Hi. This is 10 minutes to better patient communication. I’m Dr. Anne Marie Liebel.
I was recently speaking with a woman who has Stage III ovarian cancer. We were talking about the language that gets used around cancer and other terminal diseases.
She retold one conversation that stood out to her for the way her surgeon used language. She told me:
“He said, ’Y’know it’s gonna get us in the end.’ So he said us, it’s gonna get us. Not ‘it’s gonna get you.’ It was a very friendly way of [saying] we can keep giving you this and that, but ultimately we’re going to run out of things we can try. The only answer [I could give] to that was ‘Right, it’s gonna get us.’”
The seemingly simple change of one pronoun communicated volumes to this woman.
As providers, your language matters. Your words matter. Maybe more than you think. And that’s what today’s episode is about.
Linguists, lawyers, and policy wonks can all agree on this: language is intimately tied to power.
It’s easy to think of how talk is power if you’re, say, an elected official, a public figure, or the head of a company. But it’s true for each of us, everyday, in our ordinary conversations. looking closely at everyday ordinary language can show you some of its relationships to power that often go unnoticed.
And if you want to make your communication count, it will help to take a look at some of the particulars. I’ll tell you about some research in this area, and then I’ll give you four particular things you can do.
There are several forms of critical research used to show what is taken for granted in everyday speech and writing. This is an important endeavor in part because much of what we do with language escapes our conscious awareness. We rely on assumptions, and ways of talking, listening, reading, writing that we use almost automatically.
This research has been drawing attention to what people do through language—including in health-related interactions. Researchers have been examining the relationships between language and power in health care, by analyzing actual recorded conversations, for more than 40 years.
As this body of research has grown, several points have been made. I’m going to talk about one in particular about your power as the provider as it relates to your language use. So you can increase your awareness and have more control over your own language and what you’re doing with it.
One of the ways your language reflects power is in framing, or setting out the parameters of what is talked about and how.
It can be easier to notice framing when you don’t agree with it.
Consider the news.
Whatever your favorite news source, when you listen to a different network, it can put your teeth on edge. The way issues are handled just seems ridiculous or wrong to you.
But beyond the wide-brush strokes of political partisan writing, there are subtle everyday ways that our language does similar framing work. I have written before about how linguists have shown that our language—whether we’re conscious of it or not–communicates what we think is important, normal, natural, or taken for granted. It encourages certain ways of thinking and discourages others; privileges certain concepts over others, and more.
Now, when we’re the more powerful person in a conversation, we also have more power to decide what is polite or appropriate communication and what is not; who takes turns; when the conversation is over, and more. We do the framing for others. And tacitly ask them to accept it.
In the patient encounter, you the provider have more say in determining what’s on the conversational table (and what isn’t). Another way of putting this: you have more relative power to make topics talk-about-able. Just by virtue of your position.
You do more than hold sway over what’s talk-about-able. Your language indicates how it should preferably be talked about.
And you do this in all sorts of ways, embedded in your entirely ordinary, everyday patient conversations.
Let me say this in a different way. Here’s a sports metaphor:
Linguistically speaking, in the patient encounter, you have more power to determine the playing field, and to set the rules of the game. And you get the ball first, plus you have home field advantage—and this happens every single time.
What does this look like in practice?
Here are two examples from recent studies using critical discourse analysis. Studies in this tradition rely on taking audio or video recordings of actual conversations, not hypothetical conversations, and transcribing and analyzing them. So, these are quotes from practitioners in action with real patients.
One study analyzed the power of the words, phrases and metaphors used by midwives, lactation consultants and breastfeeding mothers. See if you can spot how this situation is framed by a midwife to a mother:
“Your nipples are a bit tender because you’re not used to having this little piranha hanging off them every five minutes.”
The authors point out that “Comparing the newborn breastfeeding infant to a fish whose teeth and jaws are destructive and whose appetite is insatiable positions the newborn baby as potentially an ‘enemy’.” Not a warm and fuzzy image.
This specific language use made a difference. It entered into the mother’s thinking in a powerful enough way that she used the piranha metaphor herself, in an interview, six weeks later.
Another example deals with the effects of how conversations about palliative care are initiated. In one case, researchers recorded the conversation when a physician was called to the emergency room for “a consultation with a patient diagnosed with lung cancer and suffering from difficulty breathing.” The physician said:
Hi, I am Dr [name omitted]. I am a family physician. I’m the one who helps with pain and symptom control this week. Here we call it palliative care, but elsewhere it’s called differently. So I’m the one who will be taking care of you this week…
This physician opens with the language of family practice rather than of palliative care, downplaying what the authors call “the label of palliative care, which is often associated with end-of-life care.”
Furthermore, in this opening statement, the physician frames the patient’s condition as needing management of pain and symptoms, rather than needing end-of-life care.
What I’m talking about here has already been taken up by researchers and practitioners within clinical medicine, medical education, and public health.
Here’s how you can keep an eye on the power of your language, regardless of your situation or specialization:
Notice those times when what you say helps get the effects you want.
In other words, when something good happens, note what you said. For instance, keep track of what you said when someone really opened up and shared important information. Or when you were able to move in the direction of a positive relationship.
How do you do that kind of noticing?
Here are four specific, discrete uses of language that are relatively easy to spot and keep track of:
Pronouns (like in the story from the woman with ovarian cancer)
Metaphors (like in the pirhana study)
How you open conversations (like in the palliative care study)
The kinds of questions you ask (because these are easy to notice)
Try keeping track of just one of these four, in your patient encounters. Even for just one day. Keep track of what you said when things went the way you were hoping (or better).
Remember, people are different. Just because a phrase you used clicked with one patient doesn’t mean it will click with another. So take the pressure off yourself to get it right every time. You’re looking for patterns.
You are always building relationships with patients through your language, and you only get so much time with them. The good news is, the tools to make your communication better are already in your hands.
Recognizing your power and your words’ power is what this is about. The perspectives shared here can help you see the power your language has to make things seem normal and talk-about-able—including those times when your framing is problematic, and maybe in need of some shifting.
If you are interested in taking your language use seriously, why not start with your metaphors? I have written a workshop just for you, that shows you how to break down the metaphors you use, understand their cognitive and affective aspects, and evaluate them in use. It’s fast, it’s On demand, and it’s right on the health communication partners.com.
This has been 10 minutes to better patient communication. I’m Dr. Anne Marie Liebel.