Rationale: Focus on what's still possible. Take positive next steps, rather than casting aspersions on professionals whose cooperation you may still need in moving the patient forward.
The researchers took a multi-pronged approach to studying problematic medical communication. They surveyed 20 clinicians within their professional networks, asking them to identify words or phrases they would never use with patients and what alternative language they would suggest instead.
They also conducted a comprehensive literature review to gather current best practices for difficult clinical conversations. The study team brought diverse perspectives to the analysis, including insights from critical care medicine, heart failure treatment, and health services research. One researcher's experience as both a physician and former critical care patient provided valuable dual perspective on the impact of medical communication.
The study identified numerous "never-words" and phrases that can harm the doctor-patient relationship, along with suggested alternatives. These included common expressions like "there is nothing else we can do," "withdrawing care," and "circling the drain." The researchers found that such language often creates power imbalances, shuts down dialogue, or causes unnecessary emotional distress. They also discovered that structural challenges in healthcare delivery, such as time constraints and fragmented care teams, can contribute to the use of these harmful expressions.
While the study provides valuable insights into medical communication, it has several limitations. The sample size of 20 clinicians was relatively small and may not represent all healthcare providers' experiences. The study focused primarily on serious illness and end-of-life care, so the findings might not apply equally to all medical contexts. Additionally, the researchers note that context matters significantly in medical communication - words that might be harmful in one situation could be appropriate or even helpful in another.
The research emphasizes that improving medical communication isn't just about avoiding certain words - it's about fundamentally changing how healthcare providers share power with patients in decision-making. The study suggests that medical education should include specific training about language choices and their impact on patient care.
The researchers also highlight the importance of organizational culture in supporting better communication practices. They note that while avoiding never-words isn't a complete solution to communication challenges in healthcare, it provides a concrete, actionable way to improve patient care.
According to the paper, the authors reported no competing interests in conducting this research. The specific funding sources for the study were not disclosed in the original article.