‘Everything’s going to be ok.’
No doubt you or someone you know has heard those words from a doctor – but now physicians are being warned to stop because it could lead to false hope.
A new report has identified 12 ‘never phrases’ that doctors must never use with patients with serious illnesses’, such as heart failure, cancer, and lung disease.
They explain that these ‘single words or phrases not only lack benefit but also can cause emotional harm and accentuate power differences.’
If a patient is critically ill, for example, a doctor should never mention the words ‘withdrawing care’ as this implies that the medical team are ‘giving up.’
While ‘everything will be fine’ might appear to be a comforting phrase, the researchers say that this could offer false hope when it comes to serious illness and a better turn of phrase could be ‘I’m here to support you throughout this process.’
This means no promises are made and the outcome is left undetermined. Likewise, the study authors saying something like ‘we’re going to fight this together’ could ‘imply that sheer will can overcome illness.’
But the study comes amid growing concerns about the ‘wokification’ of medicine, where doctors have become too scared to be frank with patients.
As part of an in-depth study published in Mayo Clinic Proceedings, four researchers looked at ‘never words’ and ‘what not to say to patients with serious illness’ (stock image)
The new report, published in the journal Mayo Clinic Proceedings, was carried out by four researchers — three with a medical background and one with experience as a critically ill patient.
Drawing on their own experience in the medical field, and talking to 20 external physicians, the team pinpointed 12 ‘never words’ and phrases that shouldn’t be used during end of life care.
First on their suggested list of ‘never words or phrases’ is the blunt expression, ‘there is nothing else we can do.’
Instead, they suggest a softer approach to the situation, with their suggested dialogue being: ‘Therapy X has been ineffective in controlling the cancer, but we still have the chance to focus on treatments that will improve your symptoms and, hopefully, your quality of life.’
Explaining their rationale, the researchers state: ‘Even with no prospect for cure, the clinician can still convey an ability to treat the patient as best they can.’
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Next up, the experts say that telling friends and family that a patient will ‘not get better’ is a complete no-no.
Instead, they suggest the phrase ‘I’m worried that X won’t get better’ as this replaces a ‘firm negative prognostication with an expression of concern about the poor prognosis.’
Instead, the paper states an alternative comment to family or friends could be: ‘We can shift our focus to his/ her comfort rather than persisting with the current treatment, which isn’t working.’
The researchers were shocked to find slang surfacing among medical staff and they say ‘circling the drain,’ in regards to a patient’s rapid determination and potential death, should never be used as a phrase.
Instead, they state medics should take a more considerate approach, telling those closest to the patient, ‘I’m worried X is dying.’
For this reason, ‘fight’ and ‘battle’ are listed as banned words as ‘patients may feel as if they’re letting their family down if they don’t recover.’
A doctor might ask a patient’s family ‘what would X want’ if the sick person is no longer able to communicate.
But the researchers note that ‘want’ is often an ill-defined word in a hospital setting, and what families surmise the patient would want may be impossible.’
Instead, they suggest using ‘think’ as an alternative way of addressing a patient’s needs, asking family and friends something like ‘If he could hear all of this, what might he think?’
Some patients might wait a longtime before finally addressing their illness and seeking medical help, but the researchers say the last thing clinicians should do is ‘blame’ a patient and cause more worry.
So instead of saying ‘I don’t know why you waited so long to come in’ to a patient, a kinder way of phrasing this frustration would be ‘I’m glad you came in when you did.’
Similarly, the researchers say that if a new patient visits a clinician with poor results from another doctor, the last thing the clinician should say is ‘what were your other doctors doing/thinking?’
They explain that this is a negative approach and it’s better to ‘focus on what’s still possible.’
They recommend: ‘Take positive next steps, rather than casting aspersions on professionals whose cooperation you may still need in moving the patient forward.’
Meanwhile, the study authors say that asking a critically ill patient ‘do you want us to do everything?’ is not helpful.
They say that instead of ‘using a leading question that may not align with the patient’s values or goals,’ it is better to invite dialogue.
Their suggested turn of phrase for clinicians to use is: ‘Let’s discuss the available options if the situation gets worse.’
After serving up their 12 never-words and phrases, the researchers conclude: ‘Never-words are conversation stoppers.
‘They seize power from the very patients whose own voices are essential to making optimal decisions about their medical care.
‘Clinicians should instead aim to dialogue, by inviting honest, thoughtful inquiries and responses from patients and families.
‘They should learn to recognize words and phrases that unintentionally frighten, offend, or diminish agency and work to reimagine their own communication.
‘The beneficial result: giving power back to patients so that they can actively collaborate with their care team in making the best possible treatment and care decisions, which is what all clinicians aim to achieve.’
Last year, Gallup revealed that the share of Americans who rated doctors’ ethical standards highly had dropped from 77 percent at the start of the pandemic in 2020 to 62 percent at the end of 2022 – an unusually steep 15-point fall over two years.
