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“We’re going to help you fight this”

The language that clinicians use significantly impacts patient and family choices.

Photo of Daniel Mazour
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“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:

  1. Palliative care is poorly understood, so the word itself scares some patients and families away.
  2. "Withdraw of care" is used in place of "compassionate wean" to mean taking someone off of a ventilator.
  3. DNR (do not resuscitate) is used in place of "allow a natural death."

What is a provocation or insight that might inspire others during this challenge?

How might we rebrand palliative care? How might clinicians use less clinical and more transparent, effective, and compassionate language at the end of life?

Tell us about your work experience:

Blogging @ www.sensemakingdesign.com (about end-of-life design project)

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Photo of OpenIDEO

Hi Daniel, thanks for the post! It'd be great to add an image with this. Images help grab attention and tell a story. You should be able to use the Edit Contribution button on the top of your post and follow the instructions to add images from there. Looking forward to seeing more of your inspiring insights on OpenIDEO.

Photo of A.m. Harman

Totally agree about the "DNR" comment. I think health workers are often in some way protecting themselves from emotional exhaustion with that kind of distant, clinical language.

Photo of ATTICUS TAKAYESU

Absolutely.   Like everything else, we should pay for communication like we do (or the ABMS and AMA lobby for) procedural reimbursement.  Well said!

Photo of James Takayesu

The skill of talking to patients to understand their needs and apply medicine to their individual circumstance is becoming a lost art. The time pressures of medicine and reliance on mortality reduction in treatment for the sake of CMS measures and quality metrics only exacerbates the problem. Natural and meaningful death must be an outcome too. 

Photo of Daniel Mazour

Interestingly, hospitals are motivated to incorporate palliative care programs largely because fewer patients die in hospitals as a result. When patients understand their disease trajectory and have a choice, they overwhelmingly choose to die at home. By having meaningful, transparent conversations about patient preferences, hospitals can improve measured outcomes - the incentives for palliative care line up nicely (improving outcomes saves money). The question is, how do we foster more meaningful, open doctor-patient relationships? Thanks!