11 Things You Should NOT Say to Patients: How to Replace the "Never-Words"
The 11 words and phrases, among others, are often automatic responses from clinicians in highly emotional settings of severe illness. Find 11 alternatives, here.
Even when the potential for cure no longer exists, clinicians can still offer to provide care to the best of their ability with resources available.
Rather than a declaration of the worst case scenario, it is more helpful for the patient and family to express your own concern about a poor prognosis.
Clinicians never “withdraw” care. The term implies giving up or that services will be denied to both patient and family. It is far more helpful to discuss the advantages in refocusing the goal of care on comfort measures.
Slang terms that objectify and diminish the patient create distance and an air of disregard for him or her and for the emotions of family.
Inviting dialogue about the options that can be tapped if a patient becomes worse is more helpful and supportive than a leading question that may not be in synch with the patient's or the family's values or goals for their loved one.
To say that "everything will be fine" in a situation that is clearly not going to proceed to that end offers false hope and may also be received as cynical. Offer support that is realistic and humane.
To imply that by sheer force of will a patient can overcome or vanquish severe illness can burden a patient who may then feel as if they’re letting their family down if they don’t recover (“if only she’d fought harder, she could have won.”)
The declaration closes of deliberation about the patient’s priorities. The alternative signals openness to shared decision making vs issuing a unilateral directive.
In a hospital or emergency setting, the word "want" is "often ill-defined." What a family member perceives a patient would want in a dire situation may not be possible.
It is far more productive to focus on the options that are available now that the patient is under your care than to suggest that they have caused themselves further harm by delaying care. Blame casts a shadow over the relationship.
Focus on the here and now, discussing what is possible vs judging a colleague or other professional - particularly as you may need their cooperation as treatment continues.
Source: Awdish RLA, Grafton G, Berry LL. Never-words: what not to say to patients with serious illness. Mayo Clin Proceed. 2024;99(10):1553-1557. doi: 10.1016/j.mayocp.2024.05.011
The 11 words and phrases identified as "never-words" in a paper published recently in Mayo Clinic Proceedings are often fall backs for clinicians when communicating with patients and families in the setting of a severe illness. "Engaging in sensitive, honest dialogue with seriously ill patients has become an even greater clinical challenge with the rapid progress in therapies for conditions such as advanced heart failure, cancer, and end-stage pulmonary disease," wrote the author trio from Henry Ford Hospital and Texas A&M University.
They emphasize the communication challenge for the clinician who has information to convey about treatments that are often complex and confusing and also hopes to set realistic expectations about outcomes. That task "still comes up against timeless patient experiences: fear, intense emotions, lack of medical expertise, physical pain, and the sometimes unrealistic hope for cure."
"Never-words," they explain, lack benefit, can lead to emotional harm. and magnify power differences between clinician and patient in some clinical contexts. The short slide show above provides 11 examples of the type and also alternatives as well as the authors' rationale for avoiding the language.