they strive to provide “compassionate care for all.”

ATs work closely with patients from all walks of life, so it is imperative to have a thorough understanding of how patient values such as gender, ethnicity, socioeconomic status, religion, etc. can affect the delivery of appropriate health care. The NATA Cultural Competence Work Group, a collaborative effort between members of the NATA Ethnic Diversity Advisory Committee, LGBTQ+ Committee and the NATA Executive Committee for Education along with members from the Professional Education Committee and Professional Development Committee, was established to look more closely at this topic and provide additional resources as culturally competent care continues to evolve. The workgroup collaborated together on this content series for the March 2018 NATA News and NATA Now examining religionimplicit bias, socioeconomic status and compassionate language.

This blog elaborates on Harriell's original article in the March NATA News that explained the importance of compassionate language as a health care provider and provided tips on how to address a situation when/if you have offended a patient.

 

By Kysha Harriell, PhD, LAT, ATC

 

WORD UP.

As athletic trainers, we are used to terminology changing in our profession. It wasn’t that long ago when you could read a sentence that might say, “student athletic trainers should work with ATEP faculty and their ACIs to prepare for the NATABOC exam.” We now read that and know it is old, outdated terminology. That sentence would now be written as “Athletic training students should work with their ATP faculty and preceptors to prepare for the BOC exam.” 

We all know this because we stay up to date with changes in our profession and we don’t want to sound “old-school” or not “with it” (whatever those colloquialisms mean). But, do we stay up to date with changing terminology in our world?

We each bring our own experiences and biases into any given situation, and that is especially true as it relates to what words we may or may not be OK with using. I'm black, and one of my best friends is Cuban American. She often refers to herself and her family as brown people. Often when we talk about issues, it is common for us to refer to Hispanics and African Americans as “black and brown folks.” However, I am aware that some people may take offense to being called a brown person. Isn’t that the same and just as offensive as calling an Asian person “yellow” or a Native American “red”? 

Why is it OK to say white and black, but possibly not OK to say yellow, red and brown? Who gets to decide? Does it matter who is saying it? The tone? The context? The answers could be yes, no, maybe and it depends. Whether someone is offended by a word or saying may depend on the individual, plus all of the possible variables alluded to with the questions above.

Early European “racial anthropologists” classified skulls into four racial categories based on appearance: white, black, yellow and red (and in later years, brown). However, most people don’t know that and assume it is based on skin color. In addition, many of these descriptive terms have a historical context and relevance. In the case of calling someone yellow or red, these terms were and are often used to degrade races/ethnicities and distinguish as “others,” different from white.

As a person of one or more of these races and ethnicities who were historically discriminated against, oppressed, insulted or belittled with these and similar terms, you are more likely to be aware of the historical significance, and you may have even felt or experienced these words used in hurtful ways. This may explain why certain people have very strong reactions to words that seem benign to you.

An example for me is the word “lazy.” Seems harmless, right? But as an African American, I know that historically, the word “lazy” was used to depict African Americans as “others” – describing us as lazy, ignorant and uncivilized, while whites were depicted as hard-working, educated and moral people. I never use the word “lazy,” and I have a very visceral reaction when the word is used by a white person to describe an African-American or black person/athlete/patient.

The same can be true with sayings such as “man-up” or you throw “like a girl.” These phrases depict men as strong and skillful and women as weak and unable. In a time where women are emerging in more leadership roles and continuously moving to break glass ceilings, these terms are constant macroaggressions, reminding females of how society tends to view women and girls. The same can be said for numerous racial, religious and sexual orientation terms, as well as words used to describe physical and physiological impairments.

Since getting offended by a term or saying may be specific to each individual, you may be thinking: how do I communicate without offending someone? 

You stay aware, and you think before you speak. Still, chances are at some point we will say something that offends or upsets someone. Whether you are the person who offended someone or you’re the person who was on the receiving end of the offensive comment, what you do next is very important.

 

Sorry your head got in the way!

Have you ever had someone say something to you that insulted you, made you incredibly angry or embarrassed, but you didn’t say anything? If you could go back, what would you say and what would you do? What if that person is your boss, preceptor or professor?

How about if you were told that you offended someone? Regardless of what you think about the intent of your words, what would be your most likely response?  Would you get defensive because you would never purposely offend someone and you are now embarrassed? Would you blurt out, “I didn’t mean it! It was just a joke! What’s the big deal? Are you kidding me? Stop being so sensitive!”? Or would you just pretend it never happened and stay quiet?

Picture yourself in an athletic training facility and out of nowhere, a patient throws a weighted rehab ball straight at your head. You quickly dodge, but the ball grazes you slightly. You are furious, and you ask the patient, “What were you thinking?”

The patient says, “I didn’t mean to hit you. I was trying to put the ball back in its place, and I thought I could throw it over your head.”  You demand an apology, and the patient says, “Sorry your head got in the way. I never intended to hit you.”

Wait, WHAT?  I don’t know about you, but at this point, I would be like a character in a cartoon with steam coming from my ears!”  (If you are picturing a football linebacker or a baseball player, you are stereotyping. Stop it; it is a women’s tennis player.)

The patient didn’t intend to hit you, but they did. It wasn’t because they had malicious intent, but because either they didn’t know better, were careless or weren’t thinking.  Also, the patient’s apology was ridiculous.

It’s a similar situation when you offend someone with your words and can’t understand or don’t acknowledge why they were offended. Having the attitude that people are just too sensitive or too politically correct is the equivalent to saying, “Sorry your head got in the way.”

The difficulty with words and colloquialisms is their context and meanings are continually changing. Things that were less offensive to say in the 1960s or even in the 1990s are no longer accepted. This isn’t because we are too sensitive; it is because we as a society discover or realize these words or sayings may be hurtful and offensive. We learn, we change and we do better.

I’m reminded of many of these words when I revisit some of the music I enjoyed in college. It makes me cringe when I hear it now, and I’m embarrassed that I never thought twice about what some of these lyrics and sayings meant and who might have been offended by them. Does this make me old and prude, or more experienced and aware? I like to think the latter. I hope all of us will continuously examine the words we use and ask ourselves if the words or sayings are no big deal, then why can’t we stop using them?

We will all make mistakes, and things are always evolving, just like they do in our profession. 

From an educational perspective, as we move to a higher professional degree level, I hope students will have more opportunities at the undergraduate level to be more civically engaged and take classes in areas such as history, religion and political science, as this may help gain insights into different cultures and viewpoints. These conversations should continue in every setting and at every level of our professional careers.

As a profession, we need to provide more ways for athletic trainers to receive more information, opportunities and resources about cultural and diversity competence, and we need to continuously stay informed and mindful as to how culture influences our patients and the way we provide care.