I remember going over the anesthesia plan with the family of a 10-year-old boy who needed an emergency appendectomy. After getting the room ready (this is before midazolam), when I went to get the child I noticed that he was almost in hysterics – not the usual reaction in this easy-to-work-with age group. I stopped to explore what the problem was and what came to light was that the child had been told by a family member that he was going to be put to sleep. That is what had happened to his pet dog that he never saw again. So no wonder he was upset! After explaining the differences and allowing his granddad to accompany him into the O.R., the induction went smoothly.
Words do matter. The English language may be the second most spoken (Mandarin being number one) but is number one as the official language of most countries. There are more Chinese learning to speak English than there are people in the United States.1 Why is English so popular? In part it has been the rise of the English Empire and then the transition of the United States to a superpower. However, it is also because English is an ecumenical language – freely taking words from many other languages – and it’s relatively simple. We don’t have the language police to keep it “pure” like the French. English has a richness of its vocabulary that enables many shades of distinction unavailable to non-English speakers.
So with all these choices, how do we choose our words? Dr. Frank Luntz, in his book Words that Work, aptly describes that it’s not what you say, it’s what people hear.2 He describes 10 Rules for Effective Language:
1) Simplicity: Use small words. This may not help you win an essay contest, but it will make you easier to understand for your average patient. You don’t tell your patient that you are going to give him an anticoagulant – you say “blood thinner.”
2) Brevity: Use short sentences. I have had to write patient brochures in the past and it is recommended that the writing be at the 6th grade level. This is one way to get it down – don’t use compound or complex sentences, use bullet points. And sometimes pictures are best. The old saying, a picture is worth a thousand words, is especially true in health care communications. An example of this can be found in Winston Churchill’s famous speech: “We shall not flag or fail. We shall go on to the end ... We shall never surrender.”
3) Credibility: Don’t overpromise or be afraid to say “I don’t know.” Being honest with folks, even if it isn’t what they want to hear, will in the long run improve communication. We may not be able to guarantee 100 percent that a patient won’t have nausea or pain after surgery, but we can explain what we are going to do to reach that goal and the fall-back plan, if needed.
4) Consistency matters: Successful politicians use this in their stump speeches. Those who don’t are the “flip-floppers.” Helping patients understand what is going to happen to them requires a consistent message from the entire health care team of anesthesiologists, surgeons, nurses, etc.
5) Novelty: Old words used in new ways can catch one’s attention. One of the recent acronyms coined is “DREAMers”, which stands for Development, Relief, and Education for Alien Minors (DREAM) Act. These are the children who came illegally into the country before the age of 16.
6) Sounds and texture matter: Great speech writers use these techniques by having a series of three with the same sound, first letter or cadence. Once again quoting Churchill: “Success is not final, failure is not fatal: it is the courage to continue that counts.”
7) Speak aspirationally: I think this is one of the most important rules because it takes advantage of the emotional part of our brain. Words such as “dream” and “hope” are commonly used in political speeches. Whether beating the Russians to the moon or the 100,000 lives campaign by the Institute for Healthcare Improvement, we like a challenge that inspires us to be better and do better. The Army slogan “Be all that you can be” is a great example of aspirational messaging.
8) Visualize: Use words that create a picture, the most powerful being “imagine.” This word encourages us to personalize a message with our own reality. Props can also be effectively used, such as holding up the entire Affordable Care Act along with all of its circuitous references. This visual illustrates how massive and complex this legislation really is.
9) Ask a question: Just like a schoolteacher, sometimes this is the best way to engage an audience. We automatically sit up and pay attention. This is the chief form of communicating with our patients – asking open-ended questions such as “How are you feeling today?” In political speeches, they are usually rhetorical – an answer out loud is not expected, but we are usually answering the question in our head, such as when Ronald Reagan asked, “Are you better off now than you were four years ago?” That said it all.
10) Explain relevance: How does this impact me in my daily life? This is where research can be helpful with focus groups, which finally leads me to some recent research ASA has done.
After interviewing more than 2,663 individuals, the following conclusions were gathered:
• There is a lack of understanding of what an anesthesiologist (not a simple word) is and does.
• There is a lack of understanding of what differentiates us from a nurse.
• Quality of care is more important than reduction in cost.
• In a medical emergency, people want a physician, not a nurse.
A recommendation that has come from this research is that we refer to ourselves as “physician anesthesiologists.” You might say that is redundant, since it should be implied in the term, “anesthesiologist.” However, there is clearly a lack of understanding by the lay public. If we want to distinguish ourselves from nurse anesthetists, we need to use the term “physician anesthesiologist.” After all, that is how we all started – we are physicians first before becoming specialized in anesthesiology. We are especially valued in the context of a medical emergency – this is where relevance is important. When the situation goes south in the O.R., the public wants us to be there at the helm. This is the impetus for the “When Seconds Count” campaign, which you can learn about on the ASA website where I urge you to find out more. https://www.asahq.org/Home-Page/ASA-News-and-Alerts/Whats-New/When-Seconds-Count.aspx
Mary Dale Peterson, M.D., MSHCA is CEO, Driscoll Children’s Health Plan and Vice President, Driscoll Children’s Health System; and Staff Pediatric Anesthesiologist, Driscoll Children’s Hospital, and Clinical Adjunct Associate Professor, University of Texas Medical Branch (UTMB), Corpus Christi.
1. Bryson, Bill. Mother Tongue. New York: Avon Books, 1990.
2. Lutz, Frank. Words that Work: It’s not What You Say, It’s What People Hear. New York: Harper Collins, 2007.