Me talk doctor talk one day.

Me talk doctor talk one day.

In the July 2015 Medical Ethics Advisor, I’m quoted in an article “Do physician assume they know older patients’ wishes? Negative stereotypes may lead to unwanted or inadequate care.” I spoke up on one issue that has long nagged me. Baby talk. Here’s what I said….

Some providers automatically switch to “baby talk” when communicating with older adults, says Jason Karlawish, MD, professor of medicine, medical ethics, and health policy at the University of Pennsylvania in Philadelphia.

“In taking on the tone of voice one might use with a child, you are essentially conveying a view about the patient’s capacity, and your feeling of pity or even disgust for them,” he says. The provider’s tone of voice gets in the way of effective communication and decision-making, he says.

“It can affect the information and choices you present,” says Karlawish. “Any older adult who is ill in bed will look pretty vulnerable and sick, even those with no cognitive impairment.” He tells residents to imagine Supreme Court Justice Ruth Bader Ginsburg with pneumonia in the hospital, and tells them, “I certainly hope you wouldn’t be baby-talking Justice Ginsberg.”

The first step is for clinicians to consider how their tone of voice affects the way they think about and make decisions about an older adult. “Taking on a gentle tone of voice might be appropriate. But the default is, you should talk to older adults as you talk to other adults,” he says.

Physicians sometimes make blanket assumptions about what’s typical at certain ages, such as decreased cognitive function or kidney function; this might not reflect the patient before them. “As clinicians, we want to recognize that there is substantial variability between older adults,” says Karlawish. “One must see how well the individual fits within that range of what is expected.”


Contact me for a pdf copy of the article.