Perhaps almost as important as our history-taking, our diagnosis, and our care of patients are the words we use to communicate that history-taking, that diagnosis, and that care.

Scenario one: the not so good

A while ago, I happened to witness a family hospital conference about their dad’s new diagnosis of cancer. There were ten family members present, all very devoted and concerned, though not particularly medically sophisticated. With much compassion and patience, the hospital physician reported that the X-rays showed what was almost certainly a newly discovered cancer. The doctor pointed out the multiple brain lesions on the MRI. She informed the family about other lesions showing up in the bone and still other lesions in the liver. The primary lesion, she suspected, was most likely in the lung. She then explained how lesions could spread from the primary to different parts of the body.

The family listened respectfully, but they seemed more than a bit puzzled by it all. Suddenly, one brave family member blurted out, “What’s a lesion?”

For a moment, the doctor looked crestfallen. It occurred to her that in the last five minutes, nothing she had said had been understood. Then she made a brilliant recovery. “A lesion,” she promptly declared, “is a cancer spot.”

She then went through the same spiel again, but this time, instead of the word “lesion,” she substituted the term “cancer spot.” This time, as she spoke, the family nodded with understanding. When the doctor had finished her explanation, the family, though clearly saddened by the bad news, asked about the possibility of treatment.

“Good question,” replied the doctor, “but first we need to get tissue.”

Sometimes we physicians never learn. Sometimes our medical jargon presents a barrier to communication and healing with our patients.

Or, to put this in the words of that great twentieth-century philosopher: “The biggest problem with communication,” said George Bernard Shaw, “is the illusion that it has taken place.”

Scenario two: the very good

On the other hand, the words we use can break down the barriers of communication with our patients, and they can foster healing.

Several years ago, my friend Sharon discovered a little “blemish,” as she put it, on her breast. Upon evaluation by her surgeon, Dr. Susan Heckman, the “blemish” turned out to be nothing serious at all. But during the examination, Dr. Heckman discovered in the other breast a suspicious lump. Dr. Heckman advised surgery.

However, my friend Sharon believed in the power of holistic healing. Her belief was that cancer, like all physical ailments, could be overcome by the cosmic healing power of the psyche. Given her distrust of organized medicine, Sharon had her mind made up. She would defer surgery. For the next two months, she would explore her own personal pathway to health. She would check out health food store curatives. Possibly a session with Dr. Bernie Siegel. Perhaps a séance with Deepak Chopra. Maybe some firewalking with Tony Robbins.

“If it doesn’t work out in two months,” Sharon told herself, “I’ll come back to Dr. Heckman.”

But something was puzzling Sharon. “By the way, Dr. Heckman,” she asked upon leaving, “what exactly was that ‘blemish’ that brought me here in the first place?”

Now Dr. Susan Heckman could have said a lot of things. We all have our packaged doctor spiels, medical mumbo-jargon that we love to spout, like: “That ‘blemish,’ Sharon, was merely an epithelial lesion of no clinical import.” Or “That ‘blemish,’ Sharon, was a benign pigmented nevus with inconsequential mitotic potential.”

We all know the drill. But Dr. Susan Heckman has a knack for listening to people, especially when those people happen to be her patients. I suspect Dr. Heckman had some idea about the metaphysical ballpark in which Sharon went to bat. Instead of the usual doctor-speak, here’s what Dr. Heckman answered:

“Sharon,” she smiled, “that ‘blemish’ was your guardian angel giving you a wake-up call.”

At that moment, everything changed. Sharon got it. She knew that Dr. Susan Heckman spoke her language. She knew Dr. Heckman understood. By the next morning, surgery was completed. The diagnosis was cancer. But to this day, now many years later, my friend Sharon is free of disease.

Did getting surgery two months earlier help Sharon beat breast cancer?

Maybe it did.

Maybe it didn’t.

I choose to believe it did.

As a matter of fact, I would submit that it was Dr. Susan Heckman’s skill as a communicator, as much as her expertise as a surgeon, that saved my friend Sharon’s life.

Any doubters?

Just ask Sharon’s angel.

Doctor-speak: bottom line

Our words make a difference.

Scott Abramson practiced neurology with Kaiser Permanente Northern California for over 40 years, from 1979 to 2020. Throughout those years, Dr. Abramson was passionately involved in physician communication and physician wellness endeavors. Some of his insights and stories from his experiences in these endeavors can be found in video format on his YouTube channel, Doctor Wisdom. He is also the author of Bedside Manners for Physicians and Everybody Else: What They Don’t Teach in Medical School (or Any Other School).