How to Write for Equity and Inclusion in Medicine
Language is powerful. The words we use—and how we use them—can profoundly impact our message and how we make people feel. This feeling is often what connects authors and readers, even in objective fields like science and medicine.
We may not always be aware of the subtle ways that our language can (unintentionally) impart bias or judgment. Or how even small changes in a word or order of words can affect the meaning and connotation of our message.
To help you become more aware of these nuances in your writing, here are some things to keep in mind when writing for equity and inclusion in science and medicine.
Inclusive Language
Inclusive language does not exclude any part of society. It does not classify a person or persons to a singular identity or categorize them in a specific stereotype. It also does not generalize populations. For example, instead of using the generalization minorities, use a more specific term, such as Hispanic or Asian.
Avoid: White and minority patients participated in the study.
Preferred: White, African American, and Hispanic patients participated in the study.
Race and Ethnicity
Some writers use race and ethnicity interchangeably. While these concepts can overlap, they are distinct. Race refers to a category of humankind that shares certain distinctive physical traits. Ethnicity refers groups of people classed according to common racial, national, tribal, religious, linguistic, or cultural origin or background.
Because these terms are cultural constructs that can have biological implications, you should explain how people were classified regarding race, ethnicity, or both. You should also explain who defined these classifications (eg, predetermined by the researcher, self-reported by the participant) and why they were assessed.
Also, remember to be sensitive to the designations that individuals or groups prefer. For example, some people prefer being classified as Black rather than African American, or vice versa. Also, be aware of how these preferences may change. Not everyone in a group will agree with the classification.
Sex and Gender
Gender is often confused with sex, but these terms describe two different things. Sex refers to the biological characteristics of males, females, and intersex persons. However, gender is a spectrum. It is a cultural indicator of a person’s personal and social identity.
While writing, you want to consider how specific you need to be. In other words, specify sex when it is relevant. In research, you want to report and define sex or gender and how you assessed it. Outside of research, however, choose sex-neutral terms that avoid bias.
Avoid: The female physician treated the patient.
Preferred: The physician treated the patient.
Exception: If you are comparing practices of male and female physicians, then you would want to specify the physician’s sex.
Avoid: The disease threatens mankind.
Preferred: The disease threatens humankind.
Personal Pronouns
Similar to sex/gender, you want to avoid sex-specific pronouns unless they are relevant. For example, avoid using common-gender pronouns, such as s/he, shem, and shim. They and them (as a singular form) are becoming more commonly used. However, you can also reword the sentence to use pronouns that are not sex-specific.
Avoid: The physician and his resident performed the surgery.
Preferred: The physician and their resident performed the surgery.
Better: The physician and resident performed the surgery.
Sexual Orientation
Reference to a person’s sexual orientation follows the same guidelines as sex/gender and personal pronouns. Only indicate sexual orientation when it is scientifically relevant.
When referring to specific groups, the terms lesbians and gay men are preferred to homosexuals. Also, avoid using gay or gays as a noun. You may, however, use heterosexual, homosexual, bisexual, asexual, and intersex as adjectives (eg, heterosexual men).
Avoid: The researcher collected surveys from homosexuals.
Preferred: The researcher collected surveys from lesbians and gay men.
Age
Ageism is discrimination based on age (young or old). Avoid using terms that imply a stereotype, such as seniors, elderly, and the aged. And in research studies, always state the specific ages or age groups.
Avoid: The study compared the effects of the drug on elderly patients.
Preferred: The study compared the effects of the drug on patients 65 years and older.
Avoid: The physician measured BMI in young children.
Preferred: The physician measured BMI in children between 2 and 6 years old.
Socioeconomic Status
Labeling is a form of bias or stereotyping. Avoid labeling people with their socioeconomic status. Rather than use terms like the poor or the unemployed, use low income or no income.
Avoid: We determined mortality rates in the poor.
Preferred: We determined mortality rates in persons from low-income households.
Persons with Diseases, Disorders, or Disabilities
Similar to the discussion about socioeconomic status, you want to avoid labeling (ie, equating) people with their disabilities or diseases. Some examples of this labeling include diabetics, schizophrenics, and epileptics.
Avoid: The patient is a diabetic.
Preferred: The patient has diabetes.
This labeling can also occur in a more subtle form. Some researchers run into trouble when describing patients with a particular condition, such as breast cancer. They will describe the patient by using the condition in an adjectival form: breast cancer patient. This phrasing can be okay when used enough times to create awkward text, but it is not preferred.
Avoid: The study assessed COVID-19 patients.
Preferred: The study assessed patients with COVID-19.
Avoid: The physician treated the autistic patient.
Preferred: The physician treated the patient with autism.
You also want to avoid describing persons as victims or other emotional terms that suggest helplessness, such as afflicted with or suffering from.
Avoid: The patient suffered from a myocardial infarction.
Preferred: The patient had a myocardial infarction.
Also, avoid euphemistic descriptors, such as physically challenged, special, or special needs.
Avoid: We evaluated children with special needs.
Preferred: We evaluated children with autism.
Mindfulness in Your Message
Language and society constantly evolve, so these recommendations will likely change in the future. The best advice we can give is to be mindful of the language you use and what message you want to deliver. And you if you have trouble noticing these nuances in your writing, work with a professional editor to help you find them.
Resource: AMA Manual of Style, 11th Edition
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