Words Matter: Using language that is accurate but does not provoke fear

Words Matter

Let’s play a game!  I’m going to describe an injury and you chose which explanation makes you feel most positive and hopeful about the explanation, let’s begin.

Round 1:

40 year old male presents with acute low back pain that increases with bending forward and goes away with bending backward.  Pain started a week ago when he bent forward and twisted while working out in the gym.   An MRI was not performed.   Which of the following makes you feel hopeless about the injury?

  1. “You have a herniated disc”
  2. “You irritated the ligaments in your back, which may include your disc.”

Question: Which response makes you feel more optimistic about your road to recovery?

Round 2:

50 year old female receptionist reports gradual onset of neck pain in the last 6 months.  An MRI is ordered.  The patient is told either of the following:

  1. “You have degenerative disc disease.”
  2. “You have normal age related changes in the cervical joints.”

Question: What option encourages you that you can improve your symptoms?

Round 3:

60 year old active male presents with knee pain with skiing.  Pain is worse in the morning and gets better throughout the day.  An X-ray is ordered.  The patient is told either of the follow:

  1. “Your knee is bone on bone.”
  2. “You have some degenerate changes that are normal for an active person who is 60.”

Question: Which response will encourage you to continue being active and doing the things you love?

The purpose of the above exercise was to compare and contrast how the words that providers use to explain clinical problems can either evoke fear and anxiety, or can be accurate and calming.

Part of good patient management is to reduce the unnecessary fear and anxiety associated with treatable injuries.   Reducing fear decreases the risk of conditions of becoming chronic and helps manage the overall pain level that can sometimes increase due to anxiety about a condition.

Terms like “slipped disc” and “pinched nerve” are complete unproductive terms, but they are commonly used.  There are scary terms that are generally not accurate.  These terms misrepresent injury and, as a conclusion, inadvertently suggest the treatment.  If your “disc has slipped out” then the obvious conclusion is you need to slip it back in!  (This does not happen by the way).  If you nerve is “pinched”, then you must un-pinch it!  If your back is “thrown out”, have your tried “throwing it back in”?

Poor use of language can lead to unintended consequences.  For example, let’s say I tell you that you are “inflamed” when you do not have an inflammatory process.  The unintended consequence is that you may feel like you need to take anti-inflammatories to help you when you really don’t need to be taking them.  I must confess, this has actually happened a few times when I was much less aware about how I used to talk to clients about their condition.

Another example is the “herniated disc”.  I have had some students who would tell a patient they “herniated their disc” when there was no imaging performed.  The context is there are 35 different terms to describe disc pathology and many providers use some of the terms interchangeably.  Also, 30% of people are walking around with herniated discs and disc bulges and have had no history of low back pain.  Using this term, unless it’s a confirmed new disc herniation, is rather pointless as it does give the client the best and most accurate information while at the same time scaring the hell out of them.

So the point to my story, is words matter! When seeking care, ask questions and make sure you fully understand what the true meaning of what is being said to you when seeking treatment.