:: to the teeth ::    thoughts on social justice, medicine, race, hope and beats

"Another world is not only possible, she is on her way.
On a quiet day, I can hear her breathing." :: Arundhati Roy ::

"The most common way people give up their power is by thinking they don't have any." :: Alice Walker ::
Sunday, November 20, 2005  

Language is Power.

Alright folks, gather 'round. I've got to tell you something: I'm on a mission. I'm on a mission to break down some of the language we use that's absolutely loaded with stereotypes, judgments, and institutionalized racism in our society, and more specifically, in the casual and serious discussions that occur around medicine and health.

Some may call me touchy or politically correct. First of all, "PC" is so 1990's. It's trite, overused conservative soundbite that has, in the past, put thinking people back into shut-up mode. Likewise, the words "touchy" or "sensitive" are attack words used to effectively shut down any rational discussion of anything.

SO, i'm beginning an installment on this blog, of things I come across, in daily conversations and in the press, related to these issues. Placing blame ain't my thing, my aim is not to say that x or y person is stupid, racist, or otherwise piglike. But I'm trying to encourage folks to become more aware of the use of their words, and I'm doing the same in the process (as I'm becoming more aware of my use of words, judgments, etc, I'd think *I* was a smelly pig. I don't want to think that of myself, so I won't think that of others, unless they truly are smelly pigs).

A first quick example is below -- a paragraph from an article on doctors fighting medicare payment cuts:
Dr. Cyril M. Hetsko, a trustee of the association, said paying doctors for their
performance might be a desirable goal. But he added, "Depending on how the
program is set up, it could have the unintended effect of reducing payments to
doctors with black and Hispanic patients in inner-city neighborhoods, while
rewarding doctors with healthy, better-motivated patients in affluent suburbs."

Now even though Dr. Hetsko is a trustee of the American Medical Association, and I have openly stated some of my strong opinions about the AMA in this blog, I'm not attacking Dr. Hetsko nor am I attacking the AMA in my remarks on his paragraph. In fact, I commend Dr. Hetsko for looking out for the docs who work in resource-poor inner-city neighborhoods. If a program is set up to document the decrease in patients' Hemoglobin A1C (a marker of longer term control of diabetes) over time, as a quality indicator of a physician's effectiveness, there are a ton more barriers to lowering this marker in resource-poor, economically poor neighborhoods. A discussion for another day and time would entail what should and shouldn't count as good quality indicators in health provider-care.

My issue with the good doctor's statement is the fully loaded term "better-motivated". What's the opposite of better-motivated? Lazy, of course. Again, I'm not saying that Dr. Hetsko intends to call some folks not-lazy and other lazy. We all get the gist of what he's getting at with "better motivated" (people in affluent communities can focus more on improving their health and have other advantages such as being able to pay for their medications with more ease) but perhaps there's a different way to say it. Because I sure know that the patients I see in my county hospital and clinic are super-highly motivated -- often balancing two jobs, sometimes with school, sometimes with families of their own, and often dealing with life stressors that folks in affluent neighborhoods may never face.

Alright, enough of this. Next time I post on this topic, I'll try to share a more personal experience than something I read in the paper (perhaps an overheard conversation or *gasp* something I caught myself saying.

Language is power. Word.

posted by Anjali Taneja | 11/20/2005 12:49:00 AM | |


What's the opposite of better-motivated? Lazy, of course.

I'm not sure I'm convinced by this line. If your'e right, and the implication is that the inner-city neighbhorhood patients are generally lazy, then your analysis and critique fully holds and I applaud you for it. But that's not how I would have read it. Motivation, to me anyway, does not exist on the exact same dimension as laziness/diligence or more neutrally, more or less effort. Rather, it has to do with a state of mind--it's as much a measure of hopefulness and focus as willingness to expend effort. With that connotation of hope and focus, it's also a more targetted adjective. Better-motivated about what? About fixing their health. Given the severe disadvantage that poor urban minorities have in healthcare, I wouldn't be surprised if they are generally less motivated. In fact, I wouldn't be surprised if motivation to fix one's health tracks much more proportionately with health than most things. We no longer use the phrase, "the best food money can buy," b/c there's a point at which money can't really buy you better food in our society, just fancier food. The benefits of being wealthy on food-consumption level off quickly with income, and on the whole, a bigger portion of the population has access to adaquate nutrition than, say, 100 years ago. (Whether they use that access is another matter.) We still do use the phrase, "the best healtchare money can buy." There's a strong understanding at all levels of society that "if I had more money, I could probably be healthier." Health-care is one of the great symptoms of inequality, more so than even education and housing, as you all are well aware. We are all profoundly aware of this, even if we can't articulate it. Such awareness has to impact some people's motivation. I think in Noonday Demon Andrew Solomon talks about the profound extent to which depression plagues the poor--invisibly--and the greater extent to which it is likely to ruin their health.

Your general point is totally on spot, of course. Language is dreadfully important, and it has a huge impact on psychology, and in turn, on motivation. Influential people need to recognize the responsibility they have for precise phrasing.

# posted by Blogger Saheli : 11/25/2005 2:56 PM  

i totally agree with both of you... and you bring up such an important point about motivation. we have a tendency in this world to think of motivation in a very capitalist economic theory kind of way: you either choose to work or not to work (labor and leisure) and this decides supply and demand... so you either choose to be motivated or lazy. like it just happens in a vacuum, cause people don't want to believe that their successes has anything to do with things outside of themselves. and like people don't want to be motivated: whenever i've had this discussion (why does it always seem like it's with significant others?) i always ask- do you think people don't want to be healthy and successful and happy? or are you just happy to think that other people are too ignorant to know/ want something different? and this seems to drive a lot of development-type stuff: just use condoms, exercise more, stop smoking, but we're not going to deal with you being a single mom with an abusive boyfriend because if you don't want to get out of that situation then what can we do? (sorry y'all, had a rough day at clinic... so deep, so priviledged to have these points driven home to me on the regular) but point being, this notion of where motivation comes from is so key- and it is possible to harness that energy within people's oppressive social situations, which of course people do on their own all the time. true development and change in general then comes from two sources i think: both from changing the socio-econo-political context that people live in, and by using creative means of enabling the inherent motivation that we all have.
happy new year ;)

# posted by Anonymous manel : 12/31/2005 11:34 AM  

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