Being a doctor is hard.
Not only do you have to work super hard to keep all your patients fit and healthy – whilst giving the best care to those who aren’t – you also have to be very careful with what you say and how you say it, lest you frighten your patients unnecessarily or even offend their friends and relatives.
This is according to a paper recently published in Mayo Clinical Proceedings which warns of the detrimental effect that the wrong words can have on the mental health of a patient, as well as the their trust in their doctors and the medical practice itself.
In a statement, Dr Leonard Barry from Texas A&M University explained the critical impact of a doctor’s communication:
“Serious illness is not only a matter of physical suffering, but also emotional suffering. The doctor’s behavior, including their verbal and nonverbal communication, can exacerbate or reduce emotional suffering. We believe that certain words simply should not be used by clinicians during these difficult encounters.”
Perhaps logically, some of these words and phrases are related to the inevitable death of a terminal patient. However bleak the outlook though, the researchers advise, doctors should never use phrases such as “There is nothing else we can do,” “She will not get better,” “Withdrawing care,” or the idiom “Circling the drain.”
Why? Well these phrases could have very many negative consequences. Among them, is the potential drop in morale of the patient and potential distrust from relatives, which could even subconsciously cause them to make decisions regarding end of life care that they might regret.
The paper also warns about terms that might disempower patients, meaning that they may no longer feel able to make decisions about their own treatment. Among terms like “fight” and “battle” which change perceptions of the medical treatment and may affect a patient psychologically, questions like “Do you want us to do everything?” could be seen to take away a patient’s autonomy.
Meanwhile the blaming of the patient themselves, or even other doctors, could cause them to feel helpless and hopeless and encourage a distrust in medical clinicians. In their list – which was compiled through surveys – phrases such as “I don’t know why you waited so long to come in” and “What were your other doctors doing/thinking?” were deemed particularly problematic.
Given its particularly traumatic nature, the paper has specific guidance when it comes to dialogue with cancer patients. In particular, “Let’s not worry about that now” was found to undermine the concerns of the patient, making them feel like their worries were unheard or unimportant.
So too, phrases with positive intention such as “You are lucky it’s only stage 2” implies that a patient should be grateful for having a certain type of stage of cancer, rather than the condition being treated like the serious concern it is.
Meanwhile telling a patient “You failed chemo” puts the onus on them, making them feel like the ineffectiveness of the treatment was somehow in their control.
Instead, the paper recommends that – whether embarking on detailed discussions of a patient’s condition, or giving a report of their care – medical professionals act with sensitivity toward the patients and their families. In their research, they explain some of the positive actions that clinicians can take:
“They should learn to recognize words and phrases that unintentionally frighten, offend, or diminish agency and work to reimagine their own communication.”
In particular, they recommend tempering their language choices to avoid absolute negativity in their words, whilst also avoiding language that removes the agency of their patients or undermines the seriousness of what they’re going through.
The onus is not entirely on the doctors themselves though, as Dr Barry acknowledges in the statement; instead, it should be the responsibility of medical training to equip clinicians with the most suitable language and approach to patient-doctor dialogue:
“The emphasis in medical school is understandably on the science of medicine, but it is so important to incorporate communications training into the curriculum. A key opportunity is medical school students and graduates having superb patient-centered, skilled communicators as role models in their clinical training during medical school and residency.”
Though there is not enough evidence to suggest that specific language may change a patient’s long-term prospects, it can certainly make their healthcare journeys much less stressful.
And with the right words, a patient’s faith in their doctors and themselves can be transformed.
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