The healing touch of words
By- Dr. Madhura Mandlik
Senior resident
Department of of Obstetrics and Gynaecology
Ltmnc and ltmgh, Sion, Mumbai
Robin Sharma aptly quoted,
Words can inspire and words can destroy. Choose yours well.
But what do you do, when your words are meant to bring unhappiness and sorrow to a person or their family. How do you explain an inevitable death, a person suffering from terminal illness like cancer or someone suffering from Alzheimer’s?Words are tough, using them to give scientific information is easy , but comforting others, explaining something serious is difficult.
Communication is one of they key pillars in palliative care .But the quest begins with making people understand what palliative care is ! Palliative care or end of life care are often used interchangeably. The latter is a bit more obvious, but, palliative care is a term, that is often confused wherein the next of kin ,seldom , aren’t aware that their loved one is heading towards his or her last days.
In the United Kingdom, Social Care Institute for Excellence (SCIE) and the National Council for Palliative Care (NCPC) have launched an initiative, “Thinking about the words we use”. They highlight that medical professional do not tend to use the term death, and resort to other jargon, which further confuses the kin and makes their journey of palliative care challenging.
There is a paradigm shift from operationalising end of life care to more free, communicative care. The Liverpool care pathway, was critically reviewed in More care , Less pathway and emphasised the need to cease it and bring in more clear and compassionate end of life care.
Healthcare professionals, like us , must endeavour to incorporate the following.
- When speaking to a person who is dying or their relatives, understand the impact of the terms used
- Where possible, try to explain things in plain English, rather than automatically using potentially unfamiliar terms
- Regardless of the terms used, always check what the person has understood from the conversation
- Always speak in a kind and caring way to the person who is dying, as well as to their relatives and friends
Apart from compassion and kindness while communicating in palliative care, our words can also affect the daily pain of our patients. Did you know , that a positive, warm and empathetic atmosphere, can help to bring about a positive change in our patients pain perception?
Productive communication between patient and clinician is first step towards pain management. Majority of pain management relies on communication: assessing pain and functional status, deciding on pain management goals, implementing treatment plans, and assessing the effectiveness of those plans. There are no clear studies or guidelines that help clinicians assess this. Interview and focused group discussion has often shown that most discussions about pain management, especially, about opioid analgesics, is frustrating !
A patient always remembers how the doctor communicated. How he or she was spoken to in difficult times. Not how intelligent the doctor was or how many scientific terms he was using , instead the tone and empathy, patience is what is remembered!
Communicating goes both ways and when patients narrate their complains and problems, tell your stories about how they reached their disease or state, is again a basis of pain management. Stories are a basis of humanity, we learn, grow and mature with these very stories.
The term ‘narrative medicine’ was used by Rita Charon in a paper in Annals of Internal Medicine in January 2001 where she defined narrative as “medicine practised to recognise, absorb, interpret and be moved by the stories of illness” that is , patients experience and report pain and others interpret and respond to the information provided. She is the pioneer of narrative medicine, but the roots of this were long laid before our time when Osler said ‘ The good physician treats the disease, the great physician treats the patient who has the disease.’
It includes urging patients to converse, write poems, personal essays all depicting illness. These stories written by the ailing are used to understand their perceptions and attitudes and alter the health care given, in accordance. Narrative medicine explores how, society interprets illness. Things which were considered illness or disability are now an integral part of life. People cope and thrive with it daily.
Doctors and healthcare professional, see death and despair on daily basis. Maybe in a quest to protect our own emotions and mental health , we tend to resort to less personal and more scientific terms. Also, we tend to move away from the complete narrative , the entire story of our patient, and tend to resort to desensitised words.Instead of condensing, narrative medicine offers the opportunity for expansion, with the goal to improve understanding of patients’ lived experiences. By attending to the full story and any emotions revealed in storytelling, we are provided a clearer window into our patients’ lives.
Helping the ailing, listening , doing no harm has been taught to us all in medical school . But maintaining empathy and making our words the medicine for someone’s ailment is a task that is a never ending quest and requires learning everyday. Every situation is unique, every person has his own story and every love one will react in a different way, listening , absorbing and then replying is the key. Patience to listen and the art of using words with care is something which we have to master to become better health care providers.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143552/ https://www.scie.org.uk/news/mediareleases/end-of-life-palliative-care https://go.gale.com/ps/i.do?p=AONE&u=googlescholar&id=GALE%7CA188739798&v=2.1&it=r&sid=AONE&asid=c323986d
