Clinicians rarely use words such as “death” or “dying,” instead relying mostly on medical jargon during family meetings regarding critically ill pediatric patients, according to a group of researchers.1
Investigators examined how death was discussed during 33 family meetings between clinicians and parents of critically ill infants regarding prognosis and the possibility of life-sustaining treatment. Clinicians used the words “die,” “death,” “dying,” or “stillborn” only 5% of the time. Family members used these words 15% of the time.
Family most often used colloquialisms, such as “pass away” and “not live.” Clinicians used mostly medical jargon, such as “code event” or “irrecoverable heart rate drop.”
“While this study sheds light on how death is discussed in current clinical practice, it cannot speak to parent preferences for how death ought to be discussed,” says Monica Lemmon, MD, one of the study’s authors and medical director of the Children’s Clinical Research Unit at Duke University.
Physicians often lapse into “medical speak” when discussing topics with patients.
“This starts from very early in training. The reasons for this are complex and not necessarily malign,” says Philip M. Rosoff, MD, MA, professor emeritus of pediatrics and medicine at Duke University.
As medical students and young physicians become comfortable with medical terminology, they find the precision offers an ease of communication with colleagues. “Unfortunately, they forget that patients usually lack this fluency, and then talk past or over the heads of their patients,” Rosoff notes.
Patients do not always speak up to say they do not understand. This leads to poor communication. “This is very common in informed consent discussions, both in the clinical and research settings,” Rosoff says.
When the topic under discussion is emotionally fraught, as with suffering and death, physicians might feel uncomfortable using direct, simple language. Some resort to euphemisms, such as “passing” as a substitute for “death.”
“Doctors may even avoid the topic altogether and focus on mostly irrelevant data,” Rosoff adds.
In the ICU, clinicians might fall back on discussing machine settings or drug doses rather than the fact the patient is dying. “The ethical concerns of communication failures or miscommunication are significant,” Rosoff warns.
Patients and families may lack vital information needed to make important decisions. Thus, people are shocked when a predictable outcome occurs for which they were totally unprepared. “Clinicians have an ethical obligation to guide patients through informed decision-making, including situations in which death is a reality,” Rosoff advises.
Ethicists can help clinicians be mindful of these issues. During family meetings, ethicists can gently clarify language to ensure everyone understands. Even the best communicators will encounter patients and families who will not or cannot hear the words spoken to them, especially if it is bad news. “But that’s no excuse for resorting to technical jargon to avoid difficult conversations,” Rosoff says.
REFERENCE
1. Barlet MH, Barks MC, Ubel PA, et al. Characterizing the language used to discuss death in family meetings for critically ill infants. JAMA Netw Open 2022;5:e2233722.
During family meetings, ethicists can gently clarify language to ensure everyone understands. Even the best communicators will encounter patients and families who will not or cannot hear the words spoken to them, especially if it is bad news.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content. TESTING
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content