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Doctors need to be careful about how they interact with patients – and a new study suggests there are some phrases they should never say.

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

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Because they are “naturally afraid, they hang on every word their doctor tells them,” said Dr. Leonard Berry, a professor of marketing at the Mays Business School at Texas A&M University. according to a university press release. Berry, a co-author of the study, is also a senior researcher at the Institute for Healthcare Improvement.

The study authors interviewed 20 clinicians, reviewed the literature, and used their experiences to gather best practices for difficult conversations between doctors and patients.

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

“Words never stop the conversation. 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 “forever words” are simple words (or phrases) that not only lack benefit, but can also cause emotional harm and accentuate power differentials in particular clinical contexts. »

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

Phrases and sentences that the study advises doctors against saying are:

• “There’s nothing else we can do.”
• “She won’t get better.”
• “withdraw from care”
• “go around the sewers”
• “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 says it implies that “sheer willpower can beat the disease,” adding that “patients may feel like they’re letting their families down if they do not recover.” Instead, the study suggests the phrase: “We will face this difficult disease together.” »

Instead of “circling the sewers,” the study urged doctors to try saying, “I’m afraid she’s going to die.” » Avoid slang terms that objectify and diminish patients, the study authors wrote.

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The study also drew attention to the power imbalance between doctors and patients, particularly when it comes to explaining treatment. Physicians possess a wealth of medical knowledge, while patients and their families have an “often less appreciated base of self-knowledge relevant to shared decision-making,” the study authors explain.

They said the main benefit of banning nonwords is “putting power back into the hands of patients,” so they can collaborate with healthcare teams.

However, one obstacle doctors still face is that medical school focuses primarily on medical science, Berry said, emphasizing that it is also crucial to include communications training in the curriculum. He said mentoring from “skilled, patient-centered communicators” is a good solution.

“Mentors may not only disclose harmful phrases that they have personally discarded and replaced with more generative phrases, but may also model language that comes back unwelcome,” according to the study.

The study is “intended to complement existing best practices and provide a concrete, relatively easy-to-implement approach that helps clinicians navigate difficult conversations and honor their duty to ‘do no harm’.” according to its authors.

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