Dec 08, 2024 20:00:00

10 things great doctors don't say, like 'Why did you let it get to this point?'

Patients who visit a doctor or are hospitalized due to serious illnesses are forced to make important decisions about their treatment at the most difficult and unwell time of their lives. Through interviews and literature, medical and communication experts have selected words that doctors should not say to such patients and their families, and proposed phrases to use instead. This paper summarizes best practices for medical institutions, but knowing about them may be helpful when finding a hospital or doctor who cares about patients.

Never-Words: What Not to Say to Patients With Serious Illness - Mayo Clinic Proceedings

https://www.mayoclinicproceedings.org/article/S0025-6196(24)00256-8/fulltext

◆ Current situation in the medical field
'Having sensitive, honest conversations with critically ill patients is becoming a growing clinical challenge as medical technology advances,' say Leonard L. Berry of Texas A&M University and two co-authors from Henry Ford Health, a healthcare organization in Michigan.

That's because when doctors try to explain complex treatments, they are often faced with reactions that are difficult for the doctor to change, such as fear, intense emotions, lack of expertise, and unrealistic expectations about cures.

Because such incidents are so common, it is said that clinicians who interact with patients often rely on stereotyped explanations and definitive language, but in a hospital, even a casual remark by a doctor can make patients and their families feel frightened or helpless.

◆What happens if a doctor uses taboo words?
Based on these experiences, Berry and his colleagues believed that there were certain 'never-words' that doctors should never utter. They conducted interviews with 20 clinicians belonging to professional and medical organizations, as well as several papers discussing doctor-patient interactions in the medical field, to find examples of such taboo words.

For example, one nurse said in an interview, 'Doctors often say, 'You can continue treatment, or you can just provide supportive care.'' Supportive care refers to treatment that addresses a patient's pain, but using the word 'just' gives the impression that supportive care is a minimum measure that is not the best, and reduces the patient's willingness to 'try anything.' Therefore, 'just' in this context is a taboo word.

In addition, in a 2023

paper , Jacqueline M. Kreuzer and others from the University of Wisconsin argued that the verb 'need' is taboo in certain contexts. For example, when a clinician says, 'We need intubation ' or 'We need a transplant,' patients and families take it as if they have no other options. In this case, instead of saying, 'We need a transplant,' say, 'The patient's heart is deteriorating. Let's talk about what this means and what we should do next,' and you can make open decisions together instead of unilateral instructions.

There are certain words that should not be used in certain situations, or even with certain illnesses. For example, in the case of cancer, 'Don't worry about it right now' does not address the patient's concerns, but rather ignores them. Similarly, 'You're lucky it's only stage 2' pushes the patient to feel happy, without considering the anxiety and fear that comes with actually having cancer.

10 things doctors should never say
Berry and his colleagues selected 10 specific examples of 'words that doctors should not use' that they discovered through their study, and summarized suggested phrases and reasons for rephrasing them as follows:

1. 'There's nothing I can do about it'
An alternative to this statement would be, 'Although current treatments have not been effective in controlling

cancer , there is still an opportunity to address treatments that will improve symptoms and hopefully improve quality of life.'

The rationale behind this, say Berry and his colleagues, is that it signals to clinicians that they can provide the best treatment possible, even if there is no hope of a cure.

2. 'It's never going to get better.'
The alternative is 'I'm worried that it won't get better,' and Berry and his colleagues suggest that rather than making a negative prediction, we should replace it with concern about a poor prognosis.

3. 'Cessation of care'
The alternative is that we can shift our focus to relieving the patient's pain rather than continuing with their current treatment, which is not working.

'Clinicians will never 'withdraw' care, which could mean abandoning or denying service to patients and their families. Instead, they explain the benefits of re-goaling care,' Berry and colleagues wrote.

4. 'Circling the drain'
'Circling the drain' literally means 'circling the drain.' It is a slang expression that refers to something rapidly coming to an end, especially when a patient is near death, based on the whirlpool that forms when water is finally drained from a bucket or bathtub.

Berry and his colleagues suggest that people should avoid objectifying or belittling these patients, and instead say things like, 'I'm worried that I'm going to die.'

5. 'Do you want us to do it all for you?'
Instead of asking leading questions that are not aligned with the patient's values and goals, Berry and his colleagues suggest that doctors should encourage dialogue by saying, 'Let's discuss our options if things get worse.'

6. 'Everything will be fine.'
The alternative is 'We will support you through this process,' to which Berry et al. say, 'Offer practical, compassionate support.'

7. 'Fight' or 'battle'
In Japanese, the term 'fighting an illness' can refer to facing treatment with strong willpower, but expressions like this, which suggest that the patient can overcome the illness depending on their own determination, can lead to patients blaming themselves if they are not cured.

Instead, Berry and his colleagues recommend calling on people to 'join us in taking on this difficult disease.'

8. 'What does the patient want?'
There are cases where patients are unable to express their wishes due to the worsening of their condition, etc. However, the word 'want' is vaguely defined, and families may not know what the patient wants.

As an alternative to what to say in such cases, Berry et al. recommend showing an openness to think alongside the patient by saying, 'How would the patient feel if they heard everything that has just been said?'

9. 'Why did you let it get to this point?'
Berry and his colleagues say it's counterproductive to blame patients and make them more anxious; instead, they recommend saying something like, 'I'm glad you took the time to come and see me.'

10. 'What on earth were the other teachers doing?' 'What on earth were the other teachers thinking?'
An alternative to this statement is, 'I'm glad you came in for a second opinion. Let's look at your records and figure out what to do next.'

'Rather than denigrating other doctors who may potentially work with us again, we should focus on what we can do now and be positive,' Berry and his colleagues said.

In summarizing their study, Berry and his colleagues wrote, 'Patients' own words are essential to making optimal medical decisions, but these taboo words can shut down the conversation and prevent patients and families from asking honest, thoughtful questions and answering them. To avoid this, clinicians must make an effort to recognize the words that unconsciously cause fear, discomfort, and reduce autonomy and to rethink their own communication methods.'