Do words actually carry a big impact?

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Re: Do words actually carry a big impact?

Post by Pattern-chaser »

Sushan wrote: October 19th, 2021, 5:03 am What can be gained by giving a patient false hopes?
For a specific patient, in very particular circumstances, it might not be about giving false hope, but simply not terrifying the patient for no good reason. For other patients, in other circumstances, the same conduct might even be criminally negligent. It's a judgement call; a very difficult and challenging judgement call, IMO.
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Re: Do words actually carry a big impact?

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Pattern-chaser wrote: October 19th, 2021, 9:18 am
Sushan wrote: October 19th, 2021, 5:03 am What can be gained by giving a patient false hopes?
For a specific patient, in very particular circumstances, it might not be about giving false hope, but simply not terrifying the patient for no good reason. For other patients, in other circumstances, the same conduct might even be criminally negligent. It's a judgement call; a very difficult and challenging judgement call, IMO.
A patient should never be terrified by a clinician. Even a critical result is imminent it is important as well as ethical to keep the patient calm as far as possible. But it is the right of the patient to know the truth above everything else. A very bad message will initially break the patient, but eventually he/she will cope up with that. But it will be harder to accept the truth later when a patient is hyped with false hopes that were given to him for nothing else but to avoid him/her being terrified.
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Re: Do words actually carry a big impact?

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One of the skills a clinician needs is in 'bedside manner'. A good carer can tell the patient as much as they would want to know, holding back (maybe temporarily) on the rest of the bad news. This can be done without offering false hope.

As in the other topic, I have made my point, and now I will stop. 🙂
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Re: Do words actually carry a big impact?

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Pattern-chaser wrote: October 19th, 2021, 1:09 pm One of the skills a clinician needs is in 'bedside manner'. A good carer can tell the patient as much as they would want to know, holding back (maybe temporarily) on the rest of the bad news. This can be done without offering false hope.

As in the other topic, I have made my point, and now I will stop. 🙂
One may temporarily hold any amount of information thinking that it is done for the sake of the patient, to not make him panicked. But how can we choose the moment to reveal the rest of the information?

Let's say we mastered the art of giving only the necessary information without troubling a patient's mind. Even if we succeeded in not giving false hopes, how can we be sure that the patient did not get too much negative assumptions by our holding back of details?
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Re: Do words actually carry a big impact?

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Sushan wrote: October 19th, 2021, 4:45 am
LuckyR wrote: October 15th, 2021, 1:41 am
Sushan wrote: October 14th, 2021, 7:54 pm
LuckyR wrote: October 10th, 2021, 4:53 pm

Several things:

First the placebo effect is real and been demonstrated objectively in research studies. Second, the placebo effect can even be documented when the patient is told they are receiving a sugar pill.

More to the actual point, communicating with patients, I agree with you that the effects of communication styles is small, thus they are less of an effect when the medical situation is serious and large when the patient is healthy. Obviously the latter situation is much more frequent than the former.
Presence of placebo effect is real. But I do not think of it as a measurable or predictable thing. People are different from each other, so is the placebo effect since that has lot to do with the mental component.

I am not saying that communication is less effective. Medical personnel are tested for their polite conversing ability with patients for a reason. A patient must be felt reassured when a medical professional is caring for him. But I think that conversation should only contain the truth, and revealing that truth with the least negative effect to the patient is the real skill that any medical professional should develop.
Well we are in agreement that one should never lie to a patient. Though an experienced clinician can easily deliver two truthful yet entirely opposite sounding summaries of identical information.
In vague and grey situations the tone of the voice of the clinician will give either reassurance or terror to the patient with the equal mmessage. When the clinician really cannot say whether the patient is in a critical stage or not, then it is fair enough to reassure the patient. But, yes, as soon as when the real situation is understood I think it is fair and ethical to inform it to the patient as well.
There are clinicians who make a habit of describing the situation the worst possible way, with the thought being that the patient will on average do better than what was predicted and thus the patient and their family will be happier with the outcome than if the actual outcome was predicted.
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Re: Do words actually carry a big impact?

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Pattern-chaser wrote: October 19th, 2021, 1:09 pm One of the skills a clinician needs is in 'bedside manner'. A good carer can tell the patient as much as they would want to know, holding back (maybe temporarily) on the rest of the bad news. This can be done without offering false hope.

As in the other topic, I have made my point, and now I will stop. 🙂
Sushan wrote: October 19th, 2021, 11:59 pm One may temporarily hold any amount of information thinking that it is done for the sake of the patient, to not make him panicked. But how can we choose the moment to reveal the rest of the information?

Let's say we mastered the art of giving only the necessary information without troubling a patient's mind. Even if we succeeded in not giving false hopes, how can we be sure that the patient did not get too much negative assumptions by our holding back of details?
Ah, now you approach the core of this issue. A significant part of the healer's expertise is in people-skills. The questions you ask are difficult ones, difficult to answer, too. They can be answered, in practice in the real world, but it takes skill and judgement to do it well. A healer is not just someone who knows all about disease and pharmacy.
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Re: Do words actually carry a big impact?

