Misinterpreting Words and Gestures in Medicine

Medscape

16 hours ago

This transcript has been edited for clarity.
Hello. I'm David Kerr, professor of cancer medicine at University of Oxford. Today I'd like to talk about words and gestures, and how we can communicate unconsciously with patients in ways where we can end up being misunderstood.
In the clinic on Friday, one of our patients, somebody we looked after for quite a long time, had evidence of oligometastatic recurrent colorectal cancer. By that, I mean the tumor had come back in three small spots within the peritoneal cavity. She's had multiple chemotherapies and we've done hepatic resections. We looked after her for 4.5 years with her metastatic disease and she's remained remarkably well, fully fit and active, and has been taking care of her young family and so on.
What we thought that we would do for her treatment would be to offer, with my specialist colleagues in Oxford, stereotactic body radiation therapy (SBRT). This is very highly focused radiotherapy — spot welding, if you like — that can be delivered, with fantastic accuracy, safely to small areas of disease. We had arranged for her to see one of my senior colleagues in Oxford.
The way that our NHS communicates with our patients is: A letter goes out saying, 'You have an appointment to see Professor Kerr and Dr Muirhead,' a fantastic radiotherapy colleague. Of course, our literate, clever patient looked up who Dr Muirhead was, and she saw the word "palliative" splashed across all the work that Rebecca does.
Immediately, because that word was used, she assumed that she'd come to the end of the road, that there was nothing effective that we could offer for her treatment. Quite the opposite was the case, but the use of the word "palliative," to her mind, meant palliative care, end of care, and imminent death.
For those of us who were somehow forced to do Latin to get into medical school, it comes from palliare, the Latin word for "to cloak" or "to hide." This was a word that was just utterly, completely misinterpreted, and the 2 weeks between receiving a letter and meeting me in a clinic had been the worst 2 weeks of the patient's life over the past 4.5 years. You can imagine the tears of joy when we explained exactly what it was we were going to do.
It reminded me of another time, when I was a very young doctor in Glasgow, a senior registrar in my mid-twenties. I had looked after a young woman about the same age as me with metastatic ovarian cancer, along with my boss, Stan Kaye, another fantastic oncologist.
We looked after her well and continually, but the disease caught up with her eventually. We were very active at that stage, one of the first centers in Europe to be involved in phase 1 trials with the National Cancer Institute. I wanted to explain that we could offer her a position in one of the phase 1 trials that we were doing, but of course, as a prelude to that, I had to explain that we had no more conventional treatment to offer.
I come from the west of Scotland. We're not a very naturally tactile group of male human beings, but I leaned over, held her hand, and explained the situation, thinking really nothing of that small gesture.
Later in her illness, as she did inch closer to death, we continued to look after her and to palliate — that word again. She said that the single scariest thing that she remembers of all the journey that we'd been over for all those years was when I held her hand, because she thought it must be very, very bad indeed for that young doctor to reach out, to hold her hand, and just to be gentle and kind.
Words and gestures need to be chosen carefully. But, clearly unconsciously, whether aware of it or not, we're sending subliminal messages out to our patients. We may not be able to control them, but it's interesting how patients can interpret and misinterpret what we see and sometimes do.
I'd be really interested in your own experiences, if you've come across anything even remotely similar.
As always, thanks for listening. For the time being, Medscapers, ahoy. Thank you.