By: Michael A. Gisondi (@MikeGisondi)
Language evolves over time as words are added to our vernacular (e.g., selfie, Oxford Dictionaries’ ‘word of the year’ in 2013) or take on new meanings (e.g., no American newborn will be named Karen ever again.)
The older I get, the more I am frustrated by shifts in language. Imagine me sitting across the dinner table from my exasperated teenage daughter yelling, “You can’t say that, Dad!” to whatever innocent word choice blunder I made. (She is equally frustrated by misuse of new Gen Z slang, which I do intentionally to evoke said frustration. Ex: “Gyat, his rizz is so sus, it makes me want to yeet.” She would hate that.)
Medical terminology is subject to language evolution, as well. And similarly, I can get frustrated by such change. I am especially saddened by the apparent cancellation of the adjective, vulnerable.
Vulnerability is a longstanding concept in medicine. The medical lexicon includes vulnerable patients and vulnerable patient populations, though the nuanced meanings and interpretation of these terms have evolved over many decades.
The term vulnerable comes from the Latin word ‘vulnus’ for ‘wound.’ In general, vulnerable people are those who are at risk of some type of harm, such as threats to their physical, emotional, social, financial, or legal well-being.
In medicine, vulnerable may be used to describe patients who have a disproportionate risk of harm to their health and well-being due to poor health access, inadequate care, or health disparities.
If I describe someone as a vulnerable patient, it is because I am worried about them.
Certain groups are historically more likely to experience poor health care and health disparities, and this collective risk is connotated by the descriptor vulnerable patient populations. In 2013, Waisel said that, “vulnerable populations include patients who are racial or ethnic minorities, children, elderly, socioeconomically disadvantaged, underinsured or those with certain medical conditions.”
However, vulnerable has fallen out of favor in the last decade because casual use of the term is thought to be stigmatizing to patient populations who experience health inequities.
In 2023, Munari et al. wrote, “Being vulnerable could be seen as an intrinsic deficit, inferiority or inability to protect the individual’s own best interests… depicting them as ‘others’ who are powerless and in need of protection.” They added, “the concept of vulnerability in health care has been critiqued for being “centered around disempowerment … deficits, dependency and passivity.”
Is this how the term vulnerable patient has evolved? To be a form of victim shaming rather than an expression of compassion?
Munari et al. recommend using priority populations as an alternative to saying vulnerable populations, arguing that this term is forward-thinking, removes the perceptions of blame and inferiority from the group, and focuses on the obligation of the system to ensure health equity. They also warn of other similarly stigmatizing terms including ‘marginalised’, ‘disadvantaged’, ‘at risk’, ‘underserved’ and ‘disenfranchised’. Lots to cancel.
I’m going to play the role of a grumpy old man and say, I don’t like this!
To be sure, I am not arguing that vulnerable patient may be misused or misconstrued in disrespectful ways that yield negativity. Instead, I protest the cancellation of vulnerable because we lose the emotional nature inherent to the term.
Describing someone as vulnerable punches you in the gut and evokes empathy (if you are a caring person), no matter the context in which the word is used.
Vulnerable patients aren’t simply patients at-risk of health disparities; to me, those terms carry very different connotations, the latter being wonky and devoid of emotion. Instead, when I hear vulnerable patient I think patient at-risk of suffering from the harms that may befall them.
We often socialize scientific terms in medical education that fail to capture the human element. I don’t just teach my trainees to reduce health disparities, I teach them to reduce patient suffering. Isn’t that what medicine is all about?
Words matter. We should choose them wisely.
But I am a grumpy old man… and I refuse to cancel vulnerable.
Photo: open access image from https://www.pexels.com/photo/monochrome-photo-of-man-covering-his-face-1556716/
About the author: Michael A. Gisondi, MD is an emergency physician and medical education researcher living in Palo Alto, CA, USA. He is Professor and Vice Chair of Education in the Department of Emergency Medicine at Stanford University, and an Assistant Dean for Academic Advising at Stanford School of Medicine. X: @MikeGisondi Threads: mikegisondi
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