Failing Treatment: Patients, It's Your Fault

One of the things you notice, once you've been around doctors and hospitals for a while, is the way that medical terminology sometimes seems to place a slightly unreasonable amount of blame on the part of the patient.

For example, the website for Korlym, a drug used to control high blood sugar in patients with Cushing's syndrome, states that Korlym is used "in adults with endogenous Cushing's syndrome who have type 2 diabetes mellitus or glucose intolerance and have failed surgery or cannot have surgery".

1.) I wasn't aware that surgery was a test.

2.) Surely if it were a test, the person charged with passing it would be the surgeon, not the patient zonked out on the operating table.

It seems strange to me that they went for this phrasing (and not as a one-off either, it appears elsewhere on their website). Would it really be difficult to say "patients whose surgery was unsucessful" or "patients whose surgery did not effect a cure"? It's not an isolated case restricted to one copy editor on one website either; it's fairly common to read things like "the patient failed chemotherapy"/"radiotherapy"/"to tie their shoelaces that morning, leading to chaos on Ward Five."*

Doctors of the world, please note: patients don't fail treatments.** Treatments fail patients.

It's an entirely obnoxious phrase, and when I started researching the question it was heartening to see that I am by no means the only person to object to it. As if patients don't feel crappy enough after discovering that their treatment has not succeeded, it then seems to be implied that this is in some way their fault. Yes, it's a medical convention; no, doctors don't mean to imply that the patient is to blame for the treatment not working. But as this patient points out, it's an entirely unnecessary little phrase which can serve to undermine the doctor-patient relationship. Patients who are not au fait with medical terminology - i.e. almost all of us - are unlikely to be impressed if they hear it.

There are plenty of problems out there in the world which are far more serious and important than this little question of syntax. But is it really so hard to change "[Patient Y] failed [Treatment X]" into "[Treatment X] failed [Patient Y]"?

***

UPDATE: So, there's a twist to the tale! I wrote to Corcept Therapeutics, Korlym's creators about this, because I'm pushy that way, and their Director of Commercial Operations got back to me like a bolt of extremely speedy lightning, - despite the fact that I do not have Cushing's Syndrome and thus am hardly their target audience. Here's a couple of extracts from his email:

"Our intent was certainly not to place any blame on the patient for the surgery’s failure, but I can certainly see how the words could convey this. [...] In the world of pharmaceutical marketing and communications in the US, we are highly regulated regarding what we say and how we say it, among other things. For many things, we use language directly from our FDA provided Full Prescribing Information (also known as the label or package insert) and Medication Guide. These two FDA provided documents use the exact language  “patients who…… have failed surgery”. In the case of our website copy, we picked up the language directly from these documents.

"I think we have room to improve the language, using language that you suggest, or something similar. We have a compliance team that meets semi-regularly to review our communication material. At a point in the near future, we will review this language change, in hopes to get it approved for a future website update."

So thank you very much, Corcept, and the moral of the story is this: if there's something you don't like, don't keep it to yourself - whinge!

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*Well, maybe not the last one.

**Unless of course they're non-compliant with the treatment regime. In which case, have at them.