The Power of Words

    Words—so innocent and powerless as they are, as standing in a dictionary, how potent for good and evil they become in the hands of one who knows how to combine them. Nathaniel Hawthorne (1804-1864)   Every day we use a multitude of words to express ourselves. The words we choose help define who we are, our goals, and our ideals. If you use erudite words, people will think you are intelligent. If you choose to use profane words, people will have an entirely different connotation about you—perhaps a negative one. If you use slang and colloquial words, you may be perceived as just a “good ‘ole boy.” Unfortunately, as Nathaniel Hawthorne stated, words can also be used for good or evil, for right or wrong, to guide or to manipulate. This concept is especially true in medicine. So many of the words we use are so emotionally charged that we must use extreme care when choosing which words to use. For instance, “cancer” is loaded with emotional and interpretative overtones, and the dictionary does not help us. A medical dictionary defines cancer as “a cellular tumor the natural course of which is fatal.”¹ That is exactly what our patients think when told they have a dreaded “cancer.” You and I both know that this is not always the case. There are many types of cancer that can be easily treated and are rarely, if ever, fatal. The classic examples include most common skin cancers, early cervical cancer, many prostate cancers; the list goes on and on. While the diagnosis of cancer is not necessarily a death sentence, the emotional impact of the word is such that when a patient is told that cancer is present, not another word the physician says is heard because the patient is planning a funeral. I have witnessed this many times in my surgical and wound care practice. This occurs frequently enough that I have discovered other, less emotionally charged words to use when delivering the exact same information to the patient. The choice of words makes all the difference.   There are words we can use in wound care to evoke the same response, one of which is the horrible, dreaded, gangrene. Most people think that gangrene is a death sentence—an illness even worse than cancer. As with cancer, it is also thought that gangrene must be dealt with in an expedient and radical manner to have any hope of survival. Do you believe that? Your patients do, and it appears many healthcare providers feel the same way. Gangrene is defined as the “death of tissue.”1 Don’t we deal with that every day? Dead tissue, ie, necrotic tissue, is a staple at our wound center. We see it in diabetic foot ulcers, arterial ulcers, and traumatic wounds. Almost any wound that is seen in a wound clinic has some nonviable tissue. Most of the time we don’t even mention the word, and simply debride the necrotic tissue and treat the wound. Why are patients told that they have gangrene? Many times, I believe, it is done to get a nervous reaction from the patient so that he or she will accept any suggested therapy. All one has to do to get a patient to accept a major amputation for an infected diabetic toe ulcer is tell the patient he or she has gangrene of the foot. The patient will not even question the surgeon when he mentions that an immediate below-knee amputation is necessary. Because of the patient’s response to the word, they will accept the recommendation without question and without a second opinion that might result in limb salvage: “Just get it done so I won’t die!” You may think it is funny, but it happens every day in this country. Using words in that manner borders on criminal because they are being chosen to scare and manipulate rather than to educate and inform. The important thing to remember is that we must choose our words carefully when interacting with patients. We must also spend time educating our patients on the meaning of sensitive medical terminology so that a panicked reaction is not their only response. When patients do overreact to certain words we use, it is our responsibility to first help them regain their composure, then utilize other terms to help them realize the true health issue and the appropriate treatment.   The words we use determine who we are, determine how our patients perceive us as healthcare providers, and ultimately, determine the type of care we provide for patients. Which words will you choose today?
  The basic difference between being assertive and being aggressive is how our words and behavior affect the rights and well being of others.² Sharon Anthony Bower, Communications Coach