CORR Insights®: How Do Individuals Perceive Diagnostic Labels and Explanations for Hip Pain? A Qualitative Study Among Adults With Persistent Hip Pain

Where Are We Now?

The psychosocial and treatment-related implications of diagnostic labels have been extensively explored in several medical subspecialties, particularly within the field of oncology [1, 2, 8, 9]. For example, prior studies have demonstrated that omitting the word “cancer” from diagnoses for benign lesions can reduce patient anxiety, improve decision-making, and decrease demands for potentially harmful overtreatment [1, 2]. In fact, many patients with cancer often report that the way their disease is labeled is just as important to them as the treatments they receive or the prognosis they are given [1, 2].

There is growing evidence across fields to suggest that the descriptive words clinicians use—however brief or habitual—can profoundly impact their patient’s treatment choices and expectations [9]. In this insightful study published in this issue of Clinical Orthopaedics and Related Research®, Haber et al. [4] extend this subtle yet powerful observation to the field of orthopaedics, highlighting that even objective, data-driven musculoskeletal surgeons communicate diagnoses through narrative frameworks that inevitably influence patient perceptions. These “diagnostic labels” can substantially shape a patients’ internal narratives, inform their emotional responses to illness, and guide their openness (or resistance) to various treatment pathways, including surgery. This topic has also been explored extensively in editorials in this journal [6, 7].

As Haber et al. [4] keenly note, a short clinic encounter cannot undo a patient’s lifetime of experiences, beliefs, and biases, but our words can certainly reinforce or challenge those perceptions. Whether intentional or not, the labels we use may either correct or perpetuate misconceptions, which can have real consequences for patient engagement, satisfaction, and outcomes. Yet this critical aspect of surgeon-patient communication remains surprisingly underexplored within orthopaedics, despite its clear implications.

In my own residency training, after each clinic visit, I’m tasked with making a diagnosis, communicating that to my attending, and entering it into the patient’s chart. But the process doesn’t end there. That diagnosis inevitably evolves into a label—a story—that I present to the patient as I explain their condition and outline next steps. Words like chronic hip pain, osteoarthritis, and degenerative wear are terms I’ve often used interchangeably, despite their vastly different connotations. The study by Haber et al. [4] serves as a timely reminder for me and other orthopaedic surgeons to reflect critically on the language we choose—not only for the sake of accuracy, but also for the sake of the person sitting across from us [4].

Where Do We Need To Go?

Haber et al. [4] argue that we should shift away from a narrative that describes hip osteoarthritis as a degenerative and irreversible condition. The authors caution that this prevailing diagnostic label may inadvertently affirm some patients’ unhelpful beliefs that certain exercises could worsen their condition or that surgery may be their only viable treatment option. Although these concerns are understandable, shifting away from terminology like “hip degeneration” toward language that reflects a more dynamic, potentially modifiable disease process presents a challenge.

For many orthopaedic surgeons, me included, this reframing may seemingly confront foundational concepts that we’ve been taught in medical school and that were reinforced in residency. Much of my arthroplasty training, for example, has centered around the idea that hip osteoarthritis is a degenerative disease that is best treated with total hip replacement. To illustrate this point, I searched “hip osteoarthritis” on Orthobullets—a widely used educational tool among orthopaedic residents. The site defines the condition as, “a degenerative disease of the hip joint that causes progressive loss of articular cartilage of the femoral head and acetabulum [10].”

This underscores a critical reality: The diagnostic labels that we present to our patients often mirror ones we’ve internalized as surgeons. Our subspecialty training and treatment paradigms shape how we conceptualize disease. Arthroplasty surgeons may view osteoarthritis through a surgical lens—as degeneration destined for replacement—whereas physiatrists or physical therapists may see it as a condition amenable to rehabilitation and activity modification [4]. The truth likely lies somewhere in between. Our orthopaedic lexicon should evolve to reflect our literature’s more modern and nuanced understanding of hip osteoarthritis and its treatment spectrum.

