This site is intended for health professionals only

At the heart of general practice since 1960

The power of words: how to tell a patient they have cancer

How language can influence the patient consultaton - and your CSA exam outcome.

How language can influence the patient consultaton - and your CSA exam outcome.

Last series we looked at how ‘visual perceptions' affect marking of a subjective CSA exam. Now we turn our attention to how our words are influencing both our patient consultation and our CSA exam outcome.

‘The Power of Words' by Dr Bernie Siegel talks about how the power of doctors' words may impact patients' lives. ‘Parents, teachers, clergy and physicians have the ability to change lives with their words.'

Frank Luntz, a political pollster and author of bestseller 'Words That Work: It's Not What You Say, It's What People Hear' also discusses the impact of words and how to use words with tact.

So let us reflect on how CSA candidates use language. A textbook scenario honed into every doctor during medical school is the concept of ‘breaking bad news'. A standard phrase may be ‘I'm afraid I have bad news Mr X. The chest x-ray shows you have a sinister shadow in your lung.'

Now what does the patient actually hear? Let us dissect this phrase. ‘I'm afraid' is a condescending phrase and has connotations of the sales ladies telling Julie Roberts' character, Vivian, in the film ‘Pretty Woman, ‘(I'm afraid), I don't think we have anything for you. Please leave.'

‘I'm afraid' also implies that you as a doctor are fearful, unsure of yourself, hesitant. Furthermore, neurolinguistic programming (NLP) suggests you are influencing the listener to feel fear. The classic example used in NLP training is the phrase ‘Don't think of pink elephants.' So the class recalls only the last few words (NLP) and conjure up thoughts of a pink cartoon elephant. So here the last word heard was ‘afraid' and your patient starts sweating. His heart starts racing. His face becomes petrified and eyes glaze over.

‘I have bad news'. Oh dear, now you have declared yourself the harbinger of doom, the Grim Reaper. The examiner and actor hear the words ‘I' ‘bad' in the same sentence and are influenced to fail you as you have just declared ‘I (am) bad' in front of the examiner. Poor patient is now thinking you are Shipman ‘I (am) bad' or he himself is ‘bad' or ‘evil' and has brought cancer upon himself for being a bad person.

On the verge of a heart attack, you now tell him ‘you have a sinister shadow.' The word sinister can appear as ‘sinestre' in French for ‘left' and is also derived from the Latin ‘sinestra' meaning ‘from the left-handed side', devious, cunning, presaging menace. So you have suggested in front of the examiner and actor patient that you are a ‘sinister doctor' - Shipman perhaps? Now combine this with the word ‘shadow', and the patient will now burst into tears if female or stand up and get ready to punch you in the jaw, if male. ‘Shadow' and ‘fear' conjure up Psalm 23 ‘Ye though I walk through the shadow of death, I will fear no evil.'

So now you have effectively told your patient to prepare for his own funeral. No wonder male patients get violent. I think that qualifies as a ‘fail' your CSA. So the answer is to be honest and use the word ‘cancer', but deliver with empathy and compassion, and keep it (your words) short and simple (KISS).

Another phrase I hear frequently in role-play is ‘Don't worry.' Okay you guessed it. NLP suggests that you have just told your patient to ‘worry' and surely, they start worrying, fretting, questioning, and experiencing palpitations. Best to use positive language to assuage anxiety and say ‘Everything will be fine.' This conjures up emotions from the 19th Century Camberwell-born English poet Robert Browning, ‘God's in His Heaven; all's right with the world.' The only caveat is if the patient has metastatic cancer - then we avoid false hope.

So your task is to now turn up the volume on your video playback and write down the transcript of the words you use to communicate with your patients. What exactly do they hear?

And of course to pass your CSA, strike the word ‘bad' from your vocabulary. You want to help the examiner pass you, not contribute to your own CSA demise!

Dr Una Coales: Be aware of the power of words in a patient consultation Dr Una Coales: Be aware of the power of words in a patient consultation

Rate this article  (3 average user rating)

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Readers' comments (1)

  • Some very interesting observations here and important if breaking bad news was the major part of one's job however may pprove difficult to remember when you are in the acute situation.
    I will certainly try to avoid phrases such as "bad news" in the future and replace with just "important information"

    Unsuitable or offensive? Report this comment

Have your say