Docs & Patients: When words hurt

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When words hurt

Some terms that are commonly used by medical professionals sound demeaning

and can even undermine the doctor-patient relationship.

Words are scalpels, every bit as sharp as a surgeon's tools, and sometimes

almost as dangerous.

Cutting words are at their worst when they are unintended, that is, when

they

inadvertently reveal what the speaker - the doctor - really thinks. Take

" incompetent cervix. " Granted, this is a succinct way to describe a cervix

that

can't keep the womb properly closed throughout a pregnancy. But we never

hear

the term " incompetent penis. "

Far worse is the common phrase, " The patient failed chemotherapy. " Who or

what really failed here? " The therapy failed the patient " is not only kinder

but

more accurate.

Then there's " noncompliance, " which doctors use when a patient, like a

balky,

disobedient child, did not obey the doctor's orders, such as by not taking a

prescribed drug. " Compliant " isn't much better.

Another alienating word is " denies, " as in, " the patient denies alcohol use "

or " the patient has cough but denies phlegm. " Sure, it lets one doctor know

that another has asked a patient about this, but the not-so-hidden

connotation

is that the patient is a liar.

As a much-published poet, Dr. Campo, a primary care physician at Beth

Israel Deaconess Medical Center in Boston, is attuned to the potential

damage

- and the healing power - of words.

" Some of the language we are talking about here is pervasive in the medical

profession and does potentially undermine the relationship between doctors

and

patients, " he says.

For example, doctors often say the patient came in " complaining of "

something, which makes the patient sound whiny, like " an adversary, " Campo

says. " Just

the other day, an intern was presenting a patient [to me] in front of the

patient. He said, 'Mrs. So and So is here complaining of Š' and she said, 'I

wasn't complaining, I was just telling you how I feel.' "

The term " adverse reaction [to medications] " bothers De Benedictis,

the

founder of the New England Patients' Rights Group. " It implies the drug is

OK, the patient was wrong, " she says, as if the patient is the one in a

million

for whom the drug is harmful. " Then you talk to 10 other people, and they've

had the same problem, " she says.

Patients, too, sometimes use terms that grate - such as " breast cancer

survivor. " Obviously this is a respectful way to describe someone who's

fought a

frightening disease, but it can seem politically correct to others. What

about

all those with cancer who don't survive? Were they any less heroic?

The pet peeve of Kay Redfield Jamison, author of " An Unquiet Mind, " a book

about her experience growing up with manic depression, and " Night Falls

Fast, "

about suicide, is " failed suicide attempt. " The term, she says, makes it

sound

as though a person was not only despairing but incompetent to boot.

Just as bad is " suicidal gesture, " says Dr. Leuchter, vice chairman

of

the department of psychiatry at the UCLA Neuropsychiatric Institute. What

looks to doctors like a halfhearted suicide attempt may actually be a

serious

attempt by someone who simply doesn't know how to do it.

In an article called " Words That Maim, Words That Heal, " scheduled to be

published in a leading medical journal, Dr. na Bedell, an internist at

Brigham and Women's Hospital in Boston, dissects the meanings of many

medical terms

that are unnecessarily insulting. A classic for sheer insensitivity, she

says,

is " widow maker, " used to describe a man with severely clogged coronary

arteries. Just as awful, she adds, is " deforming arthritis, " used for

patients with

severe rheumatoid arthritis.

Perhaps most galling of the unfortunate medical phrases is one often used as

a patient is dying, says Dr. Lachlan Forrow, director of ethics programs at

Beth Israel Deaconess. When people talk about withdrawing life support, he

says,

they often say " withdrawing care. " In reality, Forrow says, " We never

withdraw careŠ.We just stop the respirator if it is no longer a caring

thing. That is

the opposite of withdrawing care. "

Says Campo, the author of " The Healing Art: A Doctor's Black Bag of Poetry " :

" There is no handbook for medicalese that says we have to talk in these

termsŠ

.. But it's this kind of shorthand of formulas that gets passed down from one

generation of doctors to the next. "

http://www.latimes.com/features/health/la-he-words9feb09,1,6269778.column?co

ll=la-headlines-health

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