A woman talking to her doctor (© Alexander Raths - stock.adobe.com)
“There’s nothing else we can do.”
Six simple words that no patient ever wants to hear, yet they echo through hospital corridors far too often. But what if those words – and others like them – are doing more than just delivering bad news? What if they’re actually causing harm?
In an eye-opening study that might forever change how doctors talk to their patients, researchers have identified a collection of toxic phrases they’re calling “never-words” – language so potentially damaging to the doctor-patient relationship that it should be permanently banned from medical conversations. Think of them as the medical equivalent of George Carlin’s famous “seven words you can’t say on television,” except these words aren’t just offensive – they can actually interfere with patient care.
“Never-words are conversation stoppers. They seize power from the very patients whose own voices are essential to making optimal decisions about their medical care,” the study authors explain in a media release. “Clinicians should instead aim to start dialogue, by inviting honest, thoughtful inquiries and responses from patients and families.”
Researchers from Henry Ford Hospital and Texas A&M University say these problematic expressions aren’t just poor word choices – they’re conversation stoppers that can dramatically shift the power dynamic between doctors and patients, often at critical moments when clear communication matters most. These phrases, while perhaps commonplace in medical settings, can leave patients feeling helpless, dismissed, or even abandoned.
The “Never-Words” List:
- “There is nothing else we can do”
- “She will not get better”
- “Withdrawing care”
- “Circling the drain”
- “Do you want us to do everything?”
- “Everything will be fine”
- “Fight” or “battle” (when referring to illness)
- “What would he want?”
- “I don’t know why you waited so long to come in”
- “What were your other doctors doing/thinking?”
Cancer-Specific Never Words:
- “Let’s not worry about that now.”
- “You are lucky it’s only stage 2.”
- “You failed chemo.”
The stakes are particularly high in today’s medical landscape, where treatments for conditions like advanced heart failure, cancer, and end-stage pulmonary disease have become increasingly complex. Doctors must navigate difficult conversations about treatment options, prognosis, and end-of-life care while contending with patients’ fears, emotions, and sometimes unrealistic hopes for a cure. It’s a delicate dance that requires both medical expertise and exceptional communication skills.
Dr. Rana Lee Awdish, who brings a unique perspective as both a critical care physician and a former critically ill patient herself, led the research team in examining how certain words can create unnecessary power imbalances in the doctor-patient relationship. Together with her colleagues, Dr. Gillian Grafton and Dr. Leonard Berry, they surveyed 20 clinicians about words they would never use with patients and conducted an extensive literature review on best practices for difficult medical conversations.
“The emphasis in medical school is understandably on the science of medicine, but it is so important to incorporate communications training into the curriculum,” Berry says in a statement. “A key opportunity is medical school students and graduates having superb patient-centered, skilled communicators as role models in their clinical training during medical school and residency.”
Their findings paint a compelling picture of how seemingly innocent phrases can undermine the therapeutic relationship. Take the word “just” in the phrase “we can just do supportive care.” That single word implies that supportive care is somehow less valuable or important than other treatments, potentially steering patients away from options that might better align with their values and preferences.
The research team identified several communication models that have proven effective in facilitating difficult medical conversations. The Cleveland Clinic’s REDE model emphasizes the importance of building relationships between healthcare providers and patients. The University of Pittsburgh’s VitalTalk focuses on training medical professionals to deliver bad news and conduct family meetings. Henry Ford Health’s C.L.E.A.R. Conversations program uses actors and role-play to help doctors master challenging discussions.
Even with these tools at their disposal, doctors face significant structural challenges that can lead to the use of never-words. Time constraints, large caseloads, and the complexity of modern medical treatments can push healthcare providers toward more prescriptive communication styles. When multiple specialists are involved in a patient’s care, it might not be clear who should take responsibility for having difficult but necessary conversations.
The study provides practical alternatives to common never-words. Instead of saying, “There is nothing else we can do,” doctors are encouraged to say something like, “Therapy X has been ineffective in controlling the cancer, but we still have the chance to focus on treatments that will improve your symptoms and, hopefully, your quality of life.”
Rather than asking, “Do you want us to do everything?” – a loaded question that can pressure patients into aggressive treatments – healthcare providers should invite dialogue with statements like “Let’s discuss the available options if the situation gets worse.”
The researchers emphasize that avoiding never-words isn’t just about being polite – it’s about redistributing power back to patients so they can actively participate in their own care decisions. When a doctor declares, “Your mother needs to be intubated,” they’re closing off a discussion about the patient’s priorities. But by asking, “May we talk about what that means and what to do next?” they create space for shared decision-making.
The study also highlights how never-words can perpetuate harmful metaphors in medicine. Terms like “fight” or “battle” when discussing illness suggest that recovery is simply a matter of trying hard enough – implying that patients who don’t recover somehow failed to fight hard enough. These martial metaphors can leave families feeling guilty or questioning whether their loved one could have done more to survive.
Perhaps most importantly, the research reveals how never-words can shut down the very conversations that need to happen for optimal care. When a doctor says, “Let’s not worry about that now” in response to a patient’s concern, they’re not just avoiding a difficult topic – they’re dismissing the patient’s legitimate fears and anxieties. Similarly, telling a cancer patient “You are lucky it is only stage 2” presumes gratitude while leaving no room for the very natural feelings of fear and uncertainty that come with any cancer diagnosis.
