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Physician Scott Abramson discusses his article “How doctors’ words can make or break patient care.” Scott shares two compelling scenarios illustrating the profound impact of a physician’s communication. He recounts a family conference where a doctor’s use of medical jargon like “lesion” completely obscured the diagnosis of cancer for a concerned family, highlighting the barrier that medical language can create. Conversely, Scott details the powerful influence of a surgeon, Dr. Susan Heckman, who, faced with a patient’s holistic beliefs and initial refusal of surgery for a suspicious breast lump, used empathetic and culturally resonant language—calling the “blemish” a “guardian angel giving you a wake-up call”—to foster understanding and facilitate timely, life-saving intervention. Scott emphasizes that effective communication, beyond clinical expertise, is crucial for patient understanding, trust, and ultimately, positive health outcomes.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Scott Abramson. He’s a neurologist. Today’s KevinMD article is “How doctors’ words can make or break patient care.” Scott, welcome back to the show.

Scott Abramson: Thank you, Kevin. It’s great to be here.

Kevin Pho: All right, what’s your latest article about?

Scott Abramson: Just as you said, it’s about how words can really, really make or break communication. I think it was George Bernard Shaw who said something like: the biggest problem with communication is the illusion that it took place. If you were to interview participants after some sort of patient-doctor interaction, you would see this. If you interview the doctors and ask, “How did it go?” the doctor would say, “Yeah, it was great. I got a history. I did a physical. I explained what the problem is. I found it. I fixed it. I did a great job.” Then you ask the patient, and the patient is going to say, “I didn’t understand a word he said.”

And in this article, what I was trying to do is focus on how the words and phrases themselves can either create good communication or break it.

Kevin Pho: I think what you say is so true, especially in cognitive specialties like yours in neurology and mine in primary care. The statistics show that 80 percent of the diagnosis can be found just from the history alone. In your article, you present a couple of scenarios that really demonstrate how important words are. Share those scenarios with our audience who did not get a chance to read your article yet.

Scott Abramson: OK. The first scenario was about how, when communication is challenged, it can really interrupt that patient-doctor connection. I was at a hospital meeting where a hospital doctor was talking to a fairly large family about their loved one. I was sitting there, like a fly on the wall; I had been involved somewhat in the case.

She was explaining to the family, and she shows the MRI scan on the screen. She says, “There’s a lesion here in the brain.” And then she says, “There’s no lesion here in the liver.” And then she says, “I think the primary lesion is probably in the lung.” The family was very unsophisticated medically, and they were listening politely, but you could see that they were really puzzled. Finally, one brave family member says, “Doctor, what’s a lesion?”

The doctor then realized, “Oh my gosh, for the last five minutes, they didn’t understand a word I said.” But she made a brilliant recovery. This was great. She then repeated everything, but instead of using the word “lesion,” she used the words “cancer spot.” She went through the whole thing, and the family sort of understood this time. Finally, when she was through, one of the family members said, “Yeah, but what do we do for treatment, doctor?” And she says, “First, we have to get tissue.”

The family was looking at each other, puzzled. It’s like sometimes we just never learn.

Kevin Pho: And it’s especially because those are terms that we use all the time, and we just assume everybody understands what they are.

Scott Abramson: Yeah, Kevin, I don’t know about you, but I’m very computer-phobic. If I have a question for someone, I’m almost afraid to ask because they’re going to say something like, “Well, your server has this many gigabytes, and what is your operating system?” All they have to do is mention one of those words, and because I’m afraid to ask and appear stupid, I’m just tuned out. So, it’s really important.

The other anecdote I mentioned was where communication, just using the right words, can make all the difference in the world. I had a friend named Sharon, and she noticed what she called a little blemish on her breast. She went to see a surgeon, Dr. Susan Heckman, who is one of my colleagues. Dr. Heckman evaluated this blemish, and it turned out to be nothing. But when she was examining the other breast, she found something that was suspicious. To condense the story, she eventually advised that Sharon have surgery.

Now, my friend Sharon is one of these very new-age people. She believes that cancer, like any other illness, can be solved by psychic energy. She’s saying to herself, “I think I’m going to go visit the health-food stores. I need to get on some healthy diet. Maybe I’ll have a consultation with Dr. Bernie Siegel, a seance with Deepak Chopra. Maybe I’ll do some fire walking with Tony Robbins or whatever.” So she’s thinking all this stuff and saying to herself, “I’m going to try this, and in two months, I’ll come back and see Dr. Heckman if it’s not working.”

As she’s leaving, something is puzzling her, and she turns to Dr. Heckman and says, “Well, Dr. Heckman, what was that blemish that brought me in here in the first place?”

Now, Dr. Heckman is an excellent surgeon, but she’s also someone who is really attuned to her patient. She could have said the usual stuff: “Well, this blemish was just an epithelial lesion of no significant import. It was just a pigmented nevus with no mitotic potential.” You know the drill. She could have said all that stuff, but she’s very intuitive. She had a feeling for what metaphysical ballpark Sharon was in. So she turned to Sharon and said, “Sharon, that blemish was your guardian angel giving you a wake-up call.”

When Sharon heard that, it changed everything. She knew that Dr. Heckman was listening to her and knew who she was. The next day, they did the surgery. It turned out to be cancer, but many years later, my friend Sharon is free of cancer. She’s cured now.

