Don’t underestimate the power of words. Words can harm and words can heal. Today, let’s consider their healing power.
My outpatient exams include a running commentary. When patients are doing well, I praise their lungs. “Clear as a bell.” “Thank you for reminding me what normal lungs sound like.” “I love what I’m hearing.” “Big improvement.” Patients relax as their worry melts away. We share the joy together.
When patients are doing poorly, I pair the bad news with a plan. “You’re wheezing more today, but no worries, we’ll take care of that.” “It sounds like the fluid is returning. Let’s get an x-ray to see what we need to do.” I don't want patients to worry about facing problems alone.
The stakes are higher in the MICU, where families routinely join us on rounds. So often, I’m struck by how well we explain complex concepts while failing to say what families need to hear:
Physician: “We’re decreasing the medicine that’s supporting her blood pressure and she’s needing less oxygen today. She’s making more urine and the fever is coming down.”
Family Member: “Thank you for the clear explanation, doctor, but how is she doing?”
We need to highlight the big picture and, if the news is good, share the joy:
Physician: “We’re having a good day today. The heart, lungs, and kidneys are recovering and the infection is coming under control. This is great news, and I’m even thinking she can come off the ventilator in the next day or two.”
Family Member: “Thank you, doctor. What a relief.”
See the difference?
And when the news is bad, we can also fail to say the right thing, even when our words are clear:
Physician: “The CT scan showed extensive brain damage. This explains why his pupils are so big and why he’s still unconscious.”
Family Member: “Thank you for the information, doctor. When do you think he’ll wake up?”
The physicians’ words are inadequate; they describe details, but they don’t address prognosis, acknowledge tragedy, or show support:
Physician: “I’m afraid the CT scan showed bad news- severe brain damage- which is what we were worried about after his heart stopped. It looks like he’s not going to wake up. I think we should take some time to think this through and consider our options. These are big decisions we’ll have to make together. Should we go to the family conference room to talk?”
Family Member: “Yes, please.”
Physicians’ communication skills have improved substantially over the years. We’re better at avoiding jargon so patients and families understand what we say. But clarity falls short when our words focus on details instead of the big picture, even more so when we fail to convey compassion. The stakes are high, so let’s consider the impact of our words, choose them carefully, and never miss a chance to support, to comfort, and to heal.
Enjoy your Sunday, everyone.
PS Brett is sending out the categorical interview invitations tomorrow at 1PM.