**7.4 Orthonyms that refer to health outcomes**

*Bioethics in Medicine and Society*

sidestep bioethical principles.

name are less obvious in what they are referring to. The potential client may be left to imagine various art exhibitions, a beautiful office, or perhaps smiles so brilliant that they are art themselves. As with metaphors, the locutionary act of this dental clinic does more than just identify itself as a place to get teeth cleaned. It speaks to

Art of Modern Dentistry is located in the Lakeview neighborhood on Chicago's Northside where the population is 80% White, 8% Hispanic, 3.5% Black, 5.8% Asian, 2.5% Mixed, and 0.2% Other. The average household income is approximately \$106,900. It is no surprise that within this neighborhood the acceptable lexical values to be used in health communication may include "art" and "modern." The cultural context of this community allows this dental clinic to position itself as desirable, or a place of art and beauty [22, 36]. In fact, this descriptive name could be viewed as having the ability to slightly alter the worldview of the patient according to social semiotic theories [25]. The patient upon viewing this orthonym may now believe that going to the dentist does not have to be a routine occurrence, but

This clinic may be understood as positioning itself as a place of luxury, and positioning patients as art connoisseurs rather than ordinary persons with cavities [26, 27]. Association habits of capitalistic cultures favor the heavenly over the mundane; the name of this clinic is furthering association habits and using such association habits to its gain [24]. Dentistry is not always a trip to the museum, and using this type of language within healthcare contexts may not be in the best interest of the patient. This orthonym may be creative, but it could be argued that it

*Dental Salon.* This two-word orthonym is simple yet luxurious. The first part of this orthonym, "dental" is defined unambiguously as a that relating to dentistry. The second word in the orthonym is up for interpretation. Thoughts of relaxation could be associated with the word salon. This orthonym is on the edge of communicative effectiveness; it may take a moment to assess whether this is a dental office or perhaps a place where one can get a sort of spa treatment for their mouths. Ineffective communication in healthcare in-and-of itself may be considered to

Dental Salon is located in the Ranch Triangle neighborhood on Chicago's Northside. This neighborhood is 86.3% White, 6.7% Hispanic, .6% Black, 5.7% Asian, 3.1% Mixed, and 0.2% Other. The median household income for Ranch Triangle is \$146,600. This orthonym reflects the surrounding community and simultaneously constructs it while placing focus on patient indulgence. Bioethically the question must be asked if outpatient clinics should represent themselves in a

*Chicago Smile Design.* This is another example of the clinic being glamorized. Instead of going to get a cleaning, patients may be visiting this dentist to have the feng shui of their mouths rearranged. Design aside, the lexemes making up this proper noun are all rather familiar to the patient. The smile could be defined culturally, though facial tissue and bone are pretty culturally transcendent. However, the word design in this orthonym is where creative choices were made. When thinking

manner that may be misleading and out of the scope of healthcare.

of design, one's mind probably does not immediately imagine their dentist. Chicago Smile Design is located in the Old Town Triangle neighborhood on Chicago's Northside. The population is 77.1% White, 5% Hispanic, 5.3% Black, 8.5% Asian, 3.1% Mixed, and 1% Other with a median household income of \$99,700 per year. This orthonym is framing and positioning this dental office as a place of luxury within the community. This discourse could also be viewed as a reflection of the surrounding community; with a comparatively high median household income it is no revelation that this office is describing itself as luxurious through its

is on the brink of violating communicative maxims and ethical principles.

the patients who may wish to have a more luxurious experience [20, 35].

may be more akin to the museum experience instead.

**126**

In dentistry, health outcomes may vary from more serious, such as a periodontal procedure, to the more superficial whitening procedure. Though whitening may be more of a cosmetic procedure, than anything else, the general public tends to see bigger and brighter smiles as healthier. In this case, these will fall under the category of health outcomes, though representing cosmetic procedures such as teeth whitening as a health outcome may intrinsically be unethical. By implying that perfectly white teeth are health outcomes, more patients may opt for unnecessary treatments.

**Perfect Smile Dental Spa.** Generally, the focus of this orthonym directs patients to two areas: that of having a perfect smile, and that of going to a spa. In this orthonym the only word that may lend itself to interpretation is "spa." As previously addressed, the potential patient may not immediately realize what is meant by spa, rendering this communicative value on the verge of ineffectiveness.

