THE Seriously ill patients and their families face intense emotional sufferinga group of researchers therefore believe that doctors should engage in “compassionate communication” as part of the treatment process and to do this, they identified what they called “never words”, which under no circumstances should it be said and provide more useful language to use instead.
In the study, published in the journal Mayo Clinic Proceedings, Dr. Leonard Berry, professor of marketing at Texas A&M University and co-authors of Henry Ford Health in Detroit, both in the United States, says that despite rapid advances in the treatment of serious illnesses such as cancer, advanced heart failure and end-stage lung disease, some “eternal” aspects of the patient’s experience, such as fear.
“Communicating the nature, purpose and expected duration of often complex treatments, and setting realistic expectations for what they offer, continues to address timeless patient experiences: fear, intense emotions, lack of medical experience and the sometimes unrealistic hope of being cured,” they write. The “intense and intimidating nature of these conversations” may lead doctors to resort to learned communication habits or declarative statements.
Even A simple word can frighten patients and their families, rendering them helpless. and possibly nullify the effectiveness of shared decision-making, they point out.
“Naturally, the Serious patients and their families are afraid and “hang on” to every word their doctor says. –says Berry, researcher at the Institute for Healthcare Improvement–. Serious illness is not only about physical suffering, but also emotional suffering. “Physician behavior, including verbal and nonverbal communication, can exacerbate or reduce emotional distress.”
Berry points out that, too often, doctors use insensitive language when communicating critical informationand they generally do so without realizing the alarm or unnecessary offense they have inflicted.
Patients and their families should feel “psychologically safe” when communicating with healthcare professionalsBerry said, even while expressing concern about the proposed treatment plan or expressing fears.
Words a doctor should not say
Based on surveys of doctors, Researchers have identified the ‘never words’:
- “There’s nothing else we can do.”
- “It won’t get better.”
- “Withdraw attention.”
- “It’s terminal.”
- “Do you want us to do all this?”
- “Combat” or “battle” or “combat” and war-related terms.
- “I don’t know why you waited so long to come.”
- “What did your other doctors do/think?”
In another specific study on oncology caredoctors were asked which words or phrases they would never use with a patient, and the main results were:
- “Let’s not worry about that now.”
- “You’re lucky, it’s only phase 2.”
- “The chemo failed.”
“‘Let’s not worry about it now’ not only fails to address a legitimate patient concern, but it’s derogatory –explain the researchers.– Emphasizing that the cancer is at an early stage is presumptuous, because it assumes that the patient must feel gratitude, without leaving room for the patient’s anxiety and fear of having a cancer. ” And, according to Berry, patients don’t fail chemotherapy, but chemotherapy fails.
What doctors should say
Healthcare professionals can engage in dialogue by inviting patients and their families to ask questions and respond honestly and thoughtfully. “They must learn to recognize the words and phrases that frighten, offend or unintentionally diminish the ability to act and work to reinvent their own communication,” say the researchers.
Berry says this opportunity may arise when doctors encourage patients to talk. “Something as simple as ‘What questions do you have for me?’, instead of ‘Do you have any questions?’ “, invites a sincere conversation,” he says.
As for the “never spoken words,” the researchers recommend alternative language, as well as a rationale for each. For example, instead of: “It won’t get better,” the doctor might say, “I’m afraid it won’t get better.”. In this way, the doctor replaces a strong negative prediction with an expression of concern.
Using words such as “fight” and “battle” can imply that willpower can overcome illness and patients may feel like they are letting their loved ones down by not fighting hard enough. Instead, doctors might say: “We will face this difficult disease together” to make it clear that patients benefit from the support of a team.
