There’s power in word placement

Have you ever noticed that two people can hear the same words and have very different interpretations of what was said? We respond to our world on the basis of our experience and our expectations, so it is not uncommon that our patients “hear” very different things than we actually said. Sometimes just the intonation of a word can completely change its meaning (consider the difference in meaning between saying “right” vs. adding a sarcastic intonation and saying the same word).

Yet another important way in which our brains interpret words is based on their placement in a sentence. We are wise to make use of this powerful fact and design statements that deliver information so patients will interpret it in helpful ways. One consideration is to place the most important items first and last when presenting patients with a long list of information. We all remember the first and last (especially the last) thing that we are told better than what comes in between. A second tool is to use “turning words,” such as but and however. These words essentially negate whatever information came before them in a sentence. For instance, when telling patients about symptoms that might arise after a procedure, it’s best to state the possibility of symptoms first, add a turning word, and follow it with the appropriate reassurance. For example:

You may experience discomfort for a few hours or develop a fever, rash, or swelling for a day or two, BUT most patients do just fine.

As Thomson and Khan discuss in Magic in Practice, doctors “often report an increase in unnecessary calls or visits by worried patients” when the order is reversed.

So, in explaining the risks and benefits of a procedure, providing information about potential complications after surgery, or simply educating our patients about their condition, we can use word placement to our advantage – to emphasize what’s important and helpful, while putting the other information in proper perspective. In this way, we can improve the likelihood that our patients actually hear what we want them to and reduce the chance that they will experience unnecessary anxiety or distress.

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About Helane Fronek

Over the past 28 years I have had a fascinating and fulfilling career in medicine, initially practicing as a general internist and then as a procedural specialist, caring for patients with vein disorders. As Assistant Clinical Professor of Medicine at UC- San Diego School of Medicine, I’m thrilled to be teaching medical students crucial communication skills along with many other aspects involved in the practice of medicine.
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