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LuckyR wrote: October 20th, 2021, 3:42 am
Sushan wrote: October 19th, 2021, 4:45 am
LuckyR wrote: October 15th, 2021, 1:41 am
Sushan wrote: October 14th, 2021, 7:54 pm

Presence of placebo effect is real. But I do not think of it as a measurable or predictable thing. People are different from each other, so is the placebo effect since that has lot to do with the mental component.

I am not saying that communication is less effective. Medical personnel are tested for their polite conversing ability with patients for a reason. A patient must be felt reassured when a medical professional is caring for him. But I think that conversation should only contain the truth, and revealing that truth with the least negative effect to the patient is the real skill that any medical professional should develop.
Well we are in agreement that one should never lie to a patient. Though an experienced clinician can easily deliver two truthful yet entirely opposite sounding summaries of identical information.
In vague and grey situations the tone of the voice of the clinician will give either reassurance or terror to the patient with the equal mmessage. When the clinician really cannot say whether the patient is in a critical stage or not, then it is fair enough to reassure the patient. But, yes, as soon as when the real situation is understood I think it is fair and ethical to inform it to the patient as well.
There are clinicians who make a habit of describing the situation the worst possible way, with the thought being that the patient will on average do better than what was predicted and thus the patient and their family will be happier with the outcome than if the actual outcome was predicted.
I am sorry but I do not think any clinician with a sane mind would do such a thing unless he/she is having some agenda for popularity or to be named as a saint. And I have never seen such a practice from any clinician throughout my short career in medicine so far.

It is good to predict and expect the worst possible and act accordingly. But this sort of a behaviour is unacceptable.
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Re: Do words actually carry a big impact?

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Pattern-chaser wrote: October 20th, 2021, 8:53 am
Pattern-chaser wrote: October 19th, 2021, 1:09 pm One of the skills a clinician needs is in 'bedside manner'. A good carer can tell the patient as much as they would want to know, holding back (maybe temporarily) on the rest of the bad news. This can be done without offering false hope.

As in the other topic, I have made my point, and now I will stop. 🙂
Sushan wrote: October 19th, 2021, 11:59 pm One may temporarily hold any amount of information thinking that it is done for the sake of the patient, to not make him panicked. But how can we choose the moment to reveal the rest of the information?

Let's say we mastered the art of giving only the necessary information without troubling a patient's mind. Even if we succeeded in not giving false hopes, how can we be sure that the patient did not get too much negative assumptions by our holding back of details?
Ah, now you approach the core of this issue. A significant part of the healer's expertise is in people-skills. The questions you ask are difficult ones, difficult to answer, too. They can be answered, in practice in the real world, but it takes skill and judgement to do it well. A healer is not just someone who knows all about disease and pharmacy.
A healer should be thorough about his field, diseases and pharmacy. But along with that he should understand his clients, humans. And we should keep in mind that a healer too is a human. He can take calculated decisions, but as of any other's decisions these ones too can possibly become wrong or bad ones. As I previously mentioned holding back details can give a wrong impression to the patient. But at the same time over-reassurance will give false hopes. The balance between these two should be gained somehow and that is what a clinician should practise.
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Re: Do words actually carry a big impact?

Post by LuckyR »

Sushan wrote: October 20th, 2021, 11:58 am
LuckyR wrote: October 20th, 2021, 3:42 am
Sushan wrote: October 19th, 2021, 4:45 am
LuckyR wrote: October 15th, 2021, 1:41 am

Well we are in agreement that one should never lie to a patient. Though an experienced clinician can easily deliver two truthful yet entirely opposite sounding summaries of identical information.
In vague and grey situations the tone of the voice of the clinician will give either reassurance or terror to the patient with the equal mmessage. When the clinician really cannot say whether the patient is in a critical stage or not, then it is fair enough to reassure the patient. But, yes, as soon as when the real situation is understood I think it is fair and ethical to inform it to the patient as well.
There are clinicians who make a habit of describing the situation the worst possible way, with the thought being that the patient will on average do better than what was predicted and thus the patient and their family will be happier with the outcome than if the actual outcome was predicted.
I am sorry but I do not think any clinician with a sane mind would do such a thing unless he/she is having some agenda for popularity or to be named as a saint. And I have never seen such a practice from any clinician throughout my short career in medicine so far.

It is good to predict and expect the worst possible and act accordingly. But this sort of a behaviour is unacceptable.
Well your short career experience notwithstanding, I have observed this firsthand. True it was in the 90s and the practitioner was retirement age at the time.

Second issue, are you in a surgical field? The communication tone is very different from that of medical fields (and what I described was recommended by a surgeon).
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Re: Do words actually carry a big impact?

