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Words that Harm

How many times have you been given a phrase by a physician that, perhaps, wasn’t phrased as well as it could be? “You’ve got a time bomb in your chest” or “I don’t know how you’re walking around with that spine!” As I venture through all the information that’s required in my Orthopedic Residency, this is the one subject that I wish more healthcare providers understood.

 

Too often, I hear a new patient tell me that their referring physician told them their spine is “riddled with bulging discs” to the point that they “shouldn’t be able to move.” Put yourself in that patient’s shoes. In that moment, how would you feel? You’ve been in pain for a long time, you’ve maybe had failed alternative treatments, perhaps you’re on pain medication that you don’t like taking. And the medical professional you’ve been sent to says they can’t even fathom how you’re able to move based on what they’ve seen on your images. There’s no way in that moment you feel great about your situation. And likely you have no hope for a more conservative treatment to finally get some relief.

 

Why would a medical professional say such words to their patients, if there were the possibility of being more supportive or hopeful? It’s suggested that possibly we no longer hear the words we say; we’ve become desensitized to the anxiety or fear that they cause. Perhaps we don’t have time to think of better phrases or words to say; with the way healthcare has gone in recent years, doctors don’t have a ton of time to spend with each patient. Physical therapists, who would typically have the most time with their patients, in many clinics are seeing multiple patients at a time. So instead of explaining how MRIs have shown bulging discs in patients who are asymptomatic or how patients with debilitating pain have no significant findings on MRI, they rush through the exercises for the day and hope that patient doesn’t have any questions. It was further suggested that maybe we use fear-evoking words as a method of getting compliance out of the patient. If we tell the patient that the only way to make sure “this heartbeat isn’t the last” is if they start exercising or begin taking their medication, the fear becomes helpful to that professional. But none of these reasons are acceptable for using language that has been shown to cause undue anxiety and poor results in our patients.

What we’re learning now is how important the brain is in how we perceive pain. Many new approaches in physical therapy seek to retrain the brain and our thoughts about pain.  One of the best ways I think we can seek to provide that re-training is through better use of language. Instead of getting stuck in these negative connotation words or phrases that cause fear, I think we should seek to determine words that evoke inspiration in our patients.

So, what words should be used by healthcare professionals? Words that allow patients to feel comfortable enough to ask questions are a good place to start. Miscommunication between healthcare professionals and patients due to the patient being afraid to ask a question about their condition is unacceptable. Clear, precise language that helps the patient understand exactly what is going on in their body, while taking into consideration the patient’s understanding and educational level. Metaphors that don’t cause negative emotional reactions can be helpful, too – as the car alarm analogy that is used to explain chronic pain situations (Neuroscience Pain Education). Healthcare professionals should seek to find and use words that will boost a patient’s self-confidence in their ability to control their situation and to inspire hope for recovery or rehabilitation.

As a physical therapist, I hope to never lose the humility that allows me to talk to a patient on their level. I hope to be able to always inspire patients to take control of their situations (within their means) and to be able to manage their symptoms without dependence on me. I hope to never get caught up on medical jargon that evokes fear in my patients, and instead build a trusting relationship where all questions can be asked and answered comfortably.

Bedell, S., Graboys, T., Bedell, E., Lown, B. Words that Harm, Words that Heal. Archive of Internal Medicine, 2004; 164:1365-1368.

Louw, A., Zimney, K., O’Hotto, C., Hilton, S. The clinical application of teaching people about pain. Physiotherapy Theory and Practice, 2016. http://dx.doi.org/10.1080/09593985.2016.1194652

Dr. Tristan Faile, PT, DPT
tristan@vertexpt.com