The appropriateness of appropriate: smuggling values into clinical practice

The word appropriate has become an institutional given, part of the clinical jargon used in discussions with and about patients and families. The authors unpack appropriate, arguing that this seemingly innocuous word has implications for clinical practice. They begin with the theoretical and historical question What does appropriate "do" in clinical discourse? The answer is both grammatical and moral, rooted in the 19th-century distinction between normal and pathological and the 20th-century medicalization of behaviour. The examination references rhetorical theory and the history of statistics and psychology, and it uses pediatric health care as an example. The authors argue that the use of the word appropriate facilitates the smuggling of values into clinical encounters, which can marginalize patients and compromise therapeutic relationships. In uncovering the discursive (moral) elements of appropriate, they challenge readers to critically reflect on how they speak to and about patients and families.