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Inappropriate euphemisms


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Friday, 10 June 2011

Inappropriate euphemisms

You can not stop people turning up at A&E for the wrong reasons. If you do, you risk stopping them presenting for the right ones.

That’s why we spend so much time pussyfooting around the subject.

The worried well will keep coming and the only ones who heed pleas to stay away are the dutiful ill, those who always feel guilty about using the NHS and would sooner bleed to death than cause any inconvenience to hard-working doctors and nurses.

NHS North West reported earlier this year that Blackpool PCT had reduced A&E attendance by 10%. The SHA credited the change with a successful “choose well” scheme to educate patients to use the right service at the right time.

The dramatic fall in A&E figures had as much to do with the opening of a new urgent care centre the year before as with good communications. Local people were not just told to make better choices, they were given a better choice. 

We use the euphemism “appropriate” rather than confront the fact that people often make foolish and ill-informed decisions about where to seek care. If you want people to think about what is or isn’t appropriate, you may need to choose stronger language.

The trouble with thoughtful, intelligent campaigns such as “choose well” is that they are aimed at the thoughtful and intelligent. These people are not the problem. Alcohol is a factor in a third of cases of A&E attendance and in 70% of cases at the weekend. Rather than educate people about the appropriate use of hospitals, educate them about appropriate use of booze.

Some of the most successful health-related advertising campaigns have used shocking messages. The “clunk, click” campaign of the seventies featured footage of real patients with facial injuries filmed in hospital. The adverts seem tame now, but at the time they were highly effective.

Before the campaign most people didn’t wear seatbelts. Afterwards most did.
People die in ambulances while A&E departments are dealing with nosebleeds and sprains. You can educate people to take their nosebleeds and sprains somewhere else or you can tell them about people dying. Education takes years, but getting a hard-hitting message across on TV takes about 30 seconds.

The PR consequences of a more robust approach won’t be pretty. Somebody “turned away by hospital” will die from time to time.

Let’s not confuse cause and effect. A badly run A&E department will kill people. A bad press never does.

dbishoptrainingtree says:
Jun 10, 2011 11:49 AM
A and E, MAU, pre op planning, out patient clinics..all are opportunities to deliver personalised feedback on alcohol use. brief interventions work best when delivered in a way that's relevant to the attendance. See the SIPs research for more ideas
CherryBomb says:
Jun 10, 2011 06:27 PM
CHarge bed and breakfast rate + treatment costs.
James_Andrew says:
Jun 14, 2011 12:38 PM
"Nosebleeds and sprains" are, I imagine, brought to A&E with the patient unsure whether something more serious has occurred i.e. is it a break or a sprain?

These people can and should be presenting for assessment - there's nothing wrong with being a "worried well". The question is where. As noted in the piece, a well-advertised local alternative will stream people over time as the concept sinks in.

The PR side *is* important, however. I think that every negative article just hardens people to go to the tried & trusted A&E rather than modify their behaviour and use a new fangled service.

Finally, I also have doubts about the usefulness of "hard-hitting" advertising. Are we not generally so used to gore and pain through TV, movies and games that mere imagery washes over us, no matter how real-life we are told it is? Perhaps there is evidence that this kind of thing does work - in which case go for it - but I'm sure it's much less effective than it was.