Do No Harm: What Researchers Say Doctors Should Avoid Telling Patients
In a recent paper published in Mayo Clinic Proceedings researchers describe 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.
“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,” researchers 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.
“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:
“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 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:
“Let’s not worry about that now.”
“You are lucky it’s only stage 2.”
“You failed chemo.”
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. 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.
Reference: Never-Words: What Not to Say to Patients With Serious Illness, Lee Adawi Awdish, Rana et al., Mayo Clinic Proceedings, Volume 99, Issue 10, 1553 - 1557
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