Thin blood? Who wants that?



It happened again this week; the resigned look of stoic acceptance, the familiar phrase:

“Well I do get cold, doctor, but that’s because of my blood thinners.”

It’s usually feeling the cold that is explained in this way, but sometimes tiredness gets a mention. Mostly it is said in passing, just another component of the patient’s narrative as they share their own understanding of how they are feeling, but at times it comes with an unspoken plea to check that they really do need to take this medication. Have I clocked the price they have to pay to follow my recommendations? There is a hint that if I were to suggest we could stop their blood thinners they would jump at the chance. On occasions the plea is more overt and with a determination for change.

It makes perfect sense, of course. Thin blood sounds cold, watery and weak; there is nothing in the term ‘blood thinner’ to make you feel more energised, warmer or stronger, and if you feel the opposite why would you not think that your newly thinned blood is responsible? We even have the proverb ‘blood is thicker than water’ to remind us that blood’s very ‘thickness’ is part of its inherent worth.

What is more, while the term ‘blood thinners’ is almost universal in its common usage, it is entirely inaccurate and misleading – anticoagulants and antiplatelet drugs do not thin your blood. They make clots less likely to form, and if you cut yourself it will take longer to stop bleeding so it may appear to be thinner, but the idea that the blood coursing through your veins is in any way thinner is completely wrong, and the subliminal message that it may also be colder, weaker and less nutritious can be very unhelpful.

So why do we use the term? Well firstly because it is convenient to have a label to describe a group of medicines as an easy shorthand; blood pressure pills, water tablets, chemotherapy, immunotherapy and antidepressants are all examples, and it can help to have an accepted term to use when explaining the purpose of a tablet. In fact, none of these are without problems; how do I explain why I am recommending an antidepressant to someone who is not depressed, but affected by anxiety, for instance? Or how do I reassure my patient that a thiazide ‘water pill’ is not likely to make them spend the next two hours in the bathroom like a loop diuretic could? Problematic as all medical language can be, however, there are few examples of drug names that are as glaringly misleading as ‘blood thinners’.

Beyond the simple convenience of having an overarching description for this branch of pharmacology is the apparent merit that ‘blood thinners’ is an easy term to understand, and so could be described as patient-centred; it is jargon free and patients freely accept the term so that doctor and patient are able to speak a common language. This misunderstands the point of medical explanation, however. When doctors explain medical terminology, the primary purpose must always be to empower the patient; it doesn’t matter if we use jargon or not, as long as the patient leaves with a greater understanding of their problem and power has passed from doctor to patient. If we hand over a term that is easily understood and yet inherently wrong and misleading, we are taking power away from the patient, not giving it to them.

Unfortunately, there is no convenient replacement term that would be better ‘clot risk reducers’ just doesn’t quite work! We are left with the words anticoagulant and antiplatelet, both of which are inherently technical, but we can at least explain them in plain English. ‘They make it less likely that blood clots will form inside the body’ or ‘they make your blood less sticky’ are useful alternative phrases.

I’m not expecting the term ‘blood thinners’ to be removed from medical language any time soon, it is far too entrenched for that, but I have certainly stopped using it myself, and maybe there can be a conversation that makes us think twice about this particular expression, and we can stop using it one doctor, one nurse, one pharmacist and one paramedic at a time.

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© Martin Brunet 2020