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'Beware the creeping danger of language that leads to blame'


What’s in a name? Quite a bit it seems. Researchers, writing in the subtly titled journal Evidence Based Medicine, have found that choosing the right name is the key to success in online dating.

Am I right in thinking you are reading this article because you expect to find advice on online dating? Yes. Of course.

Anyway, it appears that choosing a playful name beginning with a letter near the start of the alphabet is as important as an attractive photograph. I’m thinking Aardvark Fluffmuffin or Barnaby Lovebucket is the way to go - neither are copyrighted so feel free to use them to seek love and please invite me to the wedding.

“I’m thinking Aardvark Fluffmuffin or Barnaby Lovebucket is the way to go”

The power of seemingly neutral language never fails to fascinate me.

By quietly relabelling public services as the public sector, politicians have managed to shift the lens of a critical public to the cost of health or education rather than the purpose or effects of it. Similarly, the subtle difference between tax avoidance and tax evasion frames the former activity as something defendable or even common sense; using language to institutionalise the terms at all allows the idea that paying tax is actually negotiable.

The framing of fundamental moral principles as flexible may be the last skill required of a modern politician. Where once we might have hoped politicians existed to help make things better, now they appear to do little more than make economic decisions more palatable.

“The framing of fundamental moral principles as flexible may be the last skill required of a modern politician”

Take obesity, for example. We know the biggest crisis the NHS faces over the next 30 years is in public health. Long-term health problems associated with lifestyle choices or difficulties were made wholly apparent in the Wanless report over a decade ago and we also know that no amount of health education or public health initiatives seem to be changing that.

We also know that people who are obese can be stigmatised, which doesn’t actually help. Yet, because we have a language that offers a hierarchy of suffering - a deserving and undeserving sick if you like - we can entertain suggestions that range from charging for certain presentations in accident and emergency to the recent “let’s run this up the flagpole and see if it flutters” Tory suggestion to stop sickness benefits for people who are obese or have drug or alcohol problems and are not seeking treatment.

Let’s not get distracted here by the stick instead of carrot therapeutics underpinning that. Nor the economic imperative that says: “Well, we have to make some savings somewhere.” Frankly, if we are interested in economics we would readdress the tax avoidance/evasion issue.

“We find ourselves embroiled again in a language that labels, punishes, stigmatises and separates out the undeserving”

What strikes me as sinister is not the content of the proposed policy. I don’t believe it will happen because it would be too expensive and ridiculous to administer. However, with its suggestion, we find ourselves embroiled again in a language that labels, punishes, stigmatises and separates out the undeserving. Such a language helps us blame and re-emphasise the unpopular “other”. In simple terms, we institutionalise something close to bullying and it makes me uncomfortable.

It flavours much of modern politics and one likes to imagine it will pass, as much political manoeuvring does. But, in terms of healthcare, one worries what residue will be left. I wonder if the future of the NHS will be flavoured in part by the consensus on who is deserving of care, which is a powerful corruption of our first principle which was always to address what patients need.

Mark Radcliffe is senior lecturer, and author of Stranger than Kindness. Follow him on twitter @markacradcliffe


Readers' comments (5)

  • michael stone

    Using language to 'push the debate to the question you want' is what politicians do all the time, as you have pointed out.

    Slightly different, I have an issue with guidance that allows for 'a lot of interpretation': healthcare guidance should be relatively unambiguous, and not similar to 'diplomatic statements' which are deliberately framed so that they can be interpreted according to the whim of the reader. Most HCPs seem to read guidance as 'instructions': and unclear instructions, are a menace, not a help !

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  • seems mr stone, your fail to understand the semantics of guidance which is guidelines and not rigid laws carved in 'Stone' as you seem to wish them. this is of necessity as they have to be adapted to a almost infinite variety of individual situations by experienced clinicians. they are there to assist in providing best available evidence based practice from the worldwide experts in their field and allow for greater consistency in diagnostic procedures, treatment and care. the difficulties are in accumulating the relevant experience leading to their correct interpretation for all of these different situations and the more so if these situations are less common or junior staff have had less opportunities to put them into practice which is why we have interdisciplinary teams and staff of different levels of skill and expertise and can very quickly draw on that of others in the organisation, nationwide or worldwide as required. and please don't start off again with all of your yes buts we don't have time for your persistent trolling and it drags the level of discussion down on these threads each time if we have to keep bending down to you level to explain everything where it has repeatedly been done before.

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  • michael stone

    Anonymous | 25-Feb-2015 12:49 pm

    The truth is the opposite - it is HCPs who keep looking to guidance, whereas I keep telling them that they should be looking at the law itself:

    'And the fundamental difference between guidance and primary legislation, also has to be understood: for the MCA, the complexity introduced by section 42 re ‘the significance of further guidance’ is also very significant, but hardly ever discussed in clinically-authored material. The further guidance, unlike the Act itself, does not apply to ‘family carers’, and the people it does apply to (professionals, welfare attorneys, court deputies) only need to ‘have regard to’ the Code of Practice, etc. Section 42 introduces huge complications, for my area of concern (end-of-life patients who are in their own homes, when viewed from the patient/relative perspective). Any drift away from what the MCA itself says, towards ‘what makes operational sense to professionals’ in professional guidance, introduces a conflict between the Act which family carers have a duty to follow, and the professional guidance which is usually what professionals tend to follow.'

    You are right to point out that the problem is that 'junior staff' tend to follow the guidance when it makes no sense to do that.

    And I'm not talking about diagnosis, or about treatment - I'm talking about decision-making, and various other issues.

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  • michael stone | 26-Feb-2015 2:14 pm

    utter rubbish!

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  • Anonymous | 26-Feb-2015 9:53 pm

    don't feed the troll!

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