Speaking power to suffering

Ben Hoban is a GP in Exeter.

Our local hospital has recently started including a glossary of technical terms in letters to patients, presumably to make it easier for busy clinicians to communicate with people who are not healthcare professionals. In the old days, of course, specialists would write instead to GPs, who acted as their interpreters. We would consider this high-handed now, both on the basis that patients are entitled to be addressed directly and because it represents a significant delegation of work from secondary to primary care. However we approach it, though, there is a language barrier between the specialist, who thinks in terms of technical problems and how to solve them, and the lay person, who is more concerned with their own experience and how to make sense of it. Anyone working in general practice soon learns to be bilingual.

It has been pointed out that doctors’ use of language often disempowers patients.¹ Medical practice is inherently conservative and it is perhaps unsurprising that we have preserved attitudes and expressions that would be considered outdated elsewhere; we speak a dialect with its own codes and conventions which overlaps with everyday speech in ways that can feel jarring. It is uncontroversial to want to avoid belittling or offending people, although it can be difficult in practice to know how best to go about it. Should we be consistent in how we talk about things amongst ourselves and with patients, without shying away from technical terms and medical turns of phrase, or should we adapt our language to our audience? Put another way, should we regard one form of speech as normative, and if so, whose norms should we adopt?

Some patients certainly seem persuaded that it is up to them to speak more like doctors, although they may simply have discovered that using medical jargon is a more efficient way of getting what they are looking for, a shortcut that bypasses the questioning stage of the consultation.² Viewed rationally, it makes sense when appealing to power to use the language of power, although this assumes that the limiting factor in healthcare is indeed that. General practice has expended considerable effort developing the contrasting view that we are limited more by a lack of understanding, and that in order to help someone, we need not just to be willing to act on their behalf, but also first able to enter the world of their experience and concerns.³ If we want to hear what someone is telling us, we need to learn their language, even if they are busy trying to speak ours.

Among the bilingual, our choice of language inevitably affects both our perception and our decision-making. We are professionally committed to a biomedical understanding of what our patients tell us, although we recognise too that much of it makes better sense within the wider context of their life. We are therefore constantly having to decide how best to listen. We can tune our ear to the elements of someone’s story that fit into an appropriate disease narrative, or recognise instead the sound of authentic testimony, accepting their experience as valid without necessarily being able to explain it. These two hermeneutic languages have their own vocabulary and prosody, although they overlap too, and there are times in a consultation when it is impossible to know whether we are speaking one or the other, or indeed both at the same time. Serious disease is always a personal experience for someone suffering from it, and suffering without disease must still express itself in the terms our society makes available within a healthcare setting. What is at issue in the consultation, then, is how to manage this ambiguity, and whether or not to frame someone’s difficulties as suitable for medical intervention. Patient and doctor may disagree, and reassurance sometimes sounds too much like rejection; GPs must act as gatekeepers, not just of biomedical care, but of biomedical validity.⁴  As with any exercise of power, this has the potential to harm, regardless of our intention, and references to medical gaslighting demonstrate that those on the receiving end may not just feel hurt, but oppressed.^5,6

It is undeniably true that the patient sitting in front of you either has  something serious like a tumour or doesn’t, just as words have a specific dictionary definition, according to which they mean one thing rather than another. In conversation, however, we usually leave the dictionary on the shelf: the sense of what we say is communicated more dynamically using whichever words come to mind, assembled into incomplete sentences, approximating a meaning which is nevertheless understood. Day-to-day language is improvised and cooperative, more like a game of charades than a darts match.⁷ The mark of successful communication is not that I have been sufficiently precise to hit my target, but that we have collectively agreed what certain gestures or symbols can and cannot represent. In the same way, the question which the consultation must address is not strictly whether the patient actually has a tumour, but how instead to articulate the possibility that they might, while also considering alternative ways of understanding their presentation. That is something which must be agreed on; it cannot be decided by one party in isolation, or at the other’s expense.

Language represents the power to determine how someone perceives and relates to the reality of their experience. We disempower patients not primarily by expressing ourselves poorly, but by deciding in advance how to express ourselves at all. If we really want to empower those who are suffering from illness, it is not enough simply to update our script. Before we can decide what to do, we must decide first which language we are speaking, and we must do this collaboratively; we should not need a glossary. 

References

1. Caitríona Cox and Zoë Fritz, Presenting complaint: use of language that disempowers patients, BMJ 2022;377:e066720 doi.org/10.1136/bmj-2021-066720
2. Harry Quinn Schone, Contested Illness in Context: An Interdisciplinary Study in Disease Definition, Routledge, 2019
3. Tuckett D, Boulton M, Olson C, Williams A. Meetings Between Experts: An Approach to Sharing Ideas in Medical Consultations. London: Routledge, 1985
4. Joanne Reeve, Medical Generalism, Now! Reclaiming the Knowledge Work of Modern Practice, CRC Press, 2023
5. Nielsen KM, Nordgaard J, Henriksen MG. Fundamental issues in epistemic injustice in healthcare. Med Health Care Philos. 2025 Jun;28(2):291-301. DOI: 10.1007/s11019-025-10259-6. Epub 2025 Mar 7. PMID: 40053307; PMCID: PMC12103466.
6. Faytong-Haro M. Medical gaslighting: navigating patient-clinician mistrust in healthcare. Front Health Serv. 2025 Nov 20;5:1633672. doi: 10.3389/frhs.2025.1633672. PMID: 41357534; PMCID: PMC12675331.
7. Morten H Christiansen and Nick Chater, The Language Game: How Improvisation Created Language and Changed the World, Bantam Press, 2022

Featured Photo by Giulia May on Unsplash