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choice of words affects choice of treatment


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MedicalXpress has an article about how the name a patient is given affects the choices made by the patient.  How your doctor describes your medical condition can encourage you to say 'yes' to surgery when there are other options

1,308 people from five countries, some with and without shoulder pain, who were randomly allocated to read one of six hypothetical scenarios. The only difference between the scenarios was the medical term used by the health professional

Health professionals use a variety of terms for [pain at the front of one of their shoulders which is made worse by lifting the arm and lying on it], including "subacromial impingement syndrome," "rotator cuff tear," "bursitis," and "rotator cuff related shoulder pain."

The terms doctors use vary so widely because it's currently impossible to pinpoint the exact cause of most shoulder pain, even with the help of sophisticated technology such as magnetic resonance imaging (MRI).

We found people told they had a "rotator cuff tear" wanted shoulder surgery the most. Those told they had "bursitis" (inflammation of a fluid-filled sac in the shoulder) wanted surgery the least. People told they had a rotator cuff tear had 24% higher perceived need for surgery than those told they had bursitis.

Based on this, the authors estimate More than 20,000 potentially unnecessary shoulder surgeries are performed in Australia each year, which we estimate to cost over A$200 million per year.

There's a type of abnormal breast cells that can build up in the milk ducts called "ductal carcinoma in situ." For many people, these cells are low-risk and won't grow, or grow so slowly they'll never cause harm.

Using the terms "cancer" or "carcinoma" to describe this condition elicits strong negative reactions from patients, and increases their desire for more aggressive treatments, including surgery.

For patients with these low-risk cells, surgery, radiotherapy and/or hormonal treatments may not improve overall survival

They found similar results for conditions like acid reflux, pink-eye, and polycystic ovary syndrome.  Perhaps one of the benefits of a second opinion is a different set of words.

A personal favorite in wording was McDonald's Quarter Pounder.  I've often wondered how many 4 Ouncers would have sold.

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Hi Coryboro!

In the shoulder example, you describe several completely different conditions, all of which produce a similar symptom.  Clearly, a patient having their pain described as being one of these conditions is not merely being giving a different phraseology for the same thing -- they are different conditions.  Any rational person would be more likely to choose surgery for the more serious conditions -- this is not a matter of the physician producing different patient decisions through semantics.

Perhaps the single payer health care system in Australia may force more limitations on the use of diagnostics -- in which case, there would be less possibility for the physician obtaining the diagnostic tests to distinguish between the very different conditions.

  --  Saul

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