Doctors should never say these words to patients, study suggests

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Doctors should be mindful when it comes to how they interact with patients — and a new study suggests there are phrases they should never, ever say.

The findings of the study featured in the October issue of medical journal Mayo Clinic Proceedings revealed that words have weight when it comes to health care, especially for seriously ill patients and their families.

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Because they are “understandably frightened, they ‘hang’ on every word their doctor will say,” said professor of marketing at the Texas A&M University’s Mays Business School Dr. Leonard Berry, per a university news release. Berry, who co-authored the study, is also a senior fellow at the Institute for Healthcare Improvement.

The study’s authors surveyed 20 clinicians, reviewed literature, and used their experiences to put together best practices when it comes to hard conversations between doctors and patients.

Two of the authors, Dr. Gillian Grafton and Dr. Rana Lee Adawi Awdish, offer care to patients with advanced heart failure and critical illness. (Awdish was a critically ill patient herself and has since become an advocate for improved communication practices.) The third author, Berry, is involved in health services research with a background in communication in cancer care.

“Never-words are conversation stoppers. They seize power from the very patients whose own voices are essential to making optimal decisions about their medical care,” they wrote in the study.

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“Such ‘never-words’ are single words (or phrases) that not only lack benefit but also can cause emotional harm and accentuate power differences in particular clinical contexts.”

The study included the list of “never-words” and offered suggestions as well as the rationale behind the suggestion.

The phrases and sentences that the study warns doctors against saying are:

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

When doctors use the word “fight,” for example, the study said it implies that “sheer will can overcome illness,” adding that “patients may feel as if they’re letting their family down if they don’t recover.” Instead, the study suggested the phrase: “We will face this difficult disease together.”

As an alternative to “circling the drain,” the study urged doctors to try saying: “I’m worried she’s dying.” Avoid slang terms that objectify and diminish patients, the study’s authors wrote.

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The study also brought attention to the power imbalance between doctors and patients, specifically as it pertains to the explanation of treatment. Doctors have a wealth of medical knowledge, while patients and their families have an “often less-appreciated base of self-knowledge that is pertinent to shared decision making,” the study’s authors explained.

They said the main benefit of banishing never-words is “giving power back to patients,” so they can collaborate with health-care teams.

However, one hurdle still faced by doctors is that the main focus in medical school is the science of medicine, Berry said, pointing out that it is also crucial to include communication training in the curriculum. He said that mentorship with “patient-centred, skilled communicators” is a good solution.

“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,” per the study.

The study is “meant to offer a complement to existing best practices and to provide a concrete, relatively easy to implement approach that assists clinicians in navigating difficult conversations and in honouring their duty to ‘do no harm,’” according to its authors.

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