A paper published in Mayo Clinic Proceedings identifies 10 words and phrases as “never words” that clinicians should avoid saying to patients, particularly during difficult encounters with emotional patients. The paper’s authors, from Texas A&M University and Henry Ford Health, emphasized the importance of “compassionate communication” as part of the patient’s treatment process.
«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,” they wrote.
It’s important for patients and their families to maintain a feeling of psychological safety in their communication with health care professionals, and the use of certain “never words” can undermine their ability to communicate freely and without fear of judgment.
“‘Never words’ are conversation stoppers,” the authors wrote. “They seize power from the very patients whose own voices are essential to making optimal decisions about their medical care.”
The emphasis in medical care is understandably on the science of medicine, but it is so important to incorporate communications training into the curriculum. A key opportunity is medical school students and graduates having superb patient-centered, skilled communicators as role models in their clinical training during medical school and residency.
Let’s see the 10 things you should never say to patients
“There is nothing else we can do”
Alternative: “Therapy X has been ineffective in controlling the cancer, but we still have the chance to focus on treatments that will improve your symptoms and, hopefully, your quality of life”
Patients and their families should not be left with a feeling of hopelessness. Even in situations where there is no possibility of a cure, clinicians can still convey an ability to treat the patient to the best of their abilities.
“She will not get better”
Alternative: “I’m worried she won’t get better”
Rather than a firm and negative prognostication, full of hopelessness, clinicians can express sympathetic concern regarding the prognosis.
“Withdrawing care”
Alternative: “We can shift our focus to his comfort rather than persisting with the current treatment, which isn’t working.”
According to the paper, clinicians never “withdraw” care, which would serve as an indication of giving up and denying further services or treatment to patients and their families. Instead, say what is really meant by the phrase, and explain the advantages of refocusing the goals of care.
“Circling the drain”
Alternative: “I’m worried she’s dying.”
“Avoid slang terms that objectify and diminish the patients,” the authors of the paper wrote.
“Do you want us to try everything?”
Alternative: “Let’s discuss the available options if the situation gets worse.”
Rather than a question that could be leading and not in line with the patients’ or their family’s goals, clinicians can invite dialogue, which could even prove to provide additional comfort.
“Everything will be fine”
Alternative: “I’m here to support you throughout this process.”
Avoid setting unrealistic expectations and making promises that things will be fine, when the outcome is actually unknown. Instead, focus on offering realistic and humane support.
“Fight” or “Battle”
Alternative: “We will face this difficult disease together.”
It shouldn’t be implied that patients can overcome illness through sheer will. This puts patients in an uncomfortable situation where they may feel that they are letting their family down if they are unable to recover. “If only she’d fought harder, she could have won” wrote the authors.
“What would he want”
Alternative: “If he could hear all of this. What might he think?”
The authors say that the word “want” is ill-defined in hospital settings. It’s impossible to tell exactly what a patient may want if they cannot communicate it themselves.
“I don’t know why you waited so long to come in”
Alternative: “I’m glad you came in when you did.”
There should be no blame placed on the patient, as it would be generally unproductive and only cause additional anxiety and stress. Instead, clinicians should focus on what can be done given the present circumstances.
“What were your other doctors doing/thinking?”
Alternative: “I’m glad you came to see me for a second opinion. Let’s look at your records and see where we can go next.”
Again, clinicians should be focus on what can be done, what is possible and what is realistic. It would be unproductive and unwise to speak negatively of other health care professionals whose cooperation may still be relied upon moving forward with the patient.
Key Takeaways
- Avoiding “never words” is crucial for maintaining psychological safety and open communication between patients and health care professionals.
- Compassionate communication is integral to the treatment process, helping manage patient emotions and expectations.
- The study suggests incorporating communication training into medical education to enhance patient-centered care.
- Role models in clinical training can significantly influence the development of effective communication skills in medical students and professionals.
