There is no easy way for a doctor to tell a patient that he or she has a life-challenging condition such as cancer, multiple sclerosis or muscular dystrophy. The diagnosis of a major illness is bound to be traumatic.
Many of us undergoing medical tests will make an educated guess about the possible diagnoses. Anticipating test results leaves people feeling fearful, distressed and worried. It's not just the patient who gets the diagnosis, it's the whole family.
Awaiting a diagnosis generates feelings of vulnerability and anxiety. It's like living on an emotional rollercoaster for the family of someone who is waiting for test results.
One issue in confronting illness is that anxiety about the outcome of tests can cause a person to experience a degree of confusion in their thinking.
Even when a doctor is careful to avoid medical jargon, many people leave the consulting room confused. This is hardly surprising because there is no formula to help doctors assess the best way to communicate effectively with a patient.
We expect doctors to have a comprehensive knowledge of illness, understand the likely course of a disease and be up to date with the treatment options open to a patient.
We also expect them to know intuitively the best way to talk to a person about a serious illness or explain the implications of a long-term, life-changing condition.
Language
The language used in giving a diagnosis has an impact on what the patient hears and understands. For example, “I’m afraid I have bad news” communicates a different message to “I’m sorry, the news is not good.” There is no universal meaning for words like “afraid” or “bad news”.
There is a widespread wrong belief that if you and I speak the same language, we attribute the same meaning to the words we use. We don't.
This explains how two people can listen to the doctor explain about a diagnosis and go away with two very different perceptions of what the doctor said.
People are fine-tuned to hear what fits in with their own beliefs about test results. They have a real emotional response to how they interpret the words they hear. Some people handle small pieces of information well. They cope best when information is given step by step with a great deal of detail.
Other people require only a brief overview. They cannot cope with details. When given too much information they switch off, only half listen and can miss what is relevant.
Misunderstandings occur when one person is concentrating on the sequence of a diagnosis step by step and another is impatiently waiting for the doctor to get to the point.
We tend to see doctors as knowledgeable authority figures. An intelligent person can hear and understand every word the doctor says and not have clarity about the diagnosis. Our emotional state also plays a part in how we listen and interpret what we hear.
Interpretation
Someone who always fears the worst will be fine-tuned to expect bad news. Fear clouds judgment.
One person may interpret “bad news” as meaning that test results are inconclusive and feel scared of having more tests. Another may assume it means the disease is terminal. A third person may look on the bright side and perceive “bad news” as a way of saying the doctor-patient relationship is about to be terminated.
It’s a wise doctor who understands how important it is to be alert, to check that anxious patients can hear and take in fully a diagnosis.
Some busy doctors assume that an intelligent patient will ask for clarification if additional information is needed. They fail to recognise the impact of the white-coat syndrome that disempowers people in a medical setting.
It is unfair to blame a doctor for failing to sense that a distressed patient is feeling anxious, unsupported and worried about the progression of the disease. Doctors are not mindreaders. They cannot know what the patient does not ask or fails to reveal during a consultation.
Information
There is no magic prescription that offers doctors the correct language to use with every patient. But there is a wealth of information available about the emotional impact of words.
Simply changing “I” to “we” communicates support and offers an emotional connection that suggests the doctor cares.
“We are disappointed with the results” offers a gentle lead-in that prepares the patient to hear that test results were not what doctor and patient desired. Such appropriate language can be helpful in minimising the trauma of a life-changing diagnosis.
There is a world of difference between a pleasant “goodbye” and the supportive language in “I’ll be looking after you for a long time.”
A simple change in language can make an enormous difference for a patient receiving a diagnosis that is life-changing.