Words and Phrases Doctors Should Never Say to Patients

Introduction

Seriously ill patients and family members face intense emotional suffering, and researchers, including a Texas A&M University professor, say clinicians must engage in "compassionate communication" as part of the treatment process. They have identified so-called "never words" that should not be said under any circumstances; offer methods for clinicians to identify their own never words; and provide more helpful language to use instead.

Main Item

In a recent paper published in Mayo Clinic Proceedings, Texas A&M University Distinguished Professor of Marketing at Mays Business School Dr. Leonard Berry and co-authors from Henry Ford Health in Detroit assert that in spite of rapid progress in the treatment of serious illnesses such as cancer, advanced heart failure and end-stage pulmonary disease, certain "timeless" aspects of the patient experience remain, like fear.

"Communicating the nature, purpose and intended duration of often complex treatments, and setting realistic expectations about what they offer still comes up against timeless patient experiences: fear, intense emotions, lack of medical expertise, and the sometimes unrealistic hope for cure," they write.

The "intense, daunting nature of these conversations" may cause clinicians to resort to learned communication habits or declarative statements.

Even a single word may scare patients and families, make them feel disempowered, and possibly negate the effectiveness of shared decision making.

"Because seriously ill patients and their families are understandably frightened, they 'hang' on every word their doctor will say," notes Berry, a senior fellow at the Institute for Healthcare Improvement. "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."

Berry said all too often, doctors use insensitive language in communicating critical information, and commonly do so without realizing the needless alarm or offense they have inflicted.

Never Words

Patients and families need to feel "psychologically safe" in communicating with health care professionals, Berry said, including in expressing concern about the proposed treatment plan or in conveying their fears. The researchers say if doctors respond using "never words," they may undermine patients' and families' confidence to speak freely.

"Never-words are conversation stoppers," the researchers write. "They seize power from the very patients whose own voices are essential to making optimal decisions about their medical care."

Utilizing clinician surveys, the researchers identified never words, including:

• Withdrawing care.
• Fight or battle.
• Circling the drain.
• She will not get better.
• There is nothing else we can do.
• Do you want us to do everything?
• What were your other doctors doing/thinking?
• I don't know why you waited so long to come in.

In another study specific to cancer care, clinicians were asked for words or phrases they would never use with a patient, with the top results including:

• You failed chemo.
• Let's not worry about that now.
• You are lucky it's only stage 2.

'"Let's not worry about that now' is not only a non-answer to a patient's legitimate concern, it's dismissive," the researchers said. Pointing out that cancer is in an early stage is "presumptive, assuming the patient should feel gratitude, without allowing room for the patient's anxiety and fear in having cancer." And, Berry said, patients do not fail chemo; chemo fails patients.

What Doctors Should Say Instead

Health care professionals can start a dialogue by inviting honest, thoughtful inquiries and responses from patients and families.

"They should learn to recognize words and phrases that unintentionally frighten, offend, or diminish agency and work to reimagine their own communication," the researchers stated.

Berry says such an opportunity can arise when doctors encourage patients to speak up.

"Something as simple as, 'What questions do you have for me?' rather than, 'Do you have any questions?' invites candid conversation," he said.

As for the never words, the researchers recommend alternative language, as well as the rationale, for each. For example, instead of, "She will not get better," the doctor could say, "I'm worried she won't get better." The rationale being the provider will replace a firm negative prediction with an expression of concern.

Using words like "fight" and "battle" may imply that sheer will can overcome illness and patients may feel as if they're letting loved ones down by not fighting hard enough. Instead, doctors could say, "We will face this difficult disease together" to make it clear patients have a team behind them.

Spreading Awareness

Medical groups and educators can bring attention to never words in multiple ways, the researchers said, including by integrating the discussion into courses and professional development.

"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 said. "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."

Mentorships are also invaluable as more experienced doctors can share communication techniques that they've found to be successful and which to avoid. The study notes:

"Mentors can not only disclose harmful phrases that they personally have abandoned and replaced by more generative phrases but may also model walking back language that lands poorly...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."

Collaborators on the study are Dr. Rana Lee Adawi Awdish, critical care physician and medical director of care experience, Henry Ford Health; and Dr. Gillian Grafton, advanced heart failure and transplant cardiologist, Cardiac Intensive Care Unit, Henry Ford Health.

Editorial Insights, Analysis, and Developments

This article highlighted the critical importance of compassionate communication in healthcare settings, particularly when dealing with seriously ill patients. By identifying specific "never words" and phrases that doctors should avoid, the research provides valuable guidance for improving doctor-patient interactions. The emphasis on patient-centered communication and the suggestion of alternative, more empathetic language demonstrates a significant shift towards a more holistic approach to healthcare. This study not only benefits medical professionals by offering practical communication strategies but also empowers patients and their families to expect and advocate for more sensitive and respectful interactions. As medical education continues to evolve, incorporating these findings into curricula and professional development programs could lead to substantial improvements in patient care, emotional well-being, and overall healthcare outcomes - Disabled World.

Attribution/Source(s):

This peer reviewed publication was selected for publishing by the editors of Disabled World due to its significant relevance to the disability community. Originally authored by Texas A&M University, and published on 2024/11/08 (Edit Update: 2024/11/09), the content may have been edited for style, clarity, or brevity. For further details or clarifications, Texas A&M University can be contacted at tamu.edu. NOTE: Disabled World does not provide any warranties or endorsements related to this article.

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