“We’re going to help you fight this” commonly accompanies a doctor’s news of a terminal diagnosis. Doctors are trained to treat and cure, not listen and comfort, so often, an incurable disease is perceived by doctors as a personal failure. Instead, I think, doctors should try to understand their patients and what they care about to create a dynamic care plan with the patient's preferences as a starting point. Often, perhaps even unintentionally, doctors will maintain hope for recovery and default to intensive treatment when neither may be appropriate. Doctors unequivocally mean well by inspiring hope, but it can be misleading and ultimately lead to decision-making that negatively impacts quality of life. Vital Talk teaches clinicians how to have tough conversations with their patients the right way (http://vitaltalk.org/).
There are other examples where clinicians’ phrasing impacts patients’ and families’ decision-making. I recently met with a palliative care specialist who handles all of the palliative care consultations in a hospital. Here are some examples from a hospital palliative care nurse where clinicians' phrasing affects how patients and families perceive their options:
- Palliative care is poorly understood, so the word itself scares some patients and families away.
- "Withdraw of care" is used in place of "compassionate wean" to mean taking someone off of a ventilator.
- DNR (do not resuscitate) is used in place of "allow a natural death."