The researchers recommend incorporating discussion of never-words into medical education and professional development. By making clinicians more aware of harmful language patterns, healthcare organizations can work to create a culture of more thoughtful, patient-centered communication. The study suggests that even experienced healthcare providers can benefit from examining their own communication habits and learning to “walk back” language that lands poorly with patients.
The Hippocratic Oath famously begins with “First, do no harm.” Thanks to this research, we now know that pledge extends beyond actions to words – proving that in medicine, as in life, it’s not just what you say, but how you say it. And sometimes, as this research shows, the most powerful thing a healthcare provider can say isn’t a declaration of what must be done, but rather a simple question: “May we talk about what happens next?”
Better Ways to Communicate: Alternatives to Never-Words
The researchers provided specific alternatives to these problematic phrases, along with the rationale for each change:
Instead of “There is nothing else we can do”:
- Say: “Therapy X has been ineffective in controlling the cancer, but we still have the chance to focus on treatments that will improve your symptoms and, hopefully, your quality of life.”
- Rationale: Even with no prospect for cure, the clinician can still convey an ability to treat the patient as best they can.
Instead of “She will not get better”:
- Say: “I’m worried she won’t get better.”
- Rationale: Replace a firm negative prognostication with an expression of concern about the poor prognosis.
Instead of “withdrawing care”:
- Say: “We can shift our focus to his comfort rather than persisting with the current treatment, which isn’t working.”
- Rationale: Clinicians never “withdraw” care, which may imply “giving up” or denial of services to patients and their families. Describe the advantage in refocusing the goal of care.
Instead of “circling the drain”:
- Say: “I’m worried she’s dying.”
- Rationale: Avoid slang terms that objectify and diminish patients.
Instead of “Do you want us to do everything?”:
- Say: “Let’s discuss the available options if the situation gets worse.”
- Rationale: Instead of using a leading question that may not align with the patient’s values or goals, invite dialogue.
Instead of “Everything will be fine”:
- Say: “I’m here to support you throughout this process.”
- Rationale: Offer support that is realistic and humane.
Instead of “fight” or “battle”:
- Say: “We will face this difficult disease together.”
- Rationale: Avoid implying that sheer will can overcome illness. Patients may feel as if they’re letting their family down if they don’t recover.
Instead of “What would he want?”:
- Say: “If he could hear all of this, what might he think?”
- Rationale: “Want” is often an ill-defined word in a hospital setting, and what families surmise the patient would want may be impossible.
Instead of “I don’t know why you waited so long to come in”:
- Say: “I’m glad you came in when you did.”
- Rationale: Blaming a patient and potentially causing more worry are unproductive. Focus on what can be done realistically in the given circumstances.
Instead of “What were your other doctors doing/thinking?”:
- Say: “I’m glad you came to see me for a second opinion. Let’s look at your records and see where we can go next.”
- Rationale: Focus on what’s still possible. Take positive next steps, rather than casting aspersions on professionals whose cooperation you may still need in moving the patient forward.
Paper Summary
Methodology
The researchers took a multi-pronged approach to studying problematic medical communication. They surveyed 20 clinicians within their professional networks, asking them to identify words or phrases they would never use with patients and what alternative language they would suggest instead.
They also conducted a comprehensive literature review to gather current best practices for difficult clinical conversations. The study team brought diverse perspectives to the analysis, including insights from critical care medicine, heart failure treatment, and health services research. One researcher’s experience as both a physician and former critical care patient provided valuable dual perspective on the impact of medical communication.
Key Results
The study identified numerous “never-words” and phrases that can harm the doctor-patient relationship, along with suggested alternatives. These included common expressions like “there is nothing else we can do,” “withdrawing care,” and “circling the drain.” The researchers found that such language often creates power imbalances, shuts down dialogue, or causes unnecessary emotional distress. They also discovered that structural challenges in healthcare delivery, such as time constraints and fragmented care teams, can contribute to the use of these harmful expressions.
Study Limitations
While the study provides valuable insights into medical communication, it has several limitations. The sample size of 20 clinicians was relatively small and may not represent all healthcare providers’ experiences. The study focused primarily on serious illness and end-of-life care, so the findings might not apply equally to all medical contexts. Additionally, the researchers note that context matters significantly in medical communication – words that might be harmful in one situation could be appropriate or even helpful in another.
Discussion & Takeaways
The research emphasizes that improving medical communication isn’t just about avoiding certain words – it’s about fundamentally changing how healthcare providers share power with patients in decision-making. The study suggests that medical education should include specific training about language choices and their impact on patient care.
The researchers also highlight the importance of organizational culture in supporting better communication practices. They note that while avoiding never-words isn’t a complete solution to communication challenges in healthcare, it provides a concrete, actionable way to improve patient care.
Funding & Disclosures
According to the paper, the authors reported no competing interests in conducting this research. The specific funding sources for the study were not disclosed in the original article.
What if the Dr. said “ don’t buy green bananas!”lol
Some more :
“Uuuh-oooh”
“Hey, I thought this tray had four clamps.”
“I think you should call the family.”
“Repeat after me. Our father which …”