The power of a doctor’s choice of words in explaining CPR

Words have power. Language has power.

The words we use may comfort or shock, allay or provoke, sooth or batter. Words often imply layers of meaning that are not explicitly articulated, yet rest beneath the surface:

“I worry that time is short for you” (You are dying) (I care about you)

“I wish we could have done more” (Nothing would have changed her death) (I am on your side)

“I hope with you that you’ll get better, but I think we should prepare in case things don’t go as we hope” (You are not getting better) (I support your hope)

I can think of no situation in which there is greater variation in how our choice of words varies than how we explain cardiopulmonary resuscitation (CPR). Many people, including me, vary the language we use depending on our recommendation for treatment. Some use more drastic language than others. Here are some examples I have encountered, again with possible implied meanings in parentheses:

“Would you like us to restart your heart if it stopped beating?” (Please say yes) (I’m just asking as a formality)

“Would you like to allow us to let you to die naturally?” (Saying no goes against nature) (We have an unnatural power over life and death)

“Would you like us, in what would naturally be your final moments, to press on your chest and break your ribs, shove a tube down your throat and poke you with needles in lots of places in a chaotic attempt that has a very small chance of giving you more time to be technically alive but unlikely to ever return to meaningful communication with others?” (Please say no) (CPR is horrific) (I don’t want to have to do this to you)

“Do not punctuate the end of your life with a senseless act of brutality!” (You’re crazy if you say you want CPR)

Using persuasion to argue for something we believe is in a patient’s best interest is ethically permissible. Coercion – the use of force or threats – is not. Guy Micco, a physician ethicist in the East Bay, talked with a philosopher who preferred the terms “influence” and “undue influence.” “Influence” is, of course, permissible – the line not to cross is the “undue” one.

Where do you see the line with these statements? What language do you use? Do you find yourself varying the language you use based on your recommendation for or against CPR? Does “unbiased” language exist?

Alex Smith is an Assistant Professor of Medicine, Department of Medicine, Division of Geriatrics at the University of California, San Francisco who blogs at GeriPal.

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  • http://drpullen.com Ed Pullen

    Nice example of the influence, hopefully not undue, that we have in many aspects of our treatment of patients. PSA testing: Do you want a test that can diagnose prostate cancer at an early stage? ( of course you do) or Do you want a test that may find you have prostate cancer but has not been shown to improve your quality of life or extend your life, rather may just tell you that you have cancer, and may lead to treatment that will likely make you impotent. (why would you want this?) I agree words have power, and the ones we choose in far less emotional choices that these have great influence on our patients.

  • Dockj

    Anyone who says that classical rhetoric is lost has not been anywhere near a hospital ICU. Ethos. Pathos. Logos. We influence decisions, regardless of how pure we think our presentation of the options are.

  • http://www.realicu.com www.realicu.com

    The words we chose when asking the question about the code status could have a significant impact on the patient’s response. Sometimes, I am trying to “direct” the patient to an answer which seems most appropriate. Is it ethical or not? I think it is our responsibility to help the patient make that disicion.

  • LJT

    >>“Would you like us to restart your heart if it stopped beating?” (Please say yes) (I’m just asking as a formality)>>

    I’ve never been asked this question, even when I had a minor surgery a few years ago. I spoke up for myself when it wasn’t asked and said: no.

    I could tell this really bothered my physician. I’m young. But I know what exactly what the alternative to DNR means, and I know that’s not what I want. It also bothered me that an assumption was made by my physician simply because I’m young and reasonably healthy.

  • http://www.AncientArtsWellness.com Janice Campbell MAc, LAc, ADS

    I am a licensed acupuncturist and a graduate of the Master’s program at the Tai Sophia Institute (www.tai.edu) where we were taught that “words are needles”. A poetic phrase, and yet, it’s true. What we say and how we say it can affect someone quite strongly on a physical level – raising blood pressure, releasing hormones, affecting homeostasis. And we were taught to use words first and then physical needles to move energy and promote health.

    It’s wonderful to hear folks in traditional western medicine talking about this too. There has actually been a partnership between the Tai Sophia Institute and the University of Pennsylvania’s medical school to teach just these skills to their med students. (I believe it’s an elective at this point.)

    We are all treating the whole person. It’s impossible not to. That’s why I prefer the term “complementary” rather than “alternative”. The more we can share knowledge and learn from each other, the better off we’ll all be.

    Thank you for this discussion.

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