Language is just one of the many clinical tools available to the endocrinologist but, as with all tools, its careful use needs to be learnt.

Endocrinology is a specialty characterised by complexity, chronicity and long-term therapeutic relationships. Clinicians care for a wide and diverse patient population, many of whom attend regular follow-up appointments, undergo repeated investigations and remain on treatment for prolonged periods, sometimes lifelong. 

In this setting, and to engage patients effectively, communication should not be considered a ‘soft’ skill, but as a core clinical competency. Language plays a central role in fostering trust and supporting collaborative partnerships that underpin effective care. Successful communication extends beyond word choice alone, encompassing how clinicians listen, respond to non-verbal cues, convey tone and demonstrate empathy.¹ 

Although effective communication is fundamental to clinical practice, evidence suggests that doctors elicit the patient’s agenda in only a small minority of consultations.² Failing to explore concerns fully can lead to patient frustration, disengagement and reduced trust.

THE EXAMPLE OF BODY WEIGHT

 

Discussions around body weight illustrate particularly clearly how language can influence engagement. Many endocrine conditions, including type 2 diabetes, polycystic ovary syndrome, hypothyroidism and Cushing’s syndrome, involve difficult conversations about weight. 

 

Patients may already carry a sense of self-blame, and those living with overweight or obesity frequently experience prejudice, ambivalence and suboptimal care within healthcare settings. Negative stereotypes about obesity remain prevalent among healthcare professionals,^3,4 and patients often perceive such attitudes as ‘fat-shaming’. 

Weight stigma can harm both physical and mental health⁵ and act as a barrier to diabetes care, contributing to patient disengagement.⁶ Importantly, its impact is not confined to obesity-related conditions. In thyroid disease, for example, weight stigma has been linked to reduced adherence to treatment, diminished trust in clinicians, lower perceived empathy and weaker therapeutic relationships.⁷ Together, these findings underline the need for careful, considered communication when addressing weight-related issues in endocrine practice.³

ADOPTING EFFECTIVE APPROACHES

Traditional directive language risks reinforcing disengagement and undermining the doctor–patient relationship.⁸ In contrast, communication approaches that emphasise partnership, motivation and mutual goals are more likely to support engagement and sustained behaviour change. Open-ended questions, acknowledgement of progress and setbacks, and collaborative problem-solving enable patients to feel supported and involved in decisions that are achievable and acceptable.⁹

A first step is recognising that certain terms and phrases may be experienced as damaging, regardless of intent. Words such as ‘compliance’, for example, imply failure and reinforce a hierarchical model of care in which responsibility rests solely with the patient. 

 

Framing conversations around partnership and shared decision-making, rather than instruction and blame, aligns with contemporary models of patient-centred care relevant in endocrinology, where patients may present with vague symptoms such as fatigue, ‘brain fog’ or mood disturbance. Actively listening, exploring concerns without judgement and validating patients’ lived experience, even when investigations appear normal, are central to maintaining trust and engagement.¹

 

ADAPTING LANGUAGE TO PATIENTS’ NEEDS

Language should be regarded as a clinical tool, used with awareness and adapted to each patient’s needs. This includes accounting for health literacy, a key social determinant of health, and ensuring communication is clear and accessible for patients with varying literacy levels.³ 

Cultural background and language proficiency also influence engagement, and patients for whom English is not a first language often experience poorer health outcomes.³ In such cases, professional interpreters should be used proactively, together with plain, jargon-free language. Avoiding metaphors and idioms and checking understanding through open questions helps ensure messages are received as intended.

DIGITAL INFORMATION AS A ROUTE TO DISCUSSION

Alongside these longstanding communication challenges, the digital information landscape has introduced new complexities into clinical consultations. In an era shaped by artificial intelligence and social media, patients increasingly consult online sources, including ‘Dr Google’ and, more recently, tools such as ChatGPT. 

While clinicians may have concerns regarding misinformation and unnecessary health anxiety, many patients use online information to explore and supplement their understanding of symptoms and diagnoses.¹⁰ When addressed openly and without judgement, these discussions allow clinicians to clarify misconceptions, answer questions and strengthen the therapeutic alliance. The digital world has the potential to transform patient engagement from a traditionally passive model into a more collaborative partnership.

BREAKING DOWN THE HIERARCHY

Ultimately, breaking down hierarchy within the doctor–patient relationship is key to engaging patients in endocrinology. Moving away from paternalistic models towards collaboration and shared understanding reflects the realities of modern endocrine practice. Acknowledging the complexity of the endocrine system and working alongside patients to navigate it may help them feel less overwhelmed, more informed and more engaged in their care.

ANJALI AMIN
Consultant in Diabetes and Endocrinology, Imperial College Healthcare NHS Trust and Honorary Clinical Senior Lecturer, Imperial College London

REFERENCES

1. Silverman J et al. 2016 Skills for Communicating with Patients, edn 3, London: CRC Press https://doi.org/10.1201/9781910227268.
2. Singh Ospina N et al. 2019 Journal of General Internal Medicine https://doi.org/10.1007/s11606-018-4540-5.
3. NHS England 2023 Language Matters: Language and Diabetes, edn 2 https://www.england.nhs.uk/wp-content/uploads/2018/06/language-matters-language-and-diabetes-v2.pdf.
4. Puhl RM & Heuer CA 2012 Obesity https://doi.org/10.1038/oby.2008.636.
5. Westbury S et al. 2023 Current Obesity Reports https://doi.org/10.1007/s13679-023-00495-3.
6. Phelan SM et al. 2015 Obesity Reviews https://doi.org/10.1111/obr.12266.
7. Snyder M et al. 2022 Journal of Health Psychology https://doi.org/10.1177/1359105320963548.
8. Street RL et al. 2009 Patient Education & Counseling https://doi.org/10.1016/j.pec.2008.11.015.
9. Elwyn G et al. 2012 Journal of General Internal Medicine https://doi.org/10.1007/s11606-012-2077-6.
10. Luo A et al. 2022 Journal of Medical Internet Research https://doi.org/10.2196/23354.