The words we use sometimes last a lifetime 

Communication can be an enormous source of comfort, and of stress, in healthcare

A common refrain from doctors is that when out socialising, people tell them about their ailments. This happens to me in a different way – people, often complete strangers, tell me about a time when their child was very ill. I don’t mind this, as I love chatting about children and anything health-related.

I’ve noticed a thread in these stories.

Stories that are told after years, decades even, recount words that people said. Specifically, what doctors and nurses said during the time that their child was critically sick. Most recently, a man repeated an exact phrase that a doctor had used about their son 20 years ago. “I’ve booked a brain scan for him,” the doctor said to their baby’s nurse. He left the room immediately after and they didn’t get a chance to ask him about it.

“I’ll never forget it. We nearly went out of our minds with worry,” the father said, shaking his head at the memory. Days later they discovered that the scan was a routine test – there had never been any real concern about their baby’s brain.

Communication can be an enormous source of comfort, but also of stress, in healthcare. Understanding the emotions experienced by two parties to any exchange of words is key to figuring out why a phrase is remembered clearly by one person, and not by the other. As healthcare staff, we are in our workplace. We come there every day, so we are mostly calm, soothed by routine. We are trained to carry out our tasks, and we are thinking about our patients. But our emotions are generally not activated.

Emotions

The patient or family member, on the other hand, is in a state of emotional distress. The injury or illness may have begun days earlier, but strong emotions such as fear persist even when the patient appears to be recovering. Numerous studies have reported that human cognitive processes are significantly affected by emotions, including attention and memory. Emotional experiences/stimuli are remembered vividly and accurately, with remarkable consistency over time.

Outside of healthcare, the same phenomenon is seen.

When a major global event occurs such as a financial crash or international conflict, the words used by our leaders hold potential to reassure or to inflame. Depending on how well they understand the public emotions, a statement from a politician can help healing to begin. However, a well-crafted apology, devoid of connection or honesty, can be perceived as hurtful and be recalled for years for the same reason. Remember Charles Haughey’s “we’re living way beyond our means”. This was said to a public beaten down in a never-ending economic recession. Hollow words even as they were spoken, they were unforgettable when the full picture emerged.

Compare that to when Mary Robinson made her acceptance speech in 1990, becoming the first female President. She spoke to a nation yearning for hope.

“The Ireland I will be representing is a new Ireland: Open, tolerant, inclusive,” she said.

Her positive words set the tone for the profound changes that took place in the following three decades. They remain memorable and relevant.

I recently attended a workshop on speaking in public, organised by Trinity Women Graduates. “Rule number one,” the voice coach said firmly, “is know your audience.”

Healthcare

As healthcare professionals, we can forget that we have an ‘audience’ in our patients and their families. Knowing what they expect, what they need and what they are feeling is vital to ensuring that the words you choose have the effect that you want them to have. Ideally, we would have plenty of time to sit with patients and their families, hear their emotions, and create a plan together to manage their illness.

Communication skills workshops have limited impact unless systemic constraints are addressed in
a meaningful way

Building relationships in healthcare requires time. When services are short-staffed, practical tasks like giving medication get prioritised. When outpatient clinics or GP appointments are overbooked, staff haven’t had time for a bathroom break and when the computer system is down, the quality of communication between healthcare professional and patient deteriorates. Our words can become hasty. It’s inevitable.

Communication skills workshops have limited impact unless systemic constraints are addressed in a meaningful way. I have no doubt that the doctor who spoke about a brain scan within earshot of reeling parents has no recollection of their words. They most likely quickly left the room to answer a bleep, make a note in a chart, and attend to the many other patients waiting for them.

Even having a psychologist supporting families doesn’t change the fact that families hang off every word spoken by a doctor about their loved one. We have all experienced hurt when those in leadership fail to understand how strongly we feel. Emotional distress forges intense memories. It will never be any other way.