When words matter, and why

Call it a teachable moment. While training at Memorial Sloan Kettering Cancer Center in New York City, Dr. Don Dizon was asked to evaluate a woman in her 60s with recurrent ovarian cancer and then present her case to a physician mentor.

He summed up the situation for his colleague: “Well, since she failed this regimen, I think she needs to start on a new salvage treatment. What about a combination?”

In a recent blog entry at ASCO Connection, Dr. Dizon describes what happened next:

He looked at me kindly but with a degree of exasperation.

“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.”

The lesson stuck. Ever since, he has been “sensitive to words and phrases, particularly when they are used in reference to patients, treatment, and circumstances surrounding recurrent disease,” Dr. Dizon writes. “I cringe when I hear someone referred for ‘salvage treatment’ or how it’s ‘too bad she failed therapy.’”

Do words matter? To patients and families, they often do because of the attitudes and expectations they convey, consciously or not.

Take the battleground metaphors so frequently used when speaking about cancer. British radio host Jenni Murray recently ranted about how “infuriating” it was to see and hear, over and over, the expression “lost his battle with cancer” in news reports of the death of Robin Gibb of the Bee Gees. She writes:

I’m at a loss to know why, despite a number of us who’ve been through the dread diagnosis and subsequent treatment pointing out that such pugilistic terminology is entirely inappropriate, we continue to be given the impression that death from cancer is somehow an indication of failure to have the moral fibre to fight and defeat it.

Not everyone who read the piece agreed with her, of course. “Self-indulgent, politically correct survivor’s guilt” was the judgment from one commenter.

Indeed, it’s hard to know at what point the line might be crossed. What’s offensive or even hurtful to one person can be a non-issue for someone else. But the fact remains that people do pay attention to language and often feel alienated or blamed by the words that are used.

Does it matter more when the words are those used by clinicians talking about their patients? Perhaps it does.

Anyone who’s ever been a patient has probably been taken a little aback when terms such as “problem list” and “chief complaint” are used to describe their visit. Like systems anywhere, the world of clinical care has its own language but the vocabulary is not necessarily understood the same way by patients and families. Take the phrase “comfort measures only,” for example. Those who work with dying patients know what this means, but what about patients and families? Do they focus on the “comfort” aspect or do they mostly hear the word “only” and feel the medical team has given up or abandoned them? When someone has “failed chemotherapy,” does this objectify or subtly shift the blame to the patient and allow the oncology team to distance themselves?

Dr. Dizon says his goal in writing about the language of medicine, especially in cancer care, is to encourage his colleagues to become more sensitive to the words they use and how they might be perceived by patients.

“Ultimately, our words should provide hope, comfort, and honesty,” he writes. “When they don’t, each of us has a personal responsibility to make things right.”

One thought on “When words matter, and why

  1. This post should ring bells for Arrested Development fans. There’s a recurrent character of a doctor who always says the wrong thing to the Bluth family. When George Sr. disappears after faking a heart attack, he tells the family “he’s gone,” leading them to believe the family patriarch has passed. When the youngest adult Bluth child is attacked by a seal, the doctor tells the family he’s “all right,” meaning he’s lost his left hand, not that he’s alright.

    While the scenarios you put forth aren’t comical, they are even more disturbing for a real patient facing a real health issue.

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