Language is the vehicle of communication that transports our visions, thoughts, and wisdom to our relationships, communities and around the globe. The words we choose to use can either foster trust or doubt. Or more importantly, it can create unity or divide us. While I have always felt that language is critical to our ability to create trusting and safe spaces for our patients, never has this been so apparent as it is right now.


As Naturopathic Doctors in Canada, our regulations and scopes of practice are as diverse as the individuals in our profes- sion. However, our professional codes of conduct are soundly based in bioethical tenets and aligned with our core naturopathic principles. Central to these codes of conduct for all primary healthcare providers are the concepts of informed consent and patient autonomy, justice, beneficence, and non-maleficence. It is our duty and obligation to uphold these principles in all that we do.


Increasingly over the past few years I have become acutely aware of how language is driving the changing landscape of medical care in Canada. More so, I fear that it is impairing our ability to achieve informed consent and create trusting and therapeutic relationships with our patients. Emphasized by the COVID-19 pandemic, I have observed an increase in refusal to discuss and shame-based language when questions concerning certain medical recommendations are proposed and this makes it impossible to achieve true informed consent for patients. I also believe this is the major driver behind the increase in hesitancy around public healthcare measures. The most poignant examples come directly from conversations around vaccination. If we do not address this, however fraught with controversy, we cannot hope to achieve informed consent and will continue to contribute to division and polarization.


Vaccination, Informed Consent, and Language



I began my practice as an ND working with families and vac- cines in Singapore seven years ago. Singapore has mandatory vaccines for children to enter school, so families saw me to help optimize vaccination for their families. The concept of vaccine optimization became a passion for me and is a critical component of my practice here in BC. These conversations are complex, emotional and time-consuming – and my patients, regardless of their decisions, leave feeling empowered, educated and informed. In Ontario vaccination is not within the scope of practice of Naturopathic Doctors and patient inquiries require a mandatory referral. The words we choose and how we approach these conversations and referrals can impact our patients and influence their decision making. Our regulatory guidelines in respect to vaccination recognize that “the nature of [our]response to the patient may create an impression or influence the patient's choice” and that it is your professional duty to respond to the patient in a “balanced and accurate manner” and “en- courage the patient to be an active participant in his/her own healthcare, which allows the patient to make fully informed decisions.” (Policy guidelines PP04.0a)


More and more, patients want to be informed and actively engage in medical decision making. In concert, they are constantly inundated with conflicting information. As Naturopathic Doctors, our relationship with our patient is strongly built on trust by way of spending the time with our patients to educate them on the risk vs benefit with any intervention we may do. This is informed consent in action and it is foundational to what we do as NDs. Providing an unbiased evidenced-based approach is what patients want, and deserve, on any topic that is presented to them in medicine. Public health measures like vaccination should be no different.


Why are there so many conversations online and fewer in doctors' offices? One obvious answer is the lack of time a doctor or nurse has available to spend with a parent with questions. For many of us, this continues to be one of the most attractive aspects of our role as Naturopathic Doctors – we can and are trained to take that time. But it goes much deeper than that. Many patient experiences with healthcare providers when questioning their recommendations is confrontational at best and in some cases, constitutes linguistic warfare.


It is important as we frame this conversation to remind our- selves of the power dynamic that is inherent in all doctor-patient relationships. Layered onto this is that over the past century, social change has resulted in a shift from a paternalistic model of practitioner-patient care (the doctor knows best model) to a more democratic, autonomy-based model of care. Patients have more access to information and research than in any other time in history. This combination can sometimes make our jobs more difficult. The need to ensure that we are achieving true informed consent with our patients is more important than ever. Patients want to be informed, but they are not trained in research or medicine; this, combined with unconscious bias, is frustrating for doctors who believe that their recommendation is truly in the best interest of the patient. Add a pandemic to an already over-taxed system and I think it is easy to see why we have reached this boiling point. And while I sympathize, it is no excuse for what I am seeing on social media and hearing from patients.


How we discuss medical decisions and interventions with patients should be neutral. An already emotionally charged subject, the healthcare provider needs to have done the personal work to recognize their biases and leave their emotions out- side the conversation. More than once in my practice, patients have come to me after meeting with another provider where the conversation left them with tremendous fear. When I hear these stories, I have to pause and grapple with how we got here. There is a line between education and coercion and when, as providers, we use fear or shame-based language – we cross it. If we study our professional codes of conduct, it is immediately clear that this kind of counsel is unethical. And yet I hear about it all the time.


I would like to specifically use as an example the term “Anti-Vax”. You see this term in the media, newspapers, from our political leaders. It wasn't until I witnessed a colleague call out a member of the public on a public social media forum using the term, that it really hit me. Regardless of the intent in which terms like "anti-vax" are used, the social context invokes shame and polarization. When we choose to use divisive language as medical professionals, we are guilty of gaslighting our patients and we effectively shut down our patient's RIGHT to ask questions. We have come to a place where many patients experience that being curious or inquisitive about public health measures like vaccination is automatically villainized and labelled with terms like uneducated, selfish, and ignorant. I strongly believe that creates trauma for our patients. I have borne witness to how using shame-based language with patients builds anxiety, hardship, and eventually deep-rooted trauma.


“Shame does not drive positive behaviour.

But instead rage, rationalization and blame.”

- Dr. Brené Brown, PhD


I am willing to go as far as to say that using this type of lan- guage breaches our code of conduct and is unbecoming of a Naturopathic Doctor. Regardless of how we might personally feel about any particular medical intervention, we have a duty to our patients to provide informed consent. We cannot do this if we do not examine our biases and recognize just how impactful our language can be. It can inspire autonomy and empower the patient, or it can breed hesitancy, shame and fear. Brené Brown has said: “Shame does not drive positive behaviour. But instead rage, rationalization and blame.” As NDs, we are privileged with the time we can spend with our patients. If we are to honour that and our commitment to our principles, we must learn to look inwards, to truly explore our own biases and critically analyze how we are speaking to our patients and how we present our- selves in the public eye.


Originally published in The Pulse, Issue 103, Fall 2021, by the Ontario Association of Naturopathic Doctors.