Perfect Smile Dental Spa is located in the North Center neighborhood on Chicago's Northwest side. North Center has a population that is 77.6% White, 11.7% Hispanic, 2.1% Black, 4.9% Asian, 3.4% Mixed, and 3% Other, with a median household income of \$89,200. Where this orthonym refers to the patient outcome of a "perfect smile" it could also be understood as reflecting the cultural ideal to have said perfect smile, though such things as bleaching or veneering may be cosmetic procedures. Within healthcare communication, part of nonmaleficence and benevolence is to keep patients properly informed and not lead them astray. This instance of communication, along with others in this case study, may be reinforcing the idea that a "perfect smile" is healthier, potentially leading to unnecessary treatments.

**Big Smile Dental.** What does one picture when reading the name "Big Smile Dental?" By cultural association, with smiles come feelings of happiness. Not only could this clinic be regarded as providing big smiles, but perhaps a lifestyle of smiles or of happiness. Big Smile Dental is located in the Logan Square neighborhood on Chicago's Westside. Logan Square is 32.4% White, 57.4% Hispanic, 6% Black, 2.4% Asian, 1.6% Mixed, and 0.2% Other, with a median household income of \$54,000.

In a sociological analysis of today's culture, big lustrous smiles are sold in every way. Where Big Smile Dental does not use words to portray itself as the most luxurious place in the city, or a place where family is created, it capitalizes on big smiles. This proper name could be taken as influencing people's point of view by associating big smiles with this particular clinic. This communicative value may serve to attract new patients seeking a beautiful smile, however, this may be interpreted as an unethical capitalistic motives in healthcare exploiting the cultural ideal and causing patients to seek more treatment than may be necessary.

### **7.5 Orthonyms that appeal to patient identity**

The identity of the patient is important—it is part of their health and can be part of their treatment. These orthonyms contain lexical values that build rapport with the patient through a focus on the patient's identity. Whereas the identity of the patient is not to be neglected, it can also be understood that it should not be used to increase monetary worth through gathering a larger patient base. Listening to the patient and understanding their culture and backstory may be a more suitable manner for connecting with the patient.

**American Dental.** This orthonym may be appealing to a sense of identity as well as patriotism. This dental clinic is located in located in Avondale on Chicago's Westside. American Dental appears to have multiple locations with the Avondale clinic selected through the random selection process. Avondale is 35.7% White, 54.5% Hispanic, 2.1% Black, 5.5% Asian, 2.0% Mixed, and 0.2% Other, with a median household income of \$54,4000. Through inserting identity markers such as "American" in its orthonym, this dental clinic could be positing itself as a place for patients who identify with American values or have a strong sense of American identity. By including unnecessary values in its name, this clinic may be ignoring the maxim of relevance; the nationality may not be an essential lexeme in discourse surrounding dental care. Where cultural competence may be necessary during the patient interaction, nationality outside of the interaction may be entirely auxiliary. In fact, this form of identity marker may serve as a potential deterrent to patients who may feel sequestered from "American" culture.

**My Dentist Chicago.** The name of this clinic alludes to ownership and uses language to frame itself within the community. Arguably, My Dentist Chicago could be considered as using the "my" in its orthonym to promote a sense of ownership with its customers. This dentist is located in Beverly View on Chicago's Southside and is 14.3% White, 1.1% Hispanic, 82.4% Black, 1.1%, Asian, 1.1% Mixed, and 0% Other. Beverly View has a median household income of \$70,300. Where the word Chicago may be viewed as a relevant location marker, the creation of a sense of ownership is a known communicative technique to create a stronger bond with patients. This could be taken as a revenue-generating practice and may therefore not be in the best ineptest of the patient. Communicatively the orthonym does not disregard communicative maxims, in fact the phrase "my dentist" may be an utterance of natural occurrence in language. However, bioethical principles must always question whether something is being used to increase patient-base.

#### **8. Discussion**

One of the larger trends observed is the difference of the language used in orthonyms of clinics in upper middle class and wealthy communities versus the language used in lower socioeconomic communities. Lexical values used in proper names in those communities that are in the middle class and wealthy category include words that appeal to a luxurious experience.

