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The pronoun distance index

In his cultural dimensions theory, Hofstede [1] described the “power distance index” (PDI) as “the extent to which the less powerful members of organizations ... accept that power is distributed unequally”. This has been shown to have a real impact on airline safety as effective communication may be reduced in high-power distance index environments. The importance of optimal communication is evidenced by the fact that pilot errors are more frequent in dual pilot versus single pilot cockpits [2]. However, in a dual pilot cockpit, safety is enhanced when the least experienced pilot is flying, as the more experienced pilot is not afraid to speak up [3]. Flying is safer when cockpit members call each other by their first names. Communication in a larger sense is important, but so are the “small” words that we use, on planes, and in labor and delivery. Some time ago, I was doing morning report with my residents and upon my asking whose patient it was, the response that I frequently received was “a clinic patient” or a “service patient” or “she’s a private patient of Dr Smith”. Only after some unwelcomed perseverance on my part, and a short stop at “ours”, did I get the presenter to acknowledge, at last, that the patient was “mine”. It occurs to me that our use of language may also have an impact on safety, especially in our use of pronouns. It became clear that in addition to the power distance index, there is a “pronoun distance index” (PDI) that may get in the way of the care of our patients. The resistance to the use of the pronoun “mine” may illustrate a subliminal reluctance to “own” the patient, to own the problem, to own the worry. The question is really – “Who owns the worry?” “Ours” is at a greater PDI than “mine”. Using someone else altogether (e.g. his, hers, or theirs), well, that PDI is off the charts. There has been an appropriate emphasis on teamwork and interdependence in both airline and medical safety. However, the use of the word “ours” must also be inclusive of “mine” or further distance is established. “Ours” is not a substitute for “mine”. Pennebaker [4], in “The Secret Life of Pronouns”, addresses the challenge of using the word “we”. He points out that when he says “we need to take out the trash ... I am not proposing to my son that we take a family outing to the trash bin”. He goes on to say that “people use the word we when they mean you. It serves as a polite form to order others around... . The reason we is such a fun word is that half of the time it is used as a way to bring the speaker closer to others and the other half of the time to deflect responsibility away from the speaker”. The complete omission of pronouns may also absolve oneself from direct responsibility, and even change the fundamental information that we are presenting. When discussing his role in the Vietnam War, the Secretary of State, Henry Kissinger, claimed “mistakes were quite possibly made by the administration in which I served” [4]. The PDI is also revealed in that way we apologize. Several years ago in an article in the New York Times entitled “A Poor Apology for a Word”, Henry Hitchings [5] examined the way we apologize. In England, for example, a person apologizes eight times a day. However, the apology is most frequently stated as “sorry”, not “I’m sorry”. In Hitchings’ words “the adjective was divorced from the person feeling the sorrow, and soon ceased to signal even regret”. Our frequent omission of the pronoun “I” when we apologize is a reflection of the distance that we place between ourselves and the problem. Hitchings puts it this way – People “appear to be very good at apologizing for things they haven’t done, but not very good at