Monday, February 11, 2019

What's in a name...Words matter!

A rose by any other name
would smell as sweet - Shakespeare
Shakespeare's saying  is interpreted to mean that the "names" we give to things does not affect what the things actually are...however the word used to represent a concept can be critical to universal understanding.

One of the goals during the development of the standardized language for dietetics was to use plain english language terms for easy understandability.  But the term selected also had to be precise enough to clearly identify a singular unique problem that a dietitian could address.

When selecting words to become terms, the emphasis was on clarity and accuracy--generally assuming that the purpose of the communication was from healthcare professional to healthcare professional.  The emphasis was not on political correctness or acceptability of using the terms from the clients' perspective.  The terms were not developed with the intention that the dietitian would actually use the words in conversations with clients.

Over the years there have been concerns about the actual words selected.  The first concerns came from the hospital legal experts who were concerned about legal liability if the dietitian identified "inadequate" intake.  They were worried that the word "inadequate" could be construed to be assigning "blame" for the inadequacy to the healthcare organization and therefore generate potential for liability/lawsuits.  The Academy sought legal advice.  The lawyer reviewed terms used by other healthcare professionals and concluded that our term was similar to other terms in use and that it should not generate liability any different than other currently used terms when used appropriately. 

However to ease the concern, the concept of a synonym was introduced.--another word or term that could be used that would mean essentially the same thing.  The alternate term selected for inadequate was "Suboptimal" intake.  Likewise for terms with "deficit" such as "Food and Nutrition Knowledge Deficit," the approved wording could be "Limited food and nutrition knowledge".  These term seemed "softer" and were chosen as the official synonym that retained the same definition and reference sheet as the original term.

The reference sheets for these terms includes a note at the bottom indicating what would be considered alternate working.  See example below:
     *If a synonym for the term "inadequate" is helpful or needed, an approved alternate is the word "suboptimal" (1))

Another concept was discussed at that time was whether local healthcare organizations who had electronic health record could develop local synonyms or alternate wording/abbreviations to appear in the text of the chart.  While this concept was discussed, the decision was made to have synonyms considered at the Academy level and if approved they would be included in subsequent revisions  to maintain consistency in use of the terms by all users.  Any user can submit a request to have a synonym considered using the process identified on the Academy website.(2)

Within the first ~5 years of development of the language, some healthcare organizations were moving toward "shared" medical records where the clients had increasing access to all information in the E H R.  At that time, there was one other term that was identified that might negatively impact client-dietitian rapport if the patient were to read it in their medical record -- "Unsupported beliefs/attitudes about food or nutrition-related topics".  In this case, a cautionary note was included in the eNCPT manual to alert dietitians that while these terms might be completely accurate, they might be inflammatory to clients and to use with caution.  See example below:
While this term was not very "patient/client friendly",  the committee could not find suitable alternate terms to convey the same concept.

Many other terms that may be accurate, could also be perceived negatively by patients if they disagree with the healthcare professional's assessment.  For example those who are consuming large quantities of alcohol may object to having "excessive alcohol intake", "Not ready for diet/lifestyle change", "inability to manage self care", or a number of other terms that describe problems that need to be addressed by dietitians.  As more organizations view the E H R as a shared document used by the healthcare community AND the client, these issues will likely become more important.

Finding the balance between terms used by healthcare professionals and client friendly words is likely to be a larger issue in healthcare--not just confined to dietetics terminology.

In the meantime, if users of the eNCPT believe that a synonym needs to be developed for a current term, they can submit suggested terms for consideration by the Academy to begin the formal dialogue. (2)


(1)   Step 2.  Nutrition Diagnosis, eNCPT Manual. Available at  Accessed Feb 1, 2019.
(2)  eNCPT Reference Manual - Submission for Changes.  Available at:;  Accessed Feb 1 2019.
(3)  Unsupported beliefs/attitudes about food or nutrition-related topics Reference Sheet.   eNCPT Manual. Available at  Accessed Feb 1, 2019.