A new report has identified 12 ‘never phrases’ that doctors must never use with patients with serious illnesses’, such as heart failure, cancer, and lung disease.
They explain that these ‘single words or phrases not only lack benefit but also can cause emotional harm and accentuate power differences.’
First on their suggested list of ‘never words or phrases’ is the blunt expression, ‘there is nothing else we can do.’
‘They seize power from the very patients whose own voices are essential to making optimal decisions about their medical care.
‘They should learn to recognize words and phrases that unintentionally frighten, offend, or diminish agency and work to reimagine their own communication.
“Everything will work out fine.”. “.”.
You or someone you know has undoubtedly heard a doctor say those things, but doctors are now being cautioned to refrain from doing so because it may give false hope.
Doctors should never use these 12 “never phrases” when treating patients who have serious illnesses like lung disease, cancer, or heart failure, according to a recent report.
They clarify that in addition to having no usefulness, these “single words or phrases” can also exacerbate power disparities and cause emotional harm. “…
For instance, a physician should never use the phrase “withdrawing care” when a patient is in critical condition because it suggests that the medical staff is “giving up.”. “…
According to the researchers, the phrase “everything will be fine” may seem reassuring, but it may give false hope in cases of serious illness. Instead, “I’m here to support you throughout this process” would be a better alternative. “…
This implies that no commitments are made and that the result is uncertain. Similarly, stating that “we’re going to fight this together” could imply that illness can be overcome by sheer willpower, according to the study’s authors. “…
The study, however, coincides with rising worries about the “wokification” of medicine, in which medical professionals are now too afraid to be honest with patients.
Four researchers—three with medical backgrounds and one with experience as a critically ill patient—performed the new study, which was published in the journal Mayo Clinic Proceedings.
The team identified 12 “never words” and phrases that should not be used during end-of-life care by consulting with 20 outside physicians and drawing on their own medical experience.
The direct statement “there is nothing else we can do” is the first item on their recommended list of “never words or phrases.”. “.”.
Rather, they advocate for a more compassionate approach, suggesting the following conversation: “Therapy X has failed to control the cancer, but we still have the opportunity to concentrate on treatments that will improve your symptoms and, hopefully, your quality of life.”. “.”.
“Even with no prospect for cure, the clinician can still convey an ability to treat the patient as best they can,” the researchers explain in their explanation. “…
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According to the experts, it is absolutely unacceptable to inform friends and family that a patient will “not get better.”.
Rather than using a “firm negative prognostication,” they recommend using the phrase “I’m worried that X won’t get better” to express concern about the poor prognosis. “.”.
“We can shift our focus to his/her comfort rather than persisting with the current treatment, which isn’t working,” the paper suggests as an alternative comment to family or friends. “.”.
When the researchers discovered slang among medical staff, they were shocked to learn that the phrase “circling the drain” should never be used in reference to a patient’s imminent death or rapid determination.
According to them, medical professionals ought to adopt a more thoughtful stance and inform the patient’s loved ones, “I’m concerned that X is dying.”. “.”.
The words “fight” and “battle” are therefore prohibited because “patients may feel as though they’re letting their family down if they don’t recover.”. “…
If a patient is unable to communicate, a doctor may ask the patient’s family “what would X want.”.
However, the researchers point out that in a hospital context, “want” is frequently ill-defined, and what families believe the patient would want might not be achievable. “.”.
They recommend asking friends and family members something like, “If he could hear all of this, what might he think?” as an alternate method of attending to a patient’s needs.
The researchers say that the last thing clinicians should do is “blame” a patient and add to their anxiety, even though some patients may wait a long time before finally addressing their illness and seeking medical assistance.
Therefore, it would be more compassionate to say, “I’m glad you came in when you did,” rather than, “I don’t know why you waited so long to come in,” to a patient. “.”.
In a similar vein, the researchers advise clinicians to ask “what were your other doctors doing/thinking?” when a new patient comes in with negative outcomes from another physician.
This is a bad strategy, they explain, and it’s better to “focus on what’s still possible.”. “.”.
They advise taking constructive action instead of criticizing experts whose assistance you might still require to advance the patient. “…
According to the study’s authors, it is ineffective to ask a critically ill patient if they want “us to do everything.”.
They claim that it is preferable to encourage conversation rather than “using a leading question that may not align with the patient’s values or goals.”.
They recommend the following phrase for clinicians to use: “If things worsen, let’s talk about the options that are available.”. “.”.
The researchers come to the conclusion that “never-words are conversation stoppers” after presenting their twelve never-words and phrases.
“They take away authority from the very patients whose opinions are crucial to deciding on the best course of treatment for themselves.”.
Instead, doctors should try to have conversations with patients and their families by asking them to be honest and thoughtful in their questions and answers.
They ought to try to rethink their own communication and learn to identify words and expressions that inadvertently frighten, offend, or decrease agency.
Giving patients their power back allows them to actively work with their care team to make the best treatment and care decisions, which is the desired outcome for all clinicians. “…
Gallup reported last year that the percentage of Americans who thought highly of doctors’ ethical standards had fallen from 77 percent at the beginning of the pandemic in 2020 to 62 percent at the end of 2022, a 15-point decline that was unusually sharp.