Although changing our diagnostic language is no small task, we can look to other specialties for inspiration. Oncology, for instance, has already undergone a shift in disease labeling. Within the last 20 years, several oncologic diagnoses have been renamed—from “cancerous lesions” to “indolent tumors” or “low-grade dysplasias”—in an effort to reduce patient anxiety and avoid unnecessary interventions [2, 3, 5]. The transition, although initially uncomfortable for physicians, has now resulted in more personalized care, improved patient understanding, and greater alignment between diagnosis and prognosis. The process has involved collaboration across specialties, patient-centered research, and a willingness to challenge long-held assumptions about disease, progression, and risk—something we in orthopaedics might also aspire to as we reconsider the language we use to describe conditions like hip osteoarthritis.

How Do We Get There?

One may reasonably ask why any of this linguistic gymnastics even matters? Can’t physicians simply diagnose hip pain as osteoarthritis, outline treatment options, and support patients in choosing care that aligns with their personal goals and preferences? In theory, yes. But in practice, within moments of conversation—whether 10 seconds or 5 minutes in—we inevitably anchor our discussion in a particular explanatory model. That model is shaped by our training, our experience, and the language we’ve inherited from our clinical environments.

That is precisely why this study is so timely. It reminds us that every diagnosis we share with a patient carries not only clinical meaning but also narrative weight. Diagnostic labels are not neutral; they are constructed through the lens of medical culture, institutional teaching, and personal bias [8, 9]. Some may be more accurate or more useful than others, but we still have much to learn about how these labels are received and interpreted across different clinical contexts.

Indeed, the work of Haber et al. [4] raises more questions than it answers. How do explanatory models vary across orthopaedic subspecialties? How do we decide which diagnostic labels best support patient understanding without misleading them? Should we prioritize labels that patients prefer, even if those terms risk oversimplifying a complex condition? How do we train orthopaedic surgeons to shift their language in ways that promote clinical accuracy and shared decision-making?

Perhaps more pressing is the need to understand how diagnostic labels are interpreted across cultures and among patients from diverse racial, ethnic, and socioeconomic backgrounds. In a country as diverse as the United States, where no two patients bring the same lived experience to the exam room, this question cannot be ignored. Although we may never fully capture the range of ways that language intersects with identity, we can strive to be more intentional and reflective in how we speak about disease. In doing so, we not only enhance shared decision-making but also build trust—ensuring that our diagnostic labels do not simply reflect our medical training but resonate meaningfully within the lived realities of those we aim to help [7]. Ultimately, acknowledging the cultural weight and nuance of language is not just a matter of semantics, it may be a fundamental step toward more equitable and effective patient care.

Moving forward, it would be powerful to explore how perceptions of diagnostic labels can affect or even improve disparities in orthopaedic care. If certain terms evoke mistrust, fear, or fatalism in some patient communities, we must ask: Are we unintentionally creating barriers to care? Could reframing the way we speak about osteoarthritis, for example, improve outcomes and close equity gaps? These are difficult but necessary questions. And as clinicians, we have both the responsibility and the opportunity to evolve—not just in what we know, but in how we communicate what we know—so that our patients feel empowered to make the best decisions for their health [7].

Read This Next

• This protocol for a systematic review synthesizes the impacts of diagnostic labeling for noncancer health conditions from the perspectives of individuals, society, and medical practitioners. It highlights several complexities associated with using diagnostic labels, including how diagnostic labels influence a patient’s perception of their symptoms and their choice of treatment [8].

• This CORR® editorial urges orthopaedic surgeons to prioritize patient health over a surgery-centric approach by using thoughtful language and emphasizing overall well-being in their conversations. The authors argue that this shift not only benefits patients, but also reduces moral distress for surgeons, ultimately enhancing both job satisfaction and the effectiveness of medical practice [7].