Fear Vs Hope: Semantics in Healthcare

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The words we choose can affect our health, recovery and overall outlook on life. As doctors, we are always learning how to communicate more effectively with patients. Choosing specific words in certain circumstances can completely alter a patient’s belief in their ability to heal themselves, and therefore can drastically affect the results they experience under our hands as Chiropractors.

One example is the word “chronic”, medically defined as a condition lasting longer than six weeks. You must admit, the word “chronic” feels more intense than that. We tend to associate “chronic” with “never-ending”, “degenerative”, “progressive”, “disabling”, “lifelong” and sometimes even “hopeless”.

Now, if you believe that chronic conditions represent these things, which most people I meet do, how likely will you be to overcome the condition? If someone of authority tells you that your condition is chronic, and therefore possibly disabling, and something you will have to learn to live with (perhaps managing it with medications for the rest of your life), it’s kind of depressing, right?

My experience tells me that patients who believe this line of reasoning, accepting these definitions of a “chronic” condition, are less likely to improve.

Let’s try another word, like “persistent”. It’s true, a “persistent” condition may end up being all those things listed above, but doesn’t this word also have inherent in its meaning the possibility of ultimately going away, as we might describe a persistent cough or bad infection, or the persistent bad behavior of a child or dog?

We must be careful of the words we accept for ourselves-the words we use to describe ourselves and our conditions. We should also be careful of how we choose to identify with our conditions, like saying “my back pain” or “my chronic neck pain”, as if it’s something you embody and will always be a part of you. This may seem subtle, but choosing to use words like “my chronic migraines” instead of, for example, “the head pain I experience”, can begin a long-term identification with that condition, making it much more difficult for you to recover from (if, indeed, there does exist a possibility for you to recover from it).

I personally am very careful about the words I use when offering a diagnosis to my patients. I do see a lot of neuromusculoskeletal conditions that, over time, may worsen, especially if specific care is not taken to correct the imbalance leading to the problem. Long-term conditions in the spine typically get named “degenerative”, as in neck or back pain caused by degenerative osteo-arthritis. But one thing that remains uncertain with conditions such as these-it’s nearly impossible to predict just how fast the condition will degenerate, which patients will succumb to more sinister degeneration, and which patients may slow the process down, and in some cases reverse the problem.

It may sound a bit silly, but I refer to degenerative arthritis as “wrinkles” in the spine, or “wear and tear”. It gets the point across while avoiding the use of the word “degenerative”, and it leaves open the possibility for improved function and healing, the chance that maybe, just maybe, tomorrow might feel better than today. And since no one ever knows for sure the exact prognosis for any one patient, I suspect it’s better to be a bit more open with predicted patient outcomes. Of course, I understand that in some cases patients really do wish to hear their doctor’s prediction for how long they might have given certain perilous disease processes. But I am also aware of many patients who end up living well past their doctor’s prognosis.

On another related tangent, where does “developing” in one’s life end and “aging” begin? Raising my daughter, I get to marvel at the developmental milestones she reaches, and as any parent will tell you, sometimes a new quality of maturity can be witnessed in your child when they wake up in the morning after one night’s sleep. Yes, sometimes you can actually see a difference in your child overnight!

We all agree that babies, teens, and adults age with each passing day, and that some qualities continue to develop throughout our lives, but somewhere along the way we stop seeing our …