Consider hearing the scary diagnosis of “heart failure” tripping lightly from your doctor’s lips as if it were no big deal. Can there be anything more terrifying and demoralizing than hearing that your heart is “failing”? And the words don’t even accurately reflect this condition, which actually means that your heart is not pumping blood as well as it should.
So why did doctors come up with this heart failure name, and what on earth were they thinking when they decided it would be a good idea to actually say these words out loud to Real Live Patients? And is there a less hurtful term they could use instead?
Using comparable terminology like “failing a treadmill stress test” or “abnormal electrocardiogram” or “sick sinus syndrome” are jarring when heard by the average freshly-diagnosed patient, according to the late cardiologist Dr. Bernard Lown, a Nobel Peace Prize recipient and author of The Lost Art of Healing.
Words like these, he says, likely reflect physicians’ use of common clinical jargon without any real awareness of the damaging impact on patients. In a paper called “Words That Harm, Words That Heal” published in The Archives of Internal Medicine(1), Dr. Lown and his colleagues explained:
“Consider the patient who has just had a heart attack: the first few hours of uncertainty in the coronary care unit are also an introduction to mortality, eliciting worry that every beep on the heart monitor might be the last.
“Then, at the height of the patient’s anxiety, the physician might come in and gravely announce:
“You have the type of lesion we call a widow maker!”
Those are precisely the same words I heard while recuperating from a heart attack in the CCU (the hospital’s intensive care unit for cardiac patients). In a more recent essay on (the enlightening and delightful blog that Dr. Lown used to write with his granddaughter, Melanie Lown), he explained further: (2)
“The doctor is part of our culture wherein doom forecasting is within the social marrow. Even the daily weather is often reported with anxiety-provoking rhetoric.
“To be heard, one learns the need to be strident, equally true for weather predictions as for medical prognostications. The end result is that doctors justify their ill-doing by their well-meaning.
“Unfortunately many doctors are poor communicators. It begins with medical school. The curriculum is weighted heavily with science while the art of medicine is given short shrift. As a result, medical students focus on the disease, rather than on the whole patient. Little time or effort is devoted to honing skills in interpersonal relations or cultivating the art of caring.
“The effect is that doctors don’t listen, trust is undermined, and patients are less likely to follow medical advice.
“Projecting a grim scenario also achieves the important objective of gaining the patient’s compliance without the need for reasoned and time-consuming explanations.
“In our health care system today there is constant pressure to minimize time with patients. The less time a doctor spends with a patient, the more profitable the encounter.
“Instilling anxiety makes for a customer ready to buy – namely, to undergo any test or procedure.”
But instilling anxiety may do far more than make a patient pay attention to what the doctor is saying. In fact, it can do just the opposite. It can also intensify the emotional distress that so often accompanies a heart disease diagnosis. At Mayo Clinic, for example, we learned that up to 65% of heart patients experience significant symptoms of depression, yet fewer than 10% are appropriately identified.
Dr. Lown believes that instilling anxiety by deliberately using alarmist language like heart failure is sometimes what a caring physician may do in order to convey a sense of urgency, thus hoping to ensure that his or her patient will comply with lifesaving recommendations. Even in non-emergency situations, the physician may believe that these words are actually necessary to persuade the patient to accomplish what needs to be done to maintain health.
The internist Dr. Eric Cassell coined this observation:“Sticks and stones may break your bones, but a word can kill you.”
As a heart attack survivor who has heard those exact words “widow maker” from a physician, I can tell you that whatever words follow those are likely completely lost in the roaring freight train rush going through the patient’s brain at that moment as we try vainly to figure out what the hell has just been said. And when frightening words finally do sink in, their effect is far more demoralizing than motivational.
Dr. Lown cites casual (or intentional) real-life physician statements like the following:
- “You have a time bomb in your chest”
- “The next heartbeat may be your last”
- “Your life is hanging by a thread”
- “There is no choice. We have to operate.”
He also describes how these common examples taken from the field of cardiology that illustrate well how words – perhaps spoken with the best of intentions – can cause what’s known as iatrogenic harm (which is defined as a new medical problem that occurs as a result of the actions of a medical provider). He adds:
“Unfortunately, medicine encourages ‘detached concern’ which devalues subjectivity, emotion, relationship, and solidarity.”
So what alternative words might physicians come up with to replace hurtful ones like “heart failure”? Dr. Lown suggests this:
“Heart failure is not a disease. It’s just a description of clinical syndromes. A heart failure prognosis is no longer what it used to be; much of the damage that occurs to the heart may be reversible and the symptoms controlled over decades.
“Perhaps a better term would be stiff muscle syndrome.”
Scottish physician Dr. Trish Elliott of Edinburgh has her own favourite substitute term instead of heart failure: “insuffisance cardiaque”, as she suggested on Twitter:
Cardiologist Dr. David Brown also suggested on Twitter this potential name to help explain the condition to patients:
The key concept is congestion to explain the symptoms of breathlessness and edema (swelling). Maybe congestive heart dysfunction?
* Words that harm, words that heal” Archives of Internal Medicine/Volume 164, July 12, 2004. Susanna E. Bedell, MD Thomas B. Graboys, MD Elizabeth Bedell, MA Bernard Lown, MD. 2004 Jul 12;164(13):1365-8.
** February 21, 2013: “The Roots of Medical Bullying” – The Lown Conversation
Q: Have you ever heard medical terminology from your doctor that you found hurtful or frightening?