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Mr Cayton has made the very useful contribution of reminding us that language, however simple, always gives away our attitudes.1 Much research has shown that most of these attitudes are both communicated and received unconsciously.
I recently reviewed the unconscious attitudes portrayed in information leaflets given to patients attending departments of radiology in two teaching hospitals for day-case or outpatient procedures, using standard techniques in functional grammatical analysis. The leaflets were extremely courteous, as Mr Cayton recommends, but they consisted almost entirely of instructions: the patients were repeatedly put under social pressure to conform to the wishes and requirements of the radiology staff. On the other hand, there was no documentation of any requirement to respond to the patients' wishes and the staff themselves appeared to have an extremely authoritative position. Most surprising of all, the only route of communication of anything other than demographic details mentioned for the patients was by means of a formal complaint to the Trust authorities. This was all in spite of the fact that at least some of these leaflets had been approved by the central Trust information committee.
In this case, an obvious plea in mitigation is that patients have to be examined in a routine manner in order to produce reliable results, and I am not necessarily advocating a major change in our practice. What has surprised me is that, when these results were presented to them, none of the professional people involved realized that such attitudes could be communicated like this.
Thus, Mr Cayton's proposal of forced change of language will not usually affect underlying attitudes, as many health professionals do not always have insight into their own attitudes and their own use of language. Changing underlying attitudes, of course, will be much more difficult.
Competing interests None declared.