Patients suffering from serious illnesses, along with their families, often experience significant emotional pain. Researchers, including a professor from Texas A&M University, emphasize that healthcare providers must practice “compassionate communication” as an essential part of treatment. They’ve pinpointed certain phrases known as “never words” that should be avoided entirely and suggest ways for clinicians to recognize their own trigger words and adopt more constructive language instead.
In a recent study published in Mayo Clinic Proceedings, Dr. Leonard Berry, a Distinguished Professor of Marketing at Mays Business School at Texas A&M University, along with his colleagues from Henry Ford Health in Detroit, highlighted that despite advancements in treatments for severe illnesses like cancer, advanced heart failure, and end-stage pulmonary disease, some core aspects of the patient experience—such as fear—remain unchanged.
They noted, “Explaining the complexities of treatments and managing patient expectations often confronts persistent feelings of fear and emotional strain, compounded by a lack of medical knowledge and unreasonable hopes for recovery.” This challenging nature of these conversations can lead clinicians to rely on habitual communication patterns or definitive statements.
Just a single word can instill fear in patients and their families, potentially making them feel powerless and undermining the effectiveness of collaborative decision-making.
“Given that seriously ill patients and their loved ones are understandably anxious, they pay close attention to every word from their doctor,” Berry, a senior fellow at the Institute for Healthcare Improvement, pointed out. “Dealing with a serious illness involves not just physical discomfort but also emotional turmoil. How doctors communicate—both verbally and nonverbally—can worsen or alleviate this emotional distress.”
Berry argued that too often, doctors inadvertently use harsh language while delivering crucial news, not realizing the undue stress or hurt it may cause.
Never Words
According to Berry, patients and their families need to feel “psychologically safe” when engaging with healthcare providers, allowing them to voice concerns about treatment plans or express their fears. Researchers warn that if doctors utilize “never words,” they might stifle patients’ and families’ ability to communicate openly.
“Never words halt conversation,” the researchers observed. “They strip power from patients, whose input is vital in making informed medical decisions.”
Through surveys conducted with clinicians, specific phrases identified as never words include:
- “There is nothing else we can do.”
- “She will not get better.”
- “Withdrawing care.”
- “Circling the drain.”
- “Do you want us to do everything?”
- “Fight” or “battle.”
- “I don’t know why you waited so long to come in.”
- “What were your other doctors doing/thinking?”
In another study focused on cancer care, clinicians listed words or phrases they would never say to a patient, with top responses including:
- “Let’s not worry about that now.”
- “You are lucky it’s only stage 2.”
- “You failed chemo.”
Researches stated, “‘Let’s not worry about that now’ dismisses a patient’s valid concern; it fails to address their anxiety. Stating that cancer is at an early stage is presumptive; it implies the patient should feel grateful without acknowledging their fear.” Additionally, Berry mentioned, patients do not fail chemotherapy; rather, chemotherapy fails patients.
What Doctors Should Say Instead
Healthcare providers can promote candid dialogue by encouraging honest and thoughtful questions from patients and families. “They should work on identifying and replacing words that unconsciously frighten or offend,” the researchers suggested.
Berry emphasizes that such moments can arise when doctors prompt patients to ask questions. “A simple phrase like, ‘What questions do you have for me?’ rather than ‘Do you have any questions?’ fosters a more open discussion,” he explained.
Regarding never words, the researchers advocate for alternative phrases along with their reasoning. For instance, instead of saying, “She will not get better,” the physician could express, “I’m worried she won’t get better,” transitioning from a definite negative outlook to a display of concern.
Using terms like “fight” or “battle” might suggest to patients that their will alone can conquer illness, potentially leading them to feel guilty for not trying hard enough. Instead, doctors could express, “We will tackle this tough illness together,” reinforcing that patients have a supportive team behind them.
Spreading Awareness
The researchers assert that medical organizations and educators can highlight the concept of never words through various means, such as incorporating these discussions into educational programs and professional training.
“While the focus in medical education is understandably on the clinical aspects of medicine, it’s equally vital to weave communication training into the curriculum,” Berry remarked. “Medical students and residents benefit significantly from having proficient, patient-centered communicators as mentors during their training.”
Mentorships are also crucial since seasoned doctors can share successful communication strategies as well as those to avoid. The study indicated, “Mentors can reveal harmful phrases they’ve moved past and suggest more constructive alternatives while also demonstrating how to retract poorly received language. Such mentorship enhances how future healthcare professionals engage with patients and encourages open discourse regarding the distress that poor communication can lead to.”
Collaborators on this study include Dr. Rana Lee Adawi Awdish, a critical care physician and medical director of care experience at Henry Ford Health, and Dr. Gillian Grafton, an advanced heart failure and transplant cardiologist at the Cardiac Intensive Care Unit of Henry Ford Health.
