By John Salak –
Medicine and treatments alone aren’t enough to heal the ill or injured. Good medicine needs compassionate communication, which is critical for truly effective care. Sadly, this essential element is often lacking in many clinicians and doctors.
The reason supportive words are needed for patients and their families is that the overriding fear associated with serious illnesses such as cancer, advanced heart failure and end-stage pulmonary disease remains a devastating factor inhibiting recovery.
Unfortunately, dealing with these associated fears has gone largely unnoticed even as great strides have been made in the treatment of the specific diseases that generate patient and family worries, according to Texas A&M researchers.
The university team went as far as identifying so-called “never words” that medical professionals should avoid under any circumstances; offering methods for clinicians to determine their own never words; and providing more helpful alternative language.
“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 a cure,” the study’s co-authors explained.
The “intense, daunting nature of these conversations” may cause clinicians to resort to learned communication habits or declarative statements. They warned that 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,” noted Dr. Leonard Berry, a distinguished professor at Texas A&M. “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.”
Often doctors use insensitive language in communicating critical information without realizing the needless alarm or offense they have inflicted, he added.
Instead, the university’s study stressed that patients and families need to feel “psychologically safe” in communicating with healthcare professionals, which includes being able to express their fears or concerns about the proposed treatment plan. It is therefore essential that professionals avoid “never words,” that undermine patients’ and families’ confidence to speak freely. These words are conversation stoppers. “They seize power from the very patients whose own voices are essential to making optimal decisions about their medical care,” the researchers reported.
The team identified these words after reviewing clinician surveys on the issue. They include:
- “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?”
Another clinician survey related specifically to cancer care and identified another three other never use phrases. They include:
- “Let’s not worry about that now.”
- “You are lucky it’s only stage 2.”
- “You failed chemo.”
The alternative approach that embraces compassionate communications starts with healthcare professionals 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.
“Something as simple as, ‘What questions do you have for me?’ rather than, ‘Do you have any questions?’ invites candid conversation,” Berry noted.
Other examples of alternative language would include a doctor saying “I’m worried she won’t get better” instead of “She will not get better.” The rationale for the change is that the provider replaces a firm negative prediction with an expression of concern.
The research team also noted that using words like “fight” and “battle” may imply that sheer will can overcome illness. This may lead to patients feeling they are letting loved ones down by not fighting hard enough. An alternative language approach would be “We will face this difficult disease together” to make it clear patients have a team behind 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 stressed. “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.”
