Person first language is the conscious change in sentence structure when referring to a person with a diagnosis in order to shift focus to the person, not the diagnosis.
PFL places the focus on a person who has a diagnosis instead of emphasizing the diagnosis before the person.
Health professionals can and should use PFL to humanize their patients, which helps providers see patients as whole people outside of a medical diagnosis.
Some people with disabilities prefer Identity First Language, so it’s important to refer to people in the way they prefer to be identified.
Why PFL matters
About 1 in 5 Americans, or 54 million people, have a disability and 133 million people have at least 1 chronic condition. Despite how common disabilities and chronic conditions are, people with these diagnoses are often perceived as helpless and inferior to people without these conditions. The media fuels stereotypes that patronize people with disabilities and chronic conditions and underestimate their capabilities as individuals.
PFL avoids this dehumanization by putting emphasis on the person as a human before their condition and rejects the notion that groups of people with a disability are all the same. Advocates of PFL say that without PFL, we reinforce that certain traits or groups of people are inherently “bad”, leading to additional bias beyond systemic discrimination. Ultimately, PFL aims to recognize a disability or chronic condition as a part of a person’s identity, but not the primary attribute of their character.
PFL in Medicine
As of 2007, PFL is a requirement in the AMA manual of style for academic charting. While PFL is widely used in academia and in health professional schools, it is not commonly practiced in the clinical setting. Patients are frequently referred to by their diagnosis (ex: STEMI patient, UTI patient, etc) in conversations and in patient education materials. When healthcare professionals don’t use PFL, they place a barrier between themselves and their patients, preventing them from seeing their patients as whole people rather than case studies. PFL helps providers provide patient-centered care and consider factors that may affect patients’ lives as a whole person outside of their diagnosis.
Medical records are an application where PFL should be broadly used to promote person-centered care. In these examples of EHR entries from allnurses.com, it is clear that PFL promotes more compassion toward patients:
Medical record entry, non-PFL:
“Stroke patient, 61-years-old arrived to the floor at 0801. He is myopic and has a cancerous history. He is handicapped with left-sided weakness of upper and lower extremities and emotionally disturbed. The patient will likely be wheelchair bound during the hospital stay.”
Medical record entry, PFL:
“Mr. Jones, a 61-year-old male with recent stroke symptoms arrived to the floor at 0801. He wears eyeglasses and has a history of prostate cancer. The assessment revealed left-sided weakness of upper and lower extremity. He is tearful when discussing his condition. Due to the weakness, he will be using a wheelchair when out of bed.”
PFL Criticism within the Disability Community
Some groups within the disability community object to the idea of PFL and choose to embrace Identity-First Language, particularly the Deaf community. The Deaf community believes that deafness is not a disability; rather that you are a part of a community of people with hearing impairments. Other critics within the disability community feel that PFL tries to completely separate the disability from the person, which can imply that the disability is a negative characteristic.
Overall, how a person chooses to self-identify is up to them. How we address someone should emphasize a person’s abilities rather than their limitations. They should not be criticized for choosing identity-first language over PFL. Ultimately, while the use of PFL is a step in the right direction for disability advocacy and a person-centered approach to healthcare, it’s not a perfect solution and should be used with the understanding that PFL isn’t accepted by everyone.
Outside the Huddle