At a time when doctors are having thousands of difficult conversations with patients and families, it may be appropriate to remember that the words we choose matter . We now know to say, "This treatment will not be beneficial" instead of "Continuing treatment is useless ," to avoid sending the message to families that their loved one is not worth caring for.
As clinical ethicists, the authors have participated in countless critical conversations. They have heard many questions and comments intended to convey one message, only to see families and patients take away another. Identified below are some commonly used phrases that can be misleading or confusing and suggest alternatives for better communication with those we serve.
"What do you understand about your father’s condition?"
This question is intended to gauge someone’s perception of their loved one’s condition, in hopes of getting a sense of whether their expectations are realistic and correcting any misinformation.
However, it may cause a family member to feel like their understanding is being questioned or that they need to prove they know the right answers. Instead, saying something like, "What have doctors been saying about your father’s condition and treatment options?" can emphasize shared responsibility for accurate communication.
"His mother is very sick"
Families already know their loved one is very sick, they just don’t know how sick. This phrase is often used to indicate that a patient is unlikely to recover, but families may mistake this for a reasonable path to recovery for those who do not.
It is difficult to say to a fearful family: “Your mother is not responding to treatment the way we expected. We don’t think she’s going to survive." Still, being clear and direct when delivering bad news allows families to make more informed decisions, if they are difficult ones.
"It’s your decision... it’s up to you"
When doctors say things along these lines, the intent is to assure the patient or family member that we respect their autonomy or decision-making authority , but this statement may seem to place the burden of decision-making solely on patients or their family members.
They may feel forced to make a decision they do not feel prepared to make or be left to take sole responsibility for its consequences. One way to avoid putting this burden on patients and their families is to choose words like: "Help me understand what is important." for you and we’ll figure out what to do together. Another approach is to ask directly about the support they would like in making decisions.
"Do you want us to do everything ?"
The framing of this question pushes patients or their families to follow all available measures. Families may be reluctant to answer "no ," feeling that the only alternative would be to "do nothing" or worry that they will give up too soon. Also, "everything" could mean different things to different people. Instead, we can be more specific in the questions we ask, identifying options and describing the various paths forward.
By saying something like, "We could keep him in the ICU on the ventilator and give him additional medications if he needs them, or we could focus more on making sure he’s comfortable than keeping him alive longer." Fully explaining what each of those options would look like can help families get a clearer idea of what would happen if they made each decision.
"There is nothing more we can do"
There is never "nothing more" we can do. This language suggests that we are abandoning our patients, distancing ourselves from them at a critical time. On the contrary, when healing options are exhausted, there is much we can do to manage pain and control symptoms.
We can also try to provide comfort and connect them with support services such as palliative care, social work or religious services. What we mean is, "We don’t have additional treatments that will lessen his wife’s illness, but we can manage her pain and make sure she is as comfortable as possible . " This approach makes it clear that they will not be alone in what is to come.
"We don’t have a crystal ball..."
This phrase is often used to make it clear to patients or families that we cannot predict prognosis with complete certainty. However, patients and their families may interpret it to mean that almost anything can happen. When they ask questions about the forecast, they generally don’t ask for guarantees. Instead, they are asking for information that can help them make decisions and prepare for what awaits them.
This information can be provided by offering specific descriptions of the possibilities and their probabilities, using phrases such as: “In my clinical experience, the best we can hope for is [X]. I think it’s very likely that [Y]." This approach helps set expectations while conveying that the prediction is not a promise.
"Do you have any questions?"
The aim of this consultation is to ensure that patients or their families have the opportunity to request information and raise any concerns they may have. However, the closed frame can be heard as a signal that the conversation is over and that they have been given all the information they need to know.
Additionally, patients and families may feel overwhelmed and confused by medical jargon and may feel guilty or embarrassed if they don’t know what questions to ask. An open-ended framework such as: "What questions can I answer for you about the treatment?" or "What else can I tell you?" Set the expectation that there is more they would like to know, sincerely inviting them to ask.
| Critical conversations are never easy—for doctors, patients, or families—but changes in the words we use can make a big difference. These insights can help make these conversations a little easier for everyone. |
