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July 12, 2004

Words That Harm, Words That Heal

Arch Intern Med. 2004;164(13):1365-1368. doi:10.1001/archinte.164.13.1365

A physician enters a patient's hospital room and says: "Good morning. Well, tell me, how is your chest pain? I just reviewed the pictures from your catheterization. You have a severe blockage, and you may be living with a time bomb in your chest." The patient sits motionless, waiting for her physician's recommendation.

Conversations akin to this one between physician and patient may seem contrived but are not uncommon. Being ill inherently humbles and corrodes the sense of self, making patients vulnerable to the words of their physicians.1-3 Language reinforces the tendency of the patient to yield to the authority of the physician, and it is one way that physicians inadvertently distance themselves from patients.4 Rather than describe the complexity of a situation, physicians may use words that generate fear, anxiety, despair, or hopelessness, thus silencing all further discussions. As a result, patients have more difficulty making intelligent decisions and becoming active participants in their care.5 Such intense emotions also dissipate hope and aggravate symptoms, and may adversely affect healing.

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