When words hurt

Words are scalpels, every bit as sharp as a surgeon’s tools, and sometimes almost as dangerous.

Cutting words are at their worst when they are unintended, that is, when they inadvertently reveal what the speaker -- the doctor -- really thinks. Take “incompetent cervix.” Granted, this is a succinct way to describe a cervix that can’t keep the womb properly closed throughout a pregnancy. But we never hear the term “incompetent penis.”

Far worse is the common phrase, “The patient failed chemotherapy.” Who or what really failed here? “The therapy failed the patient” is not only kinder but more accurate.

Then there’s “noncompliance,” which doctors use when a patient, like a balky, disobedient child, did not obey the doctor’s orders, such as by not taking a prescribed drug. “Compliant” isn’t much better.

Another alienating word is “denies,” as in, “the patient denies alcohol use” or “the patient has cough but denies phlegm.” Sure, it lets one doctor know that another has asked a patient about this, but the not-so-hidden connotation is that the patient is a liar.

As a much-published poet, Dr. Rafael Campo, a primary care physician at Beth Israel Deaconess Medical Center in Boston, is attuned to the potential damage -- and the healing power -- of words.

“Some of the language we are talking about here is pervasive in the medical profession and does potentially undermine the relationship between doctors and patients,” he says.

For example, doctors often say the patient came in “complaining of “ something, which makes the patient sound whiny, like “an adversary,” Campo says. “Just the other day, an intern was presenting a patient [to me] in front of the patient. He said, ‘Mrs. So and So is here complaining of ...’ and she said, ‘I wasn’t complaining, I was just telling you how I feel.’ ”

The term “adverse reaction [to medications]” bothers Linda De Benedictis, the founder of the New England Patients’ Rights Group. “It implies the drug is OK, the patient was wrong,” she says, as if the patient is the one in a million for whom the drug is harmful. “Then you talk to 10 other people, and they’ve had the same problem,” she says.

Patients, too, sometimes use terms that grate -- such as “breast cancer survivor.” Obviously this is a respectful way to describe someone who’s fought a frightening disease, but it can seem politically correct to others. What about all those with cancer who don’t survive? Were they any less heroic?

The pet peeve of Kay Redfield Jamison, author of “An Unquiet Mind,” a book about her experience growing up with manic depression, and “Night Falls Fast,” about suicide, is “failed suicide attempt.” The term, she says, makes it sound as though a person was not only despairing but incompetent to boot.

Just as bad is “suicidal gesture,” says Dr. Andrew Leuchter, vice chairman of the department of psychiatry at the UCLA Neuropsychiatric Institute. What looks to doctors like a halfhearted suicide attempt may actually be a serious attempt by someone who simply doesn’t know how to do it.

In an article called “Words That Maim, Words That Heal,” scheduled to be published in a leading medical journal, Dr. Susanna Bedell, an internist at Brigham and Women’s Hospital in Boston, dissects the meanings of many medical terms that are unnecessarily insulting. A classic for sheer insensitivity, she says, is “widow maker,” used to describe a man with severely clogged coronary arteries. Just as awful, she adds, is “deforming arthritis,” used for patients with severe rheumatoid arthritis.

Perhaps most galling of the unfortunate medical phrases is one often used as a patient is dying, says Dr. Lachlan Forrow, director of ethics programs at Beth Israel Deaconess. When people talk about withdrawing life support, he says, they often say “withdrawing care.” In reality, Forrow says, “We never withdraw care....We just stop the respirator if it is no longer a caring thing. That is the opposite of withdrawing care.”

Says Campo, the author of “The Healing Art: A Doctor’s Black Bag of Poetry”: “There is no handbook for medicalese that says we have to talk in these terms.... But it’s this kind of shorthand of formulas that gets passed down from one generation of doctors to the next.”