This conceptual paper examines the linguistic considerations necessary for effective medical error disclosure;

an area where communication choices directly influence patient trust and the perceptions of professional

integrity. Drawing upon theories of the Situational Crisis Communication Theory, Linguistic Category Model,

and Communication Competence Model, this paper highlights how language use can shape the attribution of

responsibility and affect relational outcomes in clinical settings. It proposes four core considerations to guide

language

Medical errors are occurrences of error within the healthcare system, with medication prescription error being

one of the more common errors as cited in past literature (Lane & Roberts, 2020). According to para 2.2.6 of

commits errors in the course of management of his patient must avoid concealing them from the patient or

those in authority and must record such events in the patient records/notes. It is unethical for the practitioner

not to be truthful and honest in such an event” (p. 29). This stresses the importance of error disclosure in

healthcare settings in Malaysia.

advancements, few studies have sought to examine the linguistic considerations of effective disclosure towards

maintaining patient-physician relationships (Lane & Roberts, 2020; Busetti et al., 2020). Therefore, this

conceptual paper draws on crisis communication and and communication competence theories to identify key

linguistic considerations in disclosing medical errors. It synthesizes insights from the theories with reference to

peer-reviewed studies on patient communication. Although not a systematic review, the scope of this paper

focuses on works that illuminate how linguistic strategies shape perceptions of responsibility and trust in

disclosure contexts.

physician-patient relationship on medical error disclosure.

One key contribution of SCCT is its typology of response strategies, which include denial, diminish, rebuild,

and bolstering (Coombs, 2007). While these strategies were originally designed for organisational crises, they

offer a useful parallel for the medical context. For instance, denial or minimisation of responsibility may

protect the physician or institution in the short term, but such approaches are associated with loss of trust and

long-term reputational harm. In contrast, rebuild strategies (such as providing an apology, compensation, or

corrective measures) are aligned with ethical imperatives in healthcare and are more likely to restore patient

confidence. This suggests that linguistic choices in disclosure are not merely semantic but function as crisis

response strategies that shape relational outcomes.

Moreover, SCCT underscores the importance of matching response strategies to the level of responsibility

While SCCT frames disclosure as a strategic response to a perceived crisis, a finer-grained analysis of how

specific linguistic choices shape perceptions of responsibility is required. This is addressed by the Linguistic

Category Model (LCM), which theorises that perceptions are shaped based on the linguistic choices that are

used to describe and discuss events (Semin & Fiedler, 1988). Based on this theory, a negative event is

as low through the linguistic choices used in disclosure. In contrast, when the physician’s responsibility is

perceived as higher, the negative event is perceived as a product of the agent or organisation. In other words,

concrete language leads perceivers to attribute outcomes to situational circumstances, whereas abstract

language leads them to attribute outcomes to the inherent character or responsibility of the organisation

increasing the level of responsibility attribution (e.g. “The physician fabricated the report”). The third are State

Verbs (SVs), where an event is connected to an intrinsic attribute of the physician, which leads to high

attribution of responsibility (e.g. “The physician was afraid of being blamed”). The last is Adjectives (ADJ),

where permanent traits are used to describe the physician, implying the highest level of responsibility to the

event (e.g. “The physician was careless”). This indicates that the LCM has theoretical potential to be applied in

medical error disclosures.

In the context of medical error disclosure, the LCM offers a systematic way to analyse how physicians’ word

choices can either deflect or accept responsibility. Unlike broader crisis communication models, the LCM

directly accounts for the cognitive and perceptual consequences of language use, allowing a finer-grained

examination of how patients may interpret explanations, apologies, or justifications. This positions the LCM as

context. The Communicative Competence Model (CCM) was introduced by Canale and Swain (1980). The

model examined four main competencies in demonstrating communication competence, which are linguistic,

sociolinguistic, strategic, and discourse competence.

In the context of medical error disclosure, the most relevant of these competencies is sociolinguistic

competence, which involves communicating following rules of discourse that is considered appropriate for a

given audience or setting. While SCCT and LCM emphasise the strategic and linguistic dimensions of

disclosure, CCM highlights effectiveness ultimately depends on whether the message is perceived as socially

appropriate and relationally sensitive. This suggests that medical disclosure training should not only focus on

accuracy and responsibility attribution, but also on the pragmatic skills required to convey difficult information

in ways that align with patients’ social and cultural contexts.

error disclosure cannot be reduced to simply admitting fault as it combines competence in strategy, linguistic

precision, and communicative appropriateness to maintain trust and credibility in healthcare.

In the disclosure of medical errors, the way physicians frame, sequence, and deliver information determines

whether patients perceive the disclosure as transparent, trustworthy, and empathic, or, conversely, evasive and

defensive. Research on error management in healthcare highlights that beyond systems for prevention,

detection, and reporting, communication practices play a decisive role in sustaining professional relationships

and public trust (Farnese et al., 2018). Consequently, this section highlights four key categories of linguistic

considerations of medical disclosure, which are sociolinguistic competence, clarity and comprehensibility,

empathy and relational framing, and timing and sequencing.

The principle aligns with SCCT, which emphasises matching communication strategies to the level of

perceived responsibility. In medical disclosure, failure to calibrate language to patient expectations risks being

interpreted as either dismissive or overly defensive. This indicates the need for physicians to demonstrate

extensive understanding of the situational appropriateness of a situation, and be able to align the way they

communicate with both the degree of responsibility perceived by the patient and the socio-emotional demands

of the interaction.

An equally important linguistic consideration is ensuring that patients fully understand what has occurred.

Studies have shown that effective disclosure involves the use of plain, non-technical language, supported by

active listening and clarification checks (Steimie et al., 2024; Lane & Roberts, 2020).

From the perspective of the LCM, the choice of concrete descriptive language (e.g., describing specific actions

taken) rather than abstract attributions reduces the likelihood of misinterpretation and situates the error within

physician–patient interactions but also strengthens institutional credibility and public trust in healthcare

systems. Table 1 provides examples of such expressions.

4. Coombs, W. T. (2007). Protecting organization reputations during a crisis: The development and application

5. Coombs, W. T., & Holladay, S. J. (1996). Communication and attributions in a crisis: An experimental study