From words like modern, art, design, and salon, these clinics are creating specific images in the community's mind that influence perceptions of dentistry. This relationship is reflexive, the community could be interpreted as maintaining these ideologies surrounding their health, which may influence the public health of the community. Something with the power to influence public health, even on a micro-scale, must be under bioethical guidance. In this example, healthcare communication could be interpreted as widening the health equity gap, therefore breaking the bioethical principle of justice. The use of such sensationalized health communication may also show disregard for the principle of nonmaleficence: It may decrease harm to the individual and the community to have this form of healthcare communication more strongly regulated.

In lieu of health communication in wealthy communities, there are many clinics in communities of lesser socioeconomic standing that seem to bypass glamorous lexical entries. The language surrounding dental clinics in these communities may be communicating something different. In these communities clinics may be named after the dentist themselves, or have other lexical entries that appeal to things like patriotism, ownership, and heritage language.

**129**

*Biomedical Ethics and Communicative Maxims: Case Studies in Outpatient Health*

One major trend includes naming a clinic after the dentist who owns or founded

Ethical questions start to arise when noting the difference between communicative practices in wealthy communities versus this communicative practice which does exist in both ends of the stratum, though more concentrated in lower- and working-class communities. This form of communication is more straightforward and to the point. Because of this it could be taken as protecting the patient's autonomy and practicing beneficence. By not using persuasive or otherwise auxiliary language to attract patients, the patient may have more agency to pick a dentist in an unbiased way. It could also be upholding the principle of beneficence in this same way; by not using persuasive language that may be deceitful, the patient is protected. However, it could also be argued that using linguistic markers like these to send cognitive cues to patients is a form of asserting authority over patients. Orthonyms with lexical entries such as "doctor," "DDS," and "DMD," can be found across socioeconomic boundaries. In this case the patient is no longer getting distracted or persuaded by lexemes, but the practitioner and practice may be using this form of health communication to build and maintain barriers between the patient and the practitioner. This practice as used across a community or region may flout the principle of nonmaleficence. By increasing barriers patients may struggle to effec-

Another observation within this case study includes names that describe health outcomes and the ideal patient. Both forms of orthonym were dispersed commonly throughout the sample, not only existing in an area of certain socioeconomic status. "Big Smile Dental" and "Perfect Smile Dental Spa" both appealed to the desired health outcomes of patients; through the use of perfect smile and big smile these clinics are advocating their ability to give patients what they want, a perfect or big smile. In another example, "Montrose Tooth Fairy," "Sonrisa Family Dental," and "1st Family Dental of Andersonville," are quite unconcealed as to whom they are

By using such markers in their proper nouns, they are effectively filtering out any patients that are looking for a spa experience, and welcoming in families and children. Alluding to health outcomes and the ideal patient for the practice do fall within the guidelines for effective communication—these modalities help patients pick a clinic to seek treatment at. However, in the same light, these practices may also be going against bioethical principles. For example, alluding to cosmetic outcomes as health outcomes may press patients to pursue procedures that are not necessary with potentially harmful side effects such as chemical burns that result from whitening procedures. This form of communication may promote the viola-

Through this case study, this research provides a foundation for the future study of clinic names as to how they might influence the patient experience, and the combination of communicative maxims with biomedical ethical principles. For example, by seeing "Perfect Smile Dental Spa" on the front door of a clinic, it could be argued that the patient has already been predisposed to feel a certain way about their experience at that clinic. The ways a patient feels about their treatment are argued to be an extension of the treatment itself. The authority of language in this application is difficult to measure due to its penchants on cognition, but is interpreted as influencing the cognition of patients nonetheless. One may ask*, If the* 

the practice along with their medical credential. Through bypassing appeals to lavishness, clinics with names that are more straightforward and only contain the name of the provider. Their qualifications could be viewed as positioning in authoritative positions within their communities. This case study argues that this may be the form of orthonym that is in least defiance of communicative maxims

*DOI: http://dx.doi.org/10.5772/intechopen.93233*

tively communicate with their practitioners.

attracting as patients: children and families.

tion of the principle of nonmaleficence.

and bioethical principles.

