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Hey Doc, Choose Your Words Carefully

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Communication is key to a successful patient-physician relationship. Unfortunately, some physicians lack the skills to do this well, especially when it comes to delivering bad news. Michael Kirsch, M.D., of MD Whistleblower shares that during his medical training, "I don't recall a single lecture on how to deliver bad news to patients."? He asks, "Should we be blunt?... Should we use euphemisms?... Should we spin the information with hope and optimism?... Should serious medical news ever be delivered on the telephone?" Perhaps there is no correct answer -- each individual and situation is unique -- but as Robert Centor, M.D., notes "breaking bad news may be the most difficult and important part"? of the medical profession.

When his supervising physician asked about the next course of treatment for a woman with ovarian cancer, Don Dizon, M.D., learned quickly the importance of choosing his words carefully. "Well, since she failed this regimen, I think she needs to start on a new salvage treatment." The supervising physician advised, 'Don, if there's one thing I've learned, it's that people do not fail chemotherapy. The chemotherapy didn't work, but no one failed; she didn't and I didn't. And, we don't salvage people. Salvage is what you do with scrap metal and trash.'"

Learning from the experience Dizon said, "[They] were words and phrases I had heard as a medical resident, and they were phrases used everywhere in oncology. Still... The way we communicate matters and even when we think our audience is our peers, in the era of social media, we must be cognizant of the wider reach of our words, our lectures, our publications, and our presentations. While our colleagues may understand what we mean when we refer to treatment as 'salvage therapy,' the same may not be said of how our patients or the public hear it."

After serving on a panel discussing end-of-life care, Howard Gleckman, author of Caring for Our Parents, observed that: "Despite our very different backgrounds and perspective, we all ended up delivering a similar message: It is essential that everyone involved with a dying patient communicate. This is important for all patients and rarely done well. But when it comes to the highly emotional and complex issues surrounding end of life, it is especially key."



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Conversation Continues feature ongoing discussions or news on current health topics with links to related materials.  They are part of the Center for Advancing Health’s portfolio of free, evidence-based coverage of what it takes to find good care and make the most of it.


Tags for this article:
Communicate with your Doctors   Participate in your Treatment  


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