Choose Your Words Carefully

"Here’s your pain medication, Mr. Smith." Change the patient’s name and that is a phrase I’ve spoken countless times in my nursing career. Most of us have, I’m sure. It never occurred to me that those words might affect the patient negatively. Quite the contrary—I thought, with that statement, that I was delivering good news. Wrong. Studies have shown that patients in a stressful situation will often misinterpret simple figures of speech or focus solely on any word with a negative connotation—in the case of my statement, the word pain. Ideally, I should have said, "Here’s some medicine to help you get comfortable, Mr. Smith."

I have always made an effort to put myself in my patient’s place but I have to admit that I have not given much consideration to the possibility that a patient would misconstrue the meaning of, or react negatively to, such simple statements that are so commonly used in the medical arena.

In his recent article on word choices (AJN, March 2008) Paul W. Schenk, PsyD, cited the example of a five-year-old who, prior to a blood draw, was told she would feel a stick. The child did not know that the word stick was a term that described a needle prick. She later told her mother that she thought she was going to be hit with a stick.

There are so many possibilities for misinterpretations that it would be difficult for any one nurse to foresee every one of them, but Dr. Schenck recommends a few specific steps that can help sidestep the problem of causing unintended negative responses by our patients.

For one, choose affirmative phrasing that eliminates don’t and emphasizes do. Rather than, "Don’t tense your arm muscle," say, "Let your arm be very limp." This is simply stating what you’d like the patient to do instead of what you don’t want him to do, which often elicits a response that is exactly opposite the desired action.

I am surprised to learn that within the often heard and spoken statement, "Just try to breathe normally," three words—just, try and normally—are considered language traps.

Briefly, just is a limiting word. It can be interpreted to mean just do this one thing (relegating to insignificant status other personal health-affecting actions the patient needs to take). To some patients, the importance of any instruction given them can be minimized when preceded by just. Also, using just as the lead word in a health-related instruction might indicate to the patient that the thing they’ve been instructed to do should be easy. When the patient finds it is not easy, anxiety can result. Ideally, just should be omitted from the beginning of such sentences.

The word try as a prelude to an instruction may convey to the patient that he is not expected to succeed, so try is another word to eliminate as a lead-in. "Try to take this medication at the same time every day," would be better stated as, "It is important to take this medication at the same time every day."

Asking a patient to breathe normally is another language trap to avoid. Physical functions, such as breathing, that are controlled by the autonomic nervous system will be altered if conscious attention is drawn to them. Requesting the patient to breathe normally guarantees that he will be unable to do so. Accurate measurement of a physical function requires avoiding talking about the function.

Dr. Schenck affirms that, as with any undesirable habit, persistence is required to break bad linguistic habits and learn, instead, habits that improve better communication. A good first step is to focus on training your ear to pick up on language traps. He recommends utilizing TV sitcoms, because they are generally rife with things you shouldn’t say and you can listen without having to respond. That accomplished, he suggests choosing one language trap and working on it for awhile before moving on to another.

Dr. Schenck’s article contains several good tips and other information for improving communication that I haven’t touched upon here. There is much to be learned by seeking out the March issue of the AJN and reading the entire piece. The skills he details would be similarly helpful in communicating with our families, friends and coworkers.

I’m going to start my bad habit transformation by concentrating on replacing don’t with do. What language change are you working on first?