Moving Toward Patient-Centered Care One Phrase at a Time
Judgmental-sounding phrases in the medical vernacular may be distressing to patients and should be changed.
The first time I heard the phrase "the patient failed treatment" was after my late husband's CT scan showed that his lung cancer tumors had increased in size and that numerous new small pulmonary nodules now inhabited in his right lung. Dan had been stable for four cycles of induction chemo and four cycles of maintenance chemo after his stage-4 lung cancer diagnosis. We were hopeful he would be one of the lucky ones who remained stable for many months on maintenance chemo.
The fact that Dan's disease had progressed was fairly devastating to us. So when a physician said Dan had "failed treatment," what I heard was that the blame was on Dan. Our oncologist saw the look on my face and commented that perhaps a more accurate description was "the treatment failed Dan."
Since that day, I cringe every time I hear or read phrases like "the patient failed treatment." This type of wording implies that physicians are considered infallible and if the treatment they prescribe doesn't work, it must mean there is something wrong with the patient.
The other phrase that makes me cringe is "the patient denies," which is often followed by information about social and behavioral factors (for example, the patient denies smoking, the patient denies alcohol use, the patient denies drug use, and so on). The word "denies" in this context seems to imply a suspicion that the patient may not be telling the truth.
I had a long twitter discussion with a pediatric infectious disease physician on the use of this phrase in medical records. He did not seem to understand my objection and viewed the phrase as standard shorthand or even a way of documenting if he asked the patient about the issue or if the patient volunteered the information. He felt as long as the noun after the word "denies" was something innocuous like headache, as compared to social and behavioral factors, it should be ok. However, regardless of the following noun, the dictionary definition of "deny" is "stating that something is not true." We often hear the verb in the context of denying accusations. Patients are likely to view the use of "deny" in the layperson context.
I would like to propose that we eliminate phrases like "patient failed treatment" and "patient denies" from any written or verbal discussions, whether or not patients are present.
If you hear your colleagues use these or other similar phrases, gently educate them that the use of these phrases can be distressing to patients. Encourage them to find substitutes, like "the treatment failed the patient" or better yet "the treatment did not work for the patient." Instead of "the patient denied," suggest "the patient reported" or "the patient said" or "the patient told me." It is possible. When my sister asked if there was anything I could have done differently to avoid the complications I experienced with my hip replacement surgery last week, the orthopedic surgeon replied "I don't like to blame my patients." Together we can move to a more patient-friendly culture, one phrase at a time.