A lot of our activity as providers of health care is gathering and providing information via the spoken language. I have noted through the observation of students and residents in training and critical reflection on my own experience, the power of words to create fear, anxiety, and uncertainty, or alternatively to create calm, reassurance and hope. Words, the ones chosen, the way they are spoken, and the way they are received and interpreted carry a powerful therapeutic effect. After years of study and practice we are still reminded of the importance of what we say and how we say it.
I operated on a patient with nerve compression who unfortunately did not experience complete relief of her neurological symptoms after surgery. In reviewing the characteristics of her persistent numbness she informed me that she knew why her hand was still numb. A jolt of concern crossed my mind thinking she may have some perception that the surgery had damaged her nerve. The procedure had been carried out under a brachial plexus block performed with ultrasound guidance. The patient related she had heard one anesthesia provider tell the other that he had “blown up the nerve”, a reference to the distribution of local anesthetic in the proper location. She was fixed in the belief that this was a mistake and the cause of her symptoms.
When speaking of thickening of the palmar fascia in Dupuytren’s contracture I always refer to the Dupuytren’s fascia. This was reinforced one day when a resident told the patient he had Dupuytren’s disease and the disease was causing the fingers to contract. The patient was shocked, upset, and totally pre-occupied with the revelation that he had a “disease”. It was an uphill struggle to then educate the patient regarding the goals of management, in other words a release of the contracture, rather than curing or ablating a disease.
Framing comments as a gain rather than a loss is a powerful therapeutic tool. A skin graft is “more than 90% healed” rather than “some of the graft did not take”. A difficult pain syndrome is “the kind of problem that does not require surgery” rather than “ there is nothing I can do for you”.
Words used by the patient can give valuable information to guide management. “Just cut it off”, “I want it fixed”, “the other doctor screwed up”, and the one my mother would like, “I heard you are the best” carry with them a clear narrative beyond the content of the words themselves. When someone tells us their problem only started after his or her repetitive job, we take note. When they say it three times in fifteen minutes that is another clear message. Through the power of words we learn a lot more about our patients than a simple list of their symptoms.
We all have developed short speeches to relay information to patients. These are developed over years of practice, good and bad experiences, and they serve to provide information in a clear, honest, non-inflammatory manner that is consistent with an efficient office practice. We learn to avoid the use of words and phrases that are ambiguous or could carry extra emotion.
When a patient is speaking we have to listen to what they are saying, how they are saying it, and think about why they are saying it. When we are speaking, to not maximize the power embedded in our own use of words ignores a strong intervention that can help our patients and make our lives easier.