Something I always try to personally remind myself when seeing a patient, is how important the use of my language and terminology is in providing them a safe, informative and hopefully, comfortable environment. I think it is fair to say that a large percentage of patient’s withhold some level of apprehension when attending a medical appointment, particularly that first meeting. For me, that first time with a patient is as much about building a strong and trustworthy relationship as it is providing a treatment plan or diagnosis. I am sure each and every medical professional has had those appointments where the time is up and nothing ‘objective’ or ‘physical’ has taken place. Instead, the time has been taken up by conversation, or possibly even one way conversation where the professional’s role has simply been to listen rather than talk. For me, this is still active treatment and often, very beneficial to the patient. On more than one occasion I have been glad to receive an email or contact from a patient with whom this has been the case, where they have simply said ‘thank you’ for giving them the time to tell their story and share their beliefs.

An interesting stat that I have always remembered is that 40-80% of medical information provided by healthcare practitioners is forgotten immediately. The greater the amount of information presented, the lower the proportion correctly recalled and furthermore, almost half of the information that is remembered is incorrect (Kessels 2003)(3). This amplifies the importance of trying to keep terminology simple and keep focus on the most relevant information for that patient. From personal experience, it is more often than not, also the negative information or language used by a health professional that the patient clings to and remembers. Linskins et. al (2023) (2) carried out a randomised control trial on the effects of negative language use of physiotherapists in the treatment of lower back pain. To no surprise, the findings were that the use of negative language heightened a patient’s state of anxiety, with higher rates of belief and concerns that their condition would last for longer. This is not to say we should be unrealistic in what a patient’s possible prognosis may be, however it is definitely an indicator that how we relay that information is key in how they may perceive their recovery or long term management of a condition. I personally always like to ensure a patient leaves their appointment having completed something ‘pain free’ or that they didn’t believe they could actually do prior to that session. It gives a great base for positive reinforcement and the use of positive language, hopefully giving them something to work with and focus on going forwards.

Through my own career to date I have been lucky enough to work with some fantastic doctors and physiotherapists and it is from these, that I believe I have been able to do my best in attempting to maximise my interpersonal and communication skills when face to face with a patient. I was recently asked by a physiotherapy student, what key pieces of advice I would give for taking an effective subjective assessment. My response was based round the following points:

• Let the patient lead the conversation
• Do not interrupt the patient when they are speaking – no matter if the clock is ticking
• Make eye contact with them, not constant eye contact with your computer screen
• Emphasise you are here as a tool for them, not as a solution – give the patient some self importance and responsibility
• Do not make the patient feel hurried
• Use simple terminology
• address the negatives, but focus on the positives

Franx and Murphy (2018) (1) summarise the importance of language in a medical setting nicely. They state that ‘listening consists of following the lead of language, often along many strange paths, until a proper understanding is reached. In this way, a patient’s true background is opened that is required for an effective intervention.’

Reference List

• Franz, B. and Murphy, J.W. (2018). Reconsidering the role of language in medicine. Philosophy, Ethics, and Humanities in Medicine, 13(1). doi:https://doi.org/10.1186/s13010-018-0058-z.

• Fieke) Linskens, F.G., van der Scheer, E.S., Stortenbeker, I., Das, E., Staal, J.B. and van Lankveld, W. (2023). Negative language use of the physiotherapist in low back pain education impacts anxiety and illness beliefs: A randomised controlled trial in healthy respondents. Patient Education and Counseling, 110, p.107649. doi:https://doi.org/10.1016/j.pec.2023.107649.

• Kessels, R.P.C. (2003). Patients’ memory for medical information. Journal of the Royal Society of Medicine, [online] 96(5), pp.219–22. doi:https://doi.org/10.1258/jrsm.96.5.219.