#### *Biomedical Ethics and Communicative Maxims: Case Studies in Outpatient Health DOI: http://dx.doi.org/10.5772/intechopen.93233*

One major trend includes naming a clinic after the dentist who owns or founded the practice along with their medical credential. Through bypassing appeals to lavishness, clinics with names that are more straightforward and only contain the name of the provider. Their qualifications could be viewed as positioning in authoritative positions within their communities. This case study argues that this may be the form of orthonym that is in least defiance of communicative maxims and bioethical principles.

Ethical questions start to arise when noting the difference between communicative practices in wealthy communities versus this communicative practice which does exist in both ends of the stratum, though more concentrated in lower- and working-class communities. This form of communication is more straightforward and to the point. Because of this it could be taken as protecting the patient's autonomy and practicing beneficence. By not using persuasive or otherwise auxiliary language to attract patients, the patient may have more agency to pick a dentist in an unbiased way. It could also be upholding the principle of beneficence in this same way; by not using persuasive language that may be deceitful, the patient is protected.

However, it could also be argued that using linguistic markers like these to send cognitive cues to patients is a form of asserting authority over patients. Orthonyms with lexical entries such as "doctor," "DDS," and "DMD," can be found across socioeconomic boundaries. In this case the patient is no longer getting distracted or persuaded by lexemes, but the practitioner and practice may be using this form of health communication to build and maintain barriers between the patient and the practitioner. This practice as used across a community or region may flout the principle of nonmaleficence. By increasing barriers patients may struggle to effectively communicate with their practitioners.

Another observation within this case study includes names that describe health outcomes and the ideal patient. Both forms of orthonym were dispersed commonly throughout the sample, not only existing in an area of certain socioeconomic status. "Big Smile Dental" and "Perfect Smile Dental Spa" both appealed to the desired health outcomes of patients; through the use of perfect smile and big smile these clinics are advocating their ability to give patients what they want, a perfect or big smile. In another example, "Montrose Tooth Fairy," "Sonrisa Family Dental," and "1st Family Dental of Andersonville," are quite unconcealed as to whom they are attracting as patients: children and families.

By using such markers in their proper nouns, they are effectively filtering out any patients that are looking for a spa experience, and welcoming in families and children. Alluding to health outcomes and the ideal patient for the practice do fall within the guidelines for effective communication—these modalities help patients pick a clinic to seek treatment at. However, in the same light, these practices may also be going against bioethical principles. For example, alluding to cosmetic outcomes as health outcomes may press patients to pursue procedures that are not necessary with potentially harmful side effects such as chemical burns that result from whitening procedures. This form of communication may promote the violation of the principle of nonmaleficence.

Through this case study, this research provides a foundation for the future study of clinic names as to how they might influence the patient experience, and the combination of communicative maxims with biomedical ethical principles. For example, by seeing "Perfect Smile Dental Spa" on the front door of a clinic, it could be argued that the patient has already been predisposed to feel a certain way about their experience at that clinic. The ways a patient feels about their treatment are argued to be an extension of the treatment itself. The authority of language in this application is difficult to measure due to its penchants on cognition, but is interpreted as influencing the cognition of patients nonetheless. One may ask*, If the* 

*Bioethics in Medicine and Society*

who may feel sequestered from "American" culture.

whether something is being used to increase patient-base.

include words that appeal to a luxurious experience.

communication more strongly regulated.

patriotism, ownership, and heritage language.

**American Dental.** This orthonym may be appealing to a sense of identity as well as patriotism. This dental clinic is located in located in Avondale on Chicago's Westside. American Dental appears to have multiple locations with the Avondale clinic selected through the random selection process. Avondale is 35.7% White, 54.5% Hispanic, 2.1% Black, 5.5% Asian, 2.0% Mixed, and 0.2% Other, with a median household income of \$54,4000. Through inserting identity markers such as "American" in its orthonym, this dental clinic could be positing itself as a place for patients who identify with American values or have a strong sense of American identity. By including unnecessary values in its name, this clinic may be ignoring the maxim of relevance; the nationality may not be an essential lexeme in discourse surrounding dental care. Where cultural competence may be necessary during the patient interaction, nationality outside of the interaction may be entirely auxiliary. In fact, this form of identity marker may serve as a potential deterrent to patients

