Are there words that doctors should never use?

Some “never words” should not be used in conversations with seriously ill patients, according to a group that warns against language that shuts down patients’ questions, offends or limits decision-making.

A doctor might say, “Your mother needs be intubated’ or ‘they’ needs a transplant,” which can effectively eliminate a patient or family’s ability to consider other avenues or options. In statements such as: ‘We can continue the treatment, or we can just now providing supportive care” “merely” involves a value judgment, where a course of treatment is “suboptimal,” explained Rana Lee Adawi Awdish, MD, of Henry Ford Hospital in Detroit, and colleagues.

Therefore, “necessary” and “just” can be considered “never words” in certain contexts, the group claimed in a Mayo Clinic procedure perspective paper. The authors conducted a literature review of best practices for difficult conversations with patients and surveyed 20 physicians within their professional networks to ask which words or phrases they would never use with a patient.

Awdish and colleagues advocated alternative expressions that could instead invite open conversations that center the patient and their family, better convey the desire to provide care, provide realistic and humane support, invite further dialogue, and avoid suggesting awakened that sheer will can overcome an illness.

For example, an alternative to a “need” statement could be: “Her heart is getting worse. Can we talk about what that means and what we need to do next?’ This wording, the authors wrote, “demonstrates openness to shared decision-making, rather than issuing a unilateral directive. More thoughtful, intentional communication redistributes power back to the patient.”

The word “ordinary” could be removed entirely, they said.

Awdish’s group provided more examples of “never words” and alternative language use:

• “There is nothing else we can do” may become “Therapy your quality of life.”
• The phrase “withdraw care” can become: “We can shift our focus to his comfort rather than continuing with the current treatment, which is not working.”
• “Do you want us to do everything?” can become, “Let’s discuss the options available if the situation worsens.”
• “Everything will be okay” can become “I am here to support you through this process.”
• Instead of “fighting” or “fighting” regarding illness, use “We will face this difficult disease together.”

If the wording is readily available, physicians may not have enough time to reiterate the shared goals for each patient across the care continuum, the authors suggested.

For a doctor with good communication skills, “conversations are faster and more meaningful than those without,” says Robert Arnold, MD, of the University of Pittsburgh, who has experience teaching communication skills for difficult conversations with patients.

“I think physicians who care for seriously ill patients want to do a good job, and I think we just have to give them the training and support that will encourage them to do a good job,” said Arnold, who also serves on the board of VitalTalk, an organization that teaches communication skills to doctors.

“My overall view is that we should focus on what we want people to do, rather than what we want people not to do,” he said. MedPage Today. “Because if we spend all our time talking about what we don’t want them to do, from an educational standpoint, they will remember that.”

“You can learn certain phrases, but you still have to adapt them to fit your personality,” Arnold suggested. “I’ve said the wrong things before – I’ve probably said some of those ‘never say’ lines, and yet if you say them out of effort and care, sometimes things go better than you might think.”

He recalled a time when he told a patient that they had “failed” at something. In response, the patient “looked at me and said, ‘I didn’t do it. It was the medicine. Your medicine didn’t work.'”

“I said, ‘Yes, you’re right,’” Arnold continued. “We were in a long-term relationship, and it was okay, and he trusted me enough to tell me when I said things he thought were stupid.”