WORDS MATTER - #1 - "FAILURE" and "BETTER"

It is what we say and how we say it that makes a difference in how we get the message across and how it is perceived by others.
This is really important when we are talking with patients and families dealing with serious illness near the end of life.
The two words I want to tackle today include "better" and "failure".

FAILURE:
Patient and families do not get the severity of the clinical condition until they hear the word failure.
If you say the kidneys are not functioning well and need dialysis, it does not sound as severe as "the kidneys are failing, or patient has kidney failure". In many instances the families that had been reluctant to let go start to see the futility of aggressive treatments in terminal patients once they realize that organs are now "failing". Like the husband of my 64 year old female patient with liver failure who was being treated aggressively with poor response. As I consulted and said to the husband ,"As you know she has liver failure". His response was"I did not know she had liver failure!" ( this is in a patient who is yellow from severe jaundice, bleeding with poor mentation). Nobody had used that word before. Once he heard it, he understood the gravity of the situation and was visibly moved. He was also then able to make more rational decisions.

BETTER:

Anytime we say to the family that their loved one is better, they assume that this means he/she is going to be ok now, will wake up, start talking and walking soon. We may have just meant that blood pressure is now normal, or the oxygenation has improved.
In terminally sick patients this is giving the wrong impression when the overall prognosis is still dismal.
I prefer to say that the blood pressure has improved WITH medication and oxygen levels are higher with the ventilator,  electrolytes have improved with dialysis BUT overall condition and prognosis is still very poor. Chances of reasonable , meaningful recovery is remote. He/she is being artificially supported.
This gives them the true picture and there is no misunderstanding or unrealistic hopes from our misconstrued words.
So, unless there is a good chance the patient is going to be overall better, please avoid that word. It will decrease unnecessary suffering in the loved ones.

In summary use the word failure truthfully and freely.
Use the word better cautiously and with full knowledge.

Thank you for this great work you all do with the severely sick.

Just Published: "Courageous Conversations on Dying - the Gift of Palliative Care"

This is a practical guide for physicians, healthcare providers and all the people they serve. Thus a good book for the physician and the patient alike.

I have been working on this for over a year and a half at least. It is a distillation of my work and knowledge I gained from many mentors, colleagues, students, patients, friends and families.

The time for these conversations on end of life goal-setting is now while we still have the capacity to make our own decisions.
No need to be shy and reticent. One never knows when the time for the tough decisions will come, but come it will.

In this book you will learn how, why when and where to have these important conversations including the words to use, how to be a good listener, how to empathize, how to help others in the decision-making, how to properly document your end of life wishes and much more. It is full of practical tips and case studies from years of experience.

I hope you find it helpful and to your liking.
Peace