PHYSICIANS COMMUNICATING WITHOUT HARM

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When someone is seriously ill, the emotional toll on both patients and their families is heavy—sometimes just as heavy as the physical burden. Researchers, including a Texas A&M professor, say that how doctors talk to patients matters as much as what treatments they offer. They argue that “compassionate communication” should be a standard part of care, not an afterthought. They’ve even created a list of “never words”—things clinicians should never say—and offer ways to replace them with language that supports rather than scares.

A recent paper in Mayo Clinic Proceedings, co-authored by Dr. Leonard Berry from Texas A&M’s Mays Business School and colleagues from Henry Ford Health in Detroit, points out that even as medicine advances for diseases like cancer and advanced heart or lung failure, some things never change. Fear, confusion, and hope—sometimes unrealistic—are always part of the patient experience. Trying to explain complex treatments or set realistic expectations often runs into these timeless emotions.

The researchers note that high-stakes conversations can overwhelm doctors, too. It’s easy for them to fall back on old habits or blunt statements, but even a single poorly chosen word can frighten patients, leave families feeling powerless, and shut down honest discussion. “Because seriously ill patients and their families are understandably frightened, they ‘hang’ on every word their doctor will say,” says Berry, a senior fellow at the Institute for Healthcare Improvement. “A doctor’s words—every bit as much as their actions—can make emotional suffering worse or help ease it.”

The Wrong Words at the Worst Times

Berry and his colleagues say doctors sometimes use language that’s needlessly harsh or final. That can leave patients and families feeling unsafe—afraid to ask questions, or to share their actual worries about the care ahead. Using “never words” can have precisely that effect, sometimes without the clinician even realizing it.

So what are these “never words”? According to surveys, they include phrases like:

• “There is nothing else we can do.”

• “She will not get better.”

• “Withdrawing care.”

• “Circling the drain.”

• “Do you want us to do everything?”

• “Fight” or “battle.”

• “I don’t know why you waited so long to come in.”

• “What were your other doctors doing/thinking?”

In cancer care settings, some additional examples came up, like:

• “Let’s not worry about that now.”

• “You are lucky it’s only stage 2.”

• “You failed chemo.”

The problem with these phrases? They can feel dismissive, judgmental, or even cruel. “Let’s not worry about that now” doesn’t address a patient’s genuine concern. Telling someone they’re “lucky” to have only stage 2 cancer assumes they should be grateful, ignoring their anxiety. And nobody “fails” chemo—sometimes the treatment simply doesn’t work.

Better Ways to Communicate

The researchers say doctors can do better by inviting honest questions and keeping the conversation open. Even changing a question from “Do you have any questions?” to “What questions do you have for me?” can make a difference—it signals that questions are expected and welcome.

For every “never word,” there’s a better alternative. Instead of “She will not get better,” a doctor might say, “I’m worried she won’t get better,” which acknowledges uncertainty and shows concern without sounding final. Avoiding “fight” or “battle” metaphors can help, too; saying “We’ll face this illness together” reminds patients they aren’t alone.

Raising Awareness and Improving Training

The authors argue that medical schools and health care systems should prioritize communication training, rather than solely focusing on the science of medicine. Having skilled, patient-centered communicators as mentors during clinical training makes a huge difference for new doctors. Mentorship is key—experienced clinicians can teach others which phrases to avoid, how to walk back language that lands poorly, and how to model conversations that empower patients instead of shutting them down.

In the end, improving communication isn’t just about avoiding the wrong words. It’s about building trust, reducing emotional suffering, and helping patients and families feel safe enough to ask questions and make hard decisions together.

Dr. Leonard Berry’s co-authors on the study are Dr. Rana Lee Adawi Awdish, a critical care physician and medical director of care experience at Henry Ford Health, and Dr. Gillian Grafton, a specialist in advanced heart failure and transplant cardiology at Henry Ford Health.

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