The use of non-person-first language in neuro-ophthalmology referrals

To investigate the prevalence of non-person-first language (PFL) in neuro-ophthalmology referrals to a single tertiary ophthalmology clinic.

Retrospective cross-sectional study.

Participants included neuro-ophthalmology patients seen for their initial visit from July 2018 to December 2022. Ten randomly selected referrals from each day were screened. Non-PFL was further categorized as per American Medical Association and American Psychological Association guidelines. Associations between non-PFL and patient age and gender, referring provider gender and specialty, and year and length of referral, were evaluated using the χ² test.

A total of 2105 referrals were included in the study and 81 (3.8%) used non-PFL, such as referring to a person with glaucoma as a "glaucoma patient". Error types included general (38.3%), stigma (25.9%), diabetes (19.8%), disability (13.6%), and obesity (2.5%). Non-PFL was significantly more likely in long referrals compared with medium and short referrals (9.9% vs 3.1% vs 1.3%; p < 0.001). Referral year was predictive of non-PFL (p = 0.0006), with a significant increase from 2018 (1.7%) to 2021 (6.1%) and decrease in 2022 (2.6%). Patient age was also predictive of non-PFL (p = 0.0359), with the highest prevalence among patients 40-69 years old (5.4%). Patient gender (p = 0.3350), referring provider gender (p = 0.3571), and referring provider specialty (p = 0.1280) were not predictive of non-PFL.

The highest proportions of non-PFL errors made were general and stigma errors. Non-PFL use was most prevalent in 2021, most commonly in referrals for patients aged 40-69 years. There exists a need for ongoing education and awareness around PFL use in physician-physician communication to enhance inclusive, nonstigmatizing care for neuro-ophthalmology patients.