How to Choose the Right Words When Talking to a Patient

by G. Richard Holt, MD, MSE, MPH, MABE, D Bioethics •

Too often I’ve heard a resident physician explain, “You have a high nasal septal deviation that’s impinging on the middle turbinate and causing sphenopalatine neuralgia,” or some such description of the pathology.

Another method for teaching and practicing effective and ethical communication with patients is through simulation. You can have trainees serve as both the patient and the physician. One trainee is the “patient” and is requested to listen to the “physician’s” discussion as she would imagine a real patient might. After reversing roles, in almost every simulation both trainees better understand the importance not only of straight talk, but also of empathetic talk, and they learn to avoid confusing and difficult medical terminology. Debriefing the trainees after each simulation will also provide an excellent forum to emphasize the important elements of clear and supportive patient–physician communication and the lessons learned from the encounter.

Give and Take

Effective communication with patients isn’t a one-size-fits-all effort. Each patient may require some consideration regarding how to convey information and how to know that he or she heard and understood it. Sometimes during the discussion, the physician will speak and the patient will listen; conversely, it’s important for the patient to speak, usually asking questions for clarification, while the physician listens. In essence, this should be a good “give and take” discussion.

It usually becomes easier to communicate with a patient once you’ve established a strong bond. Discussing important medical information with a new patient, however, requires more resourcefulness to gain a rapport and determine the level of sophistication or simplicity required to convey the information; you’ll need to listen—really listen—for understanding. Above all, communication should be patient-centered, not physician-centered. And, to paraphrase my fifth grade teacher, “patience is a virtue” in the context of these communications.

Effective and caring patient–physician communication is essential to establish a proper and effective patient–physician relationship—in fact, they’re inextricably connected. All the virtues that a physician should possess are used during patient care communication and relationship building: trustworthiness, compassion, understanding, discernment, valuing the patient, consideration, and moral integrity. Further, it isn’t just the words we use, but also how we say them that can convey these integral virtues.

What Went Wrong

In the clinical scenario above, we can identify a number of ways that Dr. Smith failed to provide effective communication, both verbally and nonverbally.

  • First, he assumed a nonchalant pose in the room, leaning against the cabinet rather than sitting at eye level with the patient, a more compassionate position for presenting unfavorable news.
  • Second, he conveyed the diagnosis in terminology that wasn’t familiar to the patient, nor could it be expected to have been familiar. In an attempt to clarify, he bluntly gave her the cancer diagnosis.
  • Third, he failed to appreciate and respond to the patient’s obvious concern about her future outcome and the potential for the cancer to develop in her daughter.
  • Fourth, he didn’t take the opportunity to express his concern for her as his patient and as a human being after he delivered the diagnosis. He expressed no words of empathy to her—not even an “I’m sorry to have to tell you this.”
  • Fifth, he made no effort to follow the patient in the future, effectively abandoning her, which may have amplified her feelings of uncertainty and devaluation.

Just being present for the patient, listening, perhaps holding her hand or gently laying a hand on her shoulder, is a form of communication that can mean a great deal to patients, perhaps even more than the correct words. Abraham Verghese, MD, MACP, the Linda R. Meier and Joan F. Lane Provostial Professor of Medicine at Stanford University, had it correct in his commencement remarks to the graduates of Stanford Medicine in 2014: “You can heal even when you cannot cure by that simple human act of being at the bedside—your presence.”

There is a sixth communication error in this scenario: when Dr. Smith dismissed the patient’s concerns and minimized the seriousness of the disease and the future struggle Mrs. Jones is about to undergo. His words rang with a false sense of hope and created a misunderstanding for the patient regarding her potential outcome from the future therapy. A physician doesn’t have the authority or the prescience to propose a longevity of “100 years” to a patient with cancer (or any other disease), no matter what the state of technological treatment advances or stage of her disease. Our moral integrity begs our adherence to professional trustworthiness and honesty. Words do matter to patients, and they should also matter to us in the care of our patients.