To the Editor:
I read with interest the article by Griswold et al (May 2005).1 The article characterized the patients who are more likely to have a high number of visits to the emergency department (ED). The study was well-conducted, confirmed previously reported data, and moved the field forward by adding solid new information.
In their article, the authors referred to the patients who had a high number of visits to the ED as "frequent fliers." I think that the use of this term, besides being misleading (patients do not get a free trip or enjoy visiting the ED frequently), dangerously stereotypes this group of patients. Stereotyping our patients should be avoided in medicine because it may lead to prejudice that will exacerbate the disparities in health care.2 This group of asthmatic patients has to deal with frequent asthmatic attacks that are poorly controlled. By calling them frequent fliers we add a stereotype to the specific sociodemographic characteristics reported by Griswold et al, which may impact the behavior of the physician during medical encounters. We should not forget that there have been reports suggesting that the race and socioeconomic status of the patient influences the physician's perception of them.3
Language plays an important and subtle role in the transmission of stereotypical views.4 Linguistic biases are believed to play a significant role in the transmission and maintenance of stereotypical views. I am concerned that by using the term frequent fliers in a prestigious journal such as CHEST, the medical community, without intention, minimizes the patient's problem and encourages an inappropriate use of slang in everyday practice. Remember the words recently written in a piece by Dr. Michael Burg: "What's off hand slang or shorthand lingo for you (physicians) really packs a wallop when it reaches a patient's ears."5
Alejandro Arroliga, MD, FCCP
Cleveland Clinic Foundation, Cleveland, OH
References
1 Griswold SK, Nordstrom CR, Clark S, et al. Asthma exacerbations in North American adults: who are the "frequent fliers" in the emergency department? Chest 2005; 127:1579-1586 Ovid Full Text Bibliographic Links Library Holdings [Context Link]
2 Balsa AI, McGuire TG. Prejudice, clinical uncertainty and stereotyping as sources of health disparities. J Health Econ 2003; 22:89-116 Full Text Bibliographic Links Library Holdings [Context Link]
3 van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians' perceptions of patients. Soc Sci Med 2000; 50:813-828 [Context Link]
4 Wigboldus DH, Semin GR, Spears R. How do we communicate stereotypes? Linguistic bases and inferential consequences. J Pers Soc Psychol 2000; 78:5-18 Bibliographic Links Library Holdings [Context Link]
5 Burg MD. A piece of my mind: Gomer. JAMA 2004; 292:1935-1936 Ovid Full Text Full Text Bibliographic Links Library Holdings [Context Link]
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Accession Number: 00002953-200512000-00046