And so I asked the question in the article: did getting surgery two months earlier save Sharon’s life? Maybe it did, maybe it didn’t. I choose to believe that it did.

Then I think I closed the article by saying something like this: If there are any doubters, just ask Sharon’s angel, because Dr. Heckman was her angel. It was her communication skills, as much as her technical skills, that I believe saved my friend’s life.

Kevin Pho: Now, you were a neurologist, and when you were practicing, neurology obviously has a lot of technical terms and medical jargon. Whenever you were talking to patients and explaining things to their families, did you sometimes have to check yourself and make sure that you were explaining things in layman’s terms? Was it a conscious thing? How did you train yourself to do that?

Scott Abramson: Yes, it really is, because I think we all tend to talk in our own jargon. When you listen to other doctors talk, and when you tape yourself during one of these interviews, you’ll see, “My God, I can’t believe I spoke like that.” So it was a learning experience for me with constant practice and constant self-checking. After 40 years of practice, I think I did get a little better at it, but it’s so easy to slip into it.

Kevin Pho: Can this be taught? I know that you’ve done a lot of workshops, and there are varying degrees in terms of how good physicians are at communicating with patients and speaking in layman’s terms. How would you teach this to a group of physicians with varying degrees of comfort in doing this?

Scott Abramson: Yes. Well, I’ll tell you one of the ways we did it at Kaiser, and I’m so glad that Kaiser provided these resources. We would have these communication-intensive workshops. Sometimes we would do them offsite for two, three, or four days. Sometimes we would do them in the clinics themselves.

What we would do is hire actors. These actors are very skilled; they’ve been trained and know about medical situations. Then we would have physicians who, let’s say, had been struggling with their patient satisfaction scores or some who just wanted to get better. We’d have these interactions and tape the interaction between the physician and the actor-patient.

Then we would play it, ask for input from the small group of people, and ask for input from the physician who was doing the role-play. We’d ask, “How did you do?” and they’d say, “God, I thought I did pretty good. I thought I explained everything.” Then we’d ask the actor who was playing the patient, “How did it work?” They would say something like, “When you said ‘malfunction,’ I wasn’t sure what that meant, or when you said ‘intestinal obstruction,’ I didn’t exactly understand what you were talking about.”

So, they would get direct feedback. Then we would play the tape, and they could hear and see themselves. Getting that feedback from someone who is actually listening to them is really a matter of practice. With patient satisfaction surveys, they’re not going to call back and say, “Gee, doctor, I didn’t understand. You use big words. I don’t appreciate that.” They’re not going to say that because they don’t want to get their doctor angry, even though the surveys are anonymous. You’re not going to get feedback that way.

If you can self-correct by watching yourself, that is absolutely the best way for any of this communication training.

Kevin Pho: How about new physicians and medical students? They’re just starting out, and the best way to learn these things is from the very beginning so that these skills are learned for life. For these new physicians and medical students listening to you right now, what kind of tips do you have for them?

Scott Abramson: Well, we did that at Kaiser. We put every new physician through this training program. We call it the four habits, and we try to make them a habit: things like investing in the beginning, getting the patient’s perspective, making an empathic statement, and closing the visit effectively. Those are the four habits, and we teach those to the medical students. So, for instance, one of the habits is getting the patient’s perspective.

People think this is really about getting a good history: “How long have you had the pain? Does it go down below the knee or to the ankle?” No, that has nothing to do with it. It has to do with asking deeper questions. Of course, you’re going to ask the routine questions, but then you’re going to say something like, “Tell me, Mrs. Jones, I’ve heard about the problem, but what are you most worried about?”

“Well, doctor, I kind of didn’t want to say this, but I had this venereal disease when I was 20 years old. Could it be something related to that?” Or, “Gosh, doc, sometimes I think it might be an aneurysm, these headaches that everybody says are tension.”

If you can dig deeper and make that connection, you are not only making a connection, but instead of just treating a tension headache, you are giving somebody real relief. “Gee, I don’t have to worry about this anymore.”

I could go on and on about the teaching and the actual program that we teach, but that’s just a small example.

Kevin Pho: We’re talking to Scott Abramson; he’s a neurologist. Today’s KevinMD article is “How doctors’ words can make or break patient care.” Scott, as always, let’s end with some take-home messages that you would like to leave with the KevinMD audience.

Scott Abramson: Gotcha. The words we use are so important. I read this a little while ago in the San Francisco Chronicle. There were these two guys sleeping in a park in San Francisco. A cop comes up to them and says, “Where are you fellas from?” The fellas say, “Frisco.” The cop handcuffs them, takes them down to the station, and it turns out that they are escaped convicts from Colorado.

Now, this is kind of inside baseball, and your audience may not know this unless you’re from San Francisco, but how did the cop know to be suspicious enough to bring these guys to the station? He asked, “Where are you fellows from?” and they said, “Frisco.”

Here’s the thing: nobody from San Francisco calls it Frisco. Nobody. It’s like if you’re from New York and you say, “I’m from the Big Apple.” People would think you’re crazy. Or where are you from? Chicago? If someone says, “I’m from the windy city,” you know there’s something wrong. It’s like if someone were to ask you where you are from, and you said, “I’m from the Maple Leaf City” or something like that. The point is, whether we are escaped convicts from Colorado or we are health care clinicians, words have consequences. Words have consequences.

That’s my message.

Kevin Pho: Scott, as always, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.

Scott Abramson: All right, thank you, Kevin. I appreciate it.