When we are vulnerable, words matter, and there are few circumstances where we are more vulnerable than when it comes to our health. The last thing you’d want to hear from your doctor is some clumsy fatalistic expression like “there’s no hope” – or worse, “they’re circling the drain”.
Even a single word can cause suffering or fear for patients and their families, undermine trust in doctors and their institutions, or even negate shared decision-making. Now researchers have identified what they refer to as “never words” that should not be used in front of patients under any circumstances; the hope is that the list will help clinicians identify their own never words so they can opt for more helpful language.
Medical science is advancing all the time, but there are some aspects of medical care that remain practically “timeless”. This includes patient experiences, like fear, lacking specialist knowledge, having unrealistic expectations, feeling pain, and so on.
Complex procedures – like those related to advanced heart failure, cancer, and end-stage pulmonary disease – often require detailed explanations to address such concerns. However, the nature of these conversations can cause some medical staff to fumble or revert to more prescriptive statements that patients and their families may view as cold, insensitive, or just insulting.
“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,” Texas A&M University’s Dr Leonard Berry expressed in a statement.
“We believe that certain words simply should not be used by clinicians during these difficult encounters,” Berry and colleagues from Henry Ford Health in Detroit write in their new paper.
“Never words”
In order to make patients and their families feel “psychologically safe”, the team drew up a list of expressions that are essentially “conversation stoppers”. They are phrases or statements that “seize power” from the patients who are disempowered to make meaningful decisions about their own care. This list was established using clinical surveys and includes:
“There is nothing else we can do.”
“She will not get better.”
“Withdrawing care.”
“Circling the drain”
“Do you want us to do everything?”
“Fight” or “battle”
“I don’t know why you waited so long to come in.”
“What were your other doctors doing/thinking?”
In relation to cancer care specifically, the team found that clinicians advised against ever using phrases like:
“Let’s not worry about that now.”
“You are lucky it’s only stage 2.”
“You failed chemo.”
These phrases can delegitimize patient’s concerns, imply that having early-stage cancer should be something to feel grateful over, and that they have somehow “failed” at a treatment, rather than the treatment failing them.
What you can do instead
According to the Berry and colleagues, medical professionals can encourage honest and thoughtful dialogue with patients and their families in a number of ways.
“They should learn to recognize words and phrases that unintentionally frighten, offend, or diminish agency and work to reimagine their own communication,” the team explain.
This type of opportunity can be created when doctors invite patients to speak up. This can be achieved by simply asking them whether they have any questions. They can also avoid never words by incorporating alternative language, which the team recommend along with a specific rationale for each example. For instance, instead of saying “she will not get better”, doctors can say “I’m worried she won’t get better.” This small tweak creates a statement of concern, rather than a firmly negative prediction.
Alternatively, words like “fight” or “battle” imply that a person’s willpower plays a determining role in overcoming an illness, which may make patients feel like they are letting others down by not fighting hard enough. To overcome this, doctors can say “We will face this difficult disease together”, so patients can feel as though they have a team with them.
“The emphasis in medical school is understandably on the science of medicine, but it is so important to incorporate communications training into the curriculum,” Berry added. “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.”
The team believe that incorporating the right training into medical and professional development courses, as well as mentorship programs, will go a long way to helping raise awareness of never words. Mentors in particular can share the phrases they have used and abandoned, as well as offer alternatives that have worked in the past.
“Such mentorship facilitates progress in how future generations of clinicians interact with patients and stimulates open dialogue about the added suffering and disempowerment that poor, unmindful communication can cause,” the team write.
The paper is published in Mayo Clinic Proceedings.
Source Link: These Are The "Never Words" Doctors Shouldn't Use With Patients
