October 11, 2012

It’s How You Say It: Why Manners Matter in Medicine

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One of my first clinical exposures as a medical student occurred in an oncologist’s office at Memorial Sloan-Kettering Cancer Center. It was late in the afternoon and the interpreter arrived only a few minutes before the oncologist and I were scheduled to meet with the patient. The patient’s tests showed that the cancer was in the end stages and the oncologist was going to ask the patient if he wished to continue with the chemotherapy or discontinue it and be treated for the pain associated with end stage cancer. When we entered the room it quickly became apparent that the patient believed he was getting better and was expecting good news from the doctor. Working through the interpreter, the oncologist diplomatically began to explain the situation to the patient. The patient and I speak the same dialect and I was able to observe the full translation of everything the oncologist said.

The interpreter was not a native speaker, but demonstrated a mastery of the language, even to the point of replicating, with good accuracy, an Iberian-American accent. However, at one point during the translation, the interpreter made a faux pas in phrasing something the oncologist said. The doctor stated, in reference to whether the patient would wish to stay on his cancer treatment or prefer to just be treated for the pain and focus on the quality of his life, that it was “his decision based on what he wanted to do with his time.” The interpreter, however, stated “es tu decesión como tú quieres pasar el tiempo que te queda,” which translates to “it’s your decision about how you want to spend the time you have left.” When the interpreter stated this, the color in the patient vanished and his face fought ferociously to hide the tremendous sorrow that overcame him. Technically, what the interpreter said was an acceptable variation of what the doctor had said, but in truth the interpreter’s words killed the patient’s spirit. Recall the patient was optimistic about his prognosis, but the interpreter’s words forced the patient to confront his own mortality in a stronger way than was intended by the doctor. The effect on the patient was profound. For the remainder of the appointment the patient was silent, and while he was physically in the room, looking into his eyes one could tell he was no longer with us.

I tell this story to drive home a point that is essential to not only the practice of medicine, but I recommend should also be a template people should follow in their everyday lives: The phrasing of your words matters just as much as the message you wish your words to convey. A sense of professionalism, good bedside manner and breaking hard news to a patient or their family all mandate that a doctor have the ability to navigate the nuances of language to make sure the essence of their message is enveloped in a tone of compassion. How a doctor describes a disease, its treatment and its prognosis has the ability to send the patient’s perspective of their disease into a dismal tailspin or give them the strength that hope gives to fight a disease.  Doctors have an obligation to do no harm, and the word harm here extends beyond the physical definition, to include the mental and spiritual aspects of that term. Our words, if chosen callously, can harm our patients in ways no medical test can detect, but all medical professionals can see. Yet, this observation is not unique to medicine.

In our age where politicians push hyperbole as fact, disturbed folk bash other people’s religions and attempt to mask their bigotry as dialogue and where hateful speech replaces courteous discussion, I think we should all reflect upon the power that our words, and especially the phrasing of our words, have on other people. In the medical realm, doctors serve the patient and part of this service is understanding that how we say something to a patient is often equally as important to the patient as what we are telling them. We must choose our words with consideration and respect because physicians do not treat disease — they treat patients who are human beings with emotions, sensitivities, families, cultures, fears and souls.

As a recent graduate of East Hill I know Cornell University to be a place where “open minds and open hearts” is not just a phrase but a modus operandi. Yet, still I would encourage you all to remember that you are all each other’s patients. You are the doctor to the kid who eats at Okies alone, to the peer who sheds a tear after the second Orgo prelim and to the student you have never met before but who happens to cross your path today for whatever reason. I wish you all a great semester, and remember: Do no harm.

Alex Pérez is a first-year M.D. / Ph.D. student at Weill Cornell Medical College. He may be reached at arp2012@med.cornell.edu. What’s Up, Doc? appears alternate Fridays this semester.

Original Author: Alex Perez