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LuckyR wrote: October 20th, 2021, 7:09 pm
Sushan wrote: October 20th, 2021, 11:58 am
LuckyR wrote: October 20th, 2021, 3:42 am
Sushan wrote: October 19th, 2021, 4:45 am

In vague and grey situations the tone of the voice of the clinician will give either reassurance or terror to the patient with the equal mmessage. When the clinician really cannot say whether the patient is in a critical stage or not, then it is fair enough to reassure the patient. But, yes, as soon as when the real situation is understood I think it is fair and ethical to inform it to the patient as well.
There are clinicians who make a habit of describing the situation the worst possible way, with the thought being that the patient will on average do better than what was predicted and thus the patient and their family will be happier with the outcome than if the actual outcome was predicted.
I am sorry but I do not think any clinician with a sane mind would do such a thing unless he/she is having some agenda for popularity or to be named as a saint. And I have never seen such a practice from any clinician throughout my short career in medicine so far.

It is good to predict and expect the worst possible and act accordingly. But this sort of a behaviour is unacceptable.
Well your short career experience notwithstanding, I have observed this firsthand. True it was in the 90s and the practitioner was retirement age at the time.

Second issue, are you in a surgical field? The communication tone is very different from that of medical fields (and what I described was recommended by a surgeon).
Yes, I was basically in surgical field but currently I am working generally in both surgical and medical fields. I am not sure whether the communication will be different depending on the speciality, since what we do is dealing with patients and illnesses, and despite the speciality the patients and their expectations are almost the same. So we have to tackle with them carefully.
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Re: Do words actually carry a big impact?

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There is something to be said for a good bedside manner. If you think that certain people will not assume that you are being condescending to them whatever you say, then you underestimate human stupidity and tetchiness. What is most important is to tell the truth as you understand it, as clearly as you know how in cases of medical information.
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Re: Do words actually carry a big impact?

Post by Belindi »

Sushan wrote:
Yes, I was basically in surgical field but currently I am working generally in both surgical and medical fields. I am not sure whether the communication will be different depending on the speciality, since what we do is dealing with patients and illnesses, and despite the speciality the patients and their expectations are almost the same. So we have to tackle with them carefully.
As an experienced patient I agree. Many patients want to participate in their treatment whether it's invasive or medical.

Obviously there is a large power imbalance between medic and patient. **Surgeons' and physicians' tone of voice or choice of words can intimidate a patient who may seek information or to express his feelings.The clinician should be truthful but avoid bullying or patronising. Proper training of medics should include useful phrases such as "Is there anything you want to tell me /know? " " How do you feel about this?" " Here is what I said in a short list / leaflet to help you to remember it all." (producing a well written leaflet in the appropriate language and reading over it with patient, soliciting comments from the P to make reasonably sure the P understands and has sufficient memory to carry out instructions.) Non-compliance is both expensive and unhealthy and these simple techniques don't take up an inordinate amount of time or money.'

In multilingual countries such as the USA it's especially important for clinicians to learn good diction, and also engage a proficient interpreter if needed.

** Not only an imbalance of knowledge but often social status too.
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Re: Do words actually carry a big impact?

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Formless777 wrote: October 22nd, 2021, 4:51 am There is something to be said for a good bedside manner. If you think that certain people will not assume that you are being condescending to them whatever you say, then you underestimate human stupidity and tetchiness. What is most important is to tell the truth as you understand it, as clearly as you know how in cases of medical information.
You don't acknowledge the existence of social skills, then? The skills that allow people to judge their audience (whether of one or many), and to put across their message in a way that does not offend or annoy? I am quite deficient in these skills, but some people are so skilled it's almost magical. These skills exist, and they are what is required in answer to your post 👆, I think.
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Re: Do words actually carry a big impact?

Post by Anand_Haqq »

. Yes.

. Because, words are the only stuff which our logical mind can understand.

. Unless, one goes beyond mind ... you will never understand that which is wordless ... that which cannot be contained by any word(s) ... because you will never be able to understand anything more other than words and jargon.

. Unless, one becomes a meditator ... one will never understand the blessings that existence is to pour on ones' being. And that experience of awe is the unnameable ... that experience of God is the indescribable.

. People live a life immersed into a pseudo-flow of words.

. And Life is not words. Words are part of the logical mind ... which in turn is an infinitesimal segment of Life.

. Before our cunning mind has entered into this universe ... which does not represent more than 3 min of this world history, if we condense it in a timeframe of 12 hours ... Life was; existence was ... This whole quintessence was already celebrating the dance of Life.

. Not that people contain words; words contain people.

. Not that people master the mind; the mind masters people.

. We cannot control our own mental responses to that which is surround us ... due to our own prejudices, which ultimately are born out of the ego.

. That is why different words mean different things for different people.
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Re: Do words actually carry a big impact?

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Anand_Haqq wrote: October 22nd, 2021, 1:50 pm . Yes.

. Because, words are the only stuff which our logical mind can understand.
...and what of our illogical minds? Logic is something we employ only occasionally, not consistently. That's just how humans are. Words carry meaning, in an approximate way. Words are what we use because we don't have telepathy. They work surprisingly well, but they are far from perfect.

Words often carry a HUGE impact. At other times, they carry much less impact. It varies according to what we are trying to communicate with those words, I think.
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