**My Dentist Chicago.** The name of this clinic alludes to ownership and uses language to frame itself within the community. Arguably, My Dentist Chicago could be considered as using the "my" in its orthonym to promote a sense of ownership with its customers. This dentist is located in Beverly View on Chicago's Southside and is 14.3% White, 1.1% Hispanic, 82.4% Black, 1.1%, Asian, 1.1% Mixed, and 0% Other. Beverly View has a median household income of \$70,300. Where the word Chicago may be viewed as a relevant location marker, the creation of a sense of ownership is a known communicative technique to create a stronger bond with patients. This could be taken as a revenue-generating practice and may therefore not be in the best ineptest of the patient. Communicatively the orthonym does not disregard communicative maxims, in fact the phrase "my dentist" may be an utterance of natural occurrence in language. However, bioethical principles must always question

One of the larger trends observed is the difference of the language used in orthonyms of clinics in upper middle class and wealthy communities versus the language used in lower socioeconomic communities. Lexical values used in proper names in those communities that are in the middle class and wealthy category

From words like modern, art, design, and salon, these clinics are creating specific images in the community's mind that influence perceptions of dentistry. This relationship is reflexive, the community could be interpreted as maintaining these ideologies surrounding their health, which may influence the public health of the community. Something with the power to influence public health, even on a micro-scale, must be under bioethical guidance. In this example, healthcare communication could be interpreted as widening the health equity gap, therefore breaking the bioethical principle of justice. The use of such sensationalized health communication may also show disregard for the principle of nonmaleficence: It may decrease harm to the individual and the community to have this form of healthcare

In lieu of health communication in wealthy communities, there are many clinics in communities of lesser socioeconomic standing that seem to bypass glamorous lexical entries. The language surrounding dental clinics in these communities may be communicating something different. In these communities clinics may be named after the dentist themselves, or have other lexical entries that appeal to things like

**128**

**8. Discussion**

*pre-dispositions on the patient's experience are good, why does it matter?* Not only is it relevant as to whether or not these communicative values are ethical or unethical, it is worth thinking of this form of communication on a spectrum. One communicative form may be more ethical than another on the spectrum, and by allowing the spectrum to exist potential divergences may occur.

If a patient is predisposed to perceive care in a certain way many violations of bioethical principles may occur. If a patient is predisposed to perceive their healthcare as a positive experience, when they were actually receiving below-standard care, it poses an ethical problem. On the other hand, if a patient is predisposed to be unsatisfied with what is actually a highly-effective treatment, their adherence to that treatment and relationship with the clinician may suffer. Along with this influence language has on healthcare, language may also assign value, or perhaps assign who is worthy to receive certain experiences as a patient. For example, the general volume of words that create a sense of luxury or relaxation in dental clinic orthonyms, including spa and salon, are indicative of the care the patient may receive at that location. As previously mentioned, the language used within a community may influence perception and cognition in a cyclical manner.

This research posits that there could be a *juste milieu* for naming in a bioethically sensible manner. Clinic names that include a combination of *the practitioner's name, medical credential,* and *specialty* could be considered as *ad hoc* guidance for clinic naming procedures. This case study argues that orthonyms such as *Dr. de Rothewelle, Periodontist, Dr. de Rothewelle, DMD, Orthodontic Associates,* and similar most clearly observe communicative and biomedical ethical standards.


*By including only the above communicative values, the patient will receive information that is appropriate in manner, relevance, quantity, and quality. These communicative values promote on a microscale the bioethical principles of beneficence, nonmaleficence, justice, and autonomy.*

*\*A note on auxiliary words: lexemes of this type, such as office, practice, associates* et cetera *may be used if doing so enhances communication.*

*\*\*A note on the use of honorifics: as in many contexts (i.e. education, research, theology, et cetera) "Dr." may be used as an honorific not denoting one's profession as a doctor. For this reason, the use of "Dr." should be followed by granted medical credential.*

Due to the role of communication's influence on the patient experience, health outcomes, and treatment satisfaction, further analyses should be extended through all communicative modalities with the potential to influence cognition and patient care. This includes units of micro-communicative value such as the proper noun. This research further suggests that the communicative maxims and bioethical principles be further analyzed in symbiosis to enhance healthcare communication.
