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’s not uncommon that our patients “hear” very different things than we actually said. One common way in which we all affect the interpretation of what we say is by varying the intonation of a word – for example, consider the difference in meaning between saying “right” as a way of agreeing 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 it will be interpreted in more helpful ways by our patients. One simple technique for using this is to place the most important items first and last when giving patients 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, followed by the appropriate reassurance. For example:

Some patients experience discomfort for a few hours and others have developed 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 or a new medication, 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 reduce the chance that our patients will experience unnecessary anxiety or distress and improve the likelihood that they will hear what we feel is most important.