When we say ‘elective’ what we really mean is ‘scheduled’

As Canadian hospitals evolve with the COVID-19 pandemic and elective surgeries resume, it is a timely opportunity to reflect on the power of language in health care.

An “elective” medical procedure is one relating to, being, or involving a nonemergency that is planned in advance and is not immediately essential to the survival of the patient.

This may include anything from hip replacements, a subset of cardiac bypass and stent procedures and preemptive cancer surgeries.

There is no doubt that the COVID-19 pandemic has required hospitals to make difficult decisions in terms of balancing prioritizing surge capacity with the continuation of urgent and life-saving treatments. But what are patients hearing when the invasive and potentially frightening procedures they have consented to are labelled as “elective” when they were previously told they were likely necessary? Is it time that we rethink this term, and the message it is conveying to our patients?

It is well established that poor communication in the health care settings leads to worse health outcomes, decreased patient satisfaction, decreased compliance with treatments and increased malpractice risk.

In the last few decades medical schools and other health professional programs have responded by beefing up professionalism, ethics and communication skills training. As early as at the level of admission, future doctors are evaluated on their communication skills and ethical approaches.

The effort is there, but the culture hasn’t completely healed. “Bounce back” is still often used instead of “readmission.” “Frequent flyer” continues to refer to a patient who seeks care often. And “Indian File” continues to be a descriptive term used to describe the appearance of certain breast cancer cells in pathology textbooks, referencing the way the First Nations were described by settlers having walked in single file.

The disclosure that physicians use inappropriate language about patients is not new. The highly successful novel “The House of God” introduced the concept into popular mainstream over 40 years ago. But good communication goes beyond just socially appropriate communication. After all, health care providers need to be precise in their language, while still being able to convey complex medical information in an easily understood way.

This point was solidified for me many years ago when I saw fear in my Polishspeaking immigrant grandmother, when she left her family doctors office thinking she had cancer. Her well-intentioned family physician was able to communicate with her in Polish, but had used a Polish term that, in translation, lost the essence of reassurance that comes with what turned out to be a pre-cancerous diagnosis.

Precision of language is extremely important in health care. Not only is it important that we avoid using judgmental or culturally insensitive terminology, but when we can, we should anticipate the interpretation of wellintentioned benign words.

What we really mean by “elective” is in fact “scheduled.” This subtle word difference avoids the confusion and cognitive dissonance patients face when they are told that their hip pain, occluded heart vessels and pre-cancerous lesions are thought of as “elective” by their health care providers.

Patients want to be heard and have their symptoms acknowledged. Hospitals need to be able to schedule care in a prioritized way with finite resources.

Let’s call it what it really is.