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The Use of Neutral, Unbiased, and Equitable Language in Medical Writing

It is increasingly important in medical writing to recognize diversity in race and ethnicity, sex and gender, sexual orientation, socioeconomic status, and disability, and to avoid assumptions about a patient’s identity or medical condition. As scientific communicators, we like to imagine we are always objective, presenting unbiased information. After all, how can data be subjective? 


But even scientific writing can end up biased, often in more subtle ways, such as in the following sentence: “The physician is to administer 10 mL of the study drug to his patients.”  

The use of the pronoun his implies an assumption about the gender of the physician, which may not be known or relevant. Personal pronouns are a common source of bias in scientific writing, and they are rarely necessary to understand the context of the data. Typically, this issue can be resolved by removing the pronoun entirely (use, for example, “to the patients”), using both the masculine and feminine forms (“to his or her patients”), or using the gender-neutral, singular “they” (“to their patients”). 

Take a look at another example: “The elderly may be susceptible to Alzheimer’s.” There is bias built into the term elderly, which could elicit assumptions about weakness or fragility that, again, may not be true or relevant. A specific age range, or minimum or maximum age, is more appropriate and precise (“people aged 65 to 79 are at the greatest risk”). 

The way we report patient data, which by necessity is often categorized by identity markers like age, race, sex, or medical condition, can provide an easy route for subjectivity creep. Race or ethnicity categories listed as “White or non-White” or “Caucasian or non-Caucasian” create silos that can diminish the representation of other groups. It is not inherently biased to provide data by categories, but the categories presented should be germane to a clear understanding of the results. For example, it would be entirely appropriate to report results specific to race if reporting a study of the increased prevalence of a genetic condition among racial groups. 

Additionally, we should avoid equating patients with their disease or disabilities, since these do not comprise the entirety of their identities. For instance, use “person with autism” instead of “autistic person,” or “persons with disabilities” rather than “the disabled.” 

Technical writing, which is often perceived as authoritative and educational, should be as precise as the underlying science and contribute to better understanding through its language, including how it shapes societal perceptions of identity. Individuals or groups may decide to identify using terms discouraged in scientific writing, but our community should allow for their discretion and strive for objectivity that operates within a framework of inclusivity.  

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