Health care professionals: watch your language

I recently saw a new OB-GYN for the first time. Overall, I liked her a lot. She was no-nonsense, but seemed personable, and she knew her stuff. During our visit, we discussed permanent birth control for me. I can’t take hormonal birth control any more, and the other available options either have the potential for failure or would not be a good choice, given my birth history. It would be extremely risky if I were to get pregnant again, and combined with my age, permanent birth control is the most logical choice.

At some point while I was providing her with information, I mentioned to my OB-GYN that I narrowly escaped having a hysterectomy after my postpartum hemorrhage. She remarked, “Well, if you had had a hysterectomy, it would have taken care of the birth control issue for you.” I know this is a logical conclusion that someone trained in science and surgery would come to, but common sense should dictate that you don’t actually say that to someone. My scarred, but intact uterus is a badge of honor. It means I did not lose more of myself that day than I already had. My uterus is still a meaningful and necessary part of my body and identity as a woman.

Although the procedure will be non-surgical (meaning that it does not require an incision) it still means a hospital procedure under sedation because of my insurer’s requirements. My OB-GYN was clued in enough to recommend a minimally invasive option since she knows my history was traumatic, but not clued enough in to watch her language when talking about it. There is the tendency by health care professionals to view body parts in terms of their function, and not how we emotionally associate them.

Today, I went for my first mammogram. The radiology tech that did my mammogram hefted my right breast in my hand and asked, “Do you have implants?” I joked that if I had, they’d look perkier. I added I was glad they didn’t droop after breastfeeding (because mothers do care about that.) She adjusted the mammography machine and replied, “Yeah and you only did it once, which was good.” Once again, a case of speaking and not thinking. I know she was trying to affirm that yes, breastfeeding had a minimal impact on my appearance. But for someone who can only have one child, the implied comment was that breastfeeding another child probably would have made them look bad, so it was better that I didn’t have more. It really would have been enough for her to stop at “yeah” or nod and then go image my breast.

Time and time again I find that many health care professionals make these offhand statements, unaware of how it might sound to their patients. Most doctors who truly have a great bedside manner seem to come by it naturally. Doctors are often too busy and two steps ahead in their head in terms of getting you through the appointment and getting you out the door. What comes out of their mouth is rarely what’s really on their mind.

When I am with my clients, I am exceedingly careful with what I do and don’t say. Many of them who come in for Reiki treatments or coaching sessions are dealing with physical or emotional issues, and may be in a lot of pain. I can’t diagnose, but I do have to respect what they are feeling is real and is valid for them. That often means being mindful of more subtle cues or information my clients provide. Some do need more affirmation or information, but sometimes saying too much is more than what a client needs at that moment.

I usually don’t take what someone says to me personally when I know the intentions aren’t malicious. Neither my OB-GYN nor the radiology tech was trying to hit a nerve. However, I do know many women who would be hurt or insulted to have received these kinds of comments. Occasionally, some health care professionals are jerks or are taking their bad day out on someone else, but the vast majority of them aren’t. They just aren’t hearing themselves.

Believe me, I’ve been on the receiving end of more of these kinds of offhand, insensitive comments from health care professionals than I can even recount. The worst was the neurosurgeon who treated me so callously when I was hospitalized 20 years ago for cervical spine neuropathy. He was smooth as butter until the tests indicated I had a congenital condition he didn’t have the opportunity to operate on. Suddenly had no interest in my situation. I still remember with great clarity when he walked into my hospital room, explained my situation, and shrugged. “You’re just going to have to learn how to live with the pain,” he told me, and walked back out.

What a doctor or other medical professional says can positively or negatively influence their patient’s state of mind or recovery. It’s time for medical professionals – doctors, nurses, techs, and so on – to receive more training in how to read a patient more closely and use supportive language. The chart only tells part of the story. There’s a time to be clinical, and there’s a time to be compassionate. Health care professionals should use language that reflects both of these aspects.

(Photo credit: comedy_nose on Flickr)

10 responses to “Health care professionals: watch your language”

  1. Wow. It really makes you feel like part of the system instead of a person, doesn’t it? I’ve heard horror stories, both when I was part of the medical system and now that I’m an “auxiliary healthcare professional.”

    Insensitivity about our “reproductive processes” seems to be the worst. For example, my PCP asked if I was going to have children at my physical when I was 33. I told her it was in the plan, but not immediately, and then she tapped her watch at me! Right, like that’s going to help me negotiate my ambivalence about making a major life change. I left angry, not motivated to go home and make a baby.

    Great post, as always!


    1. I don’t blame you for being angry about your PCP’s attitude. According to some comments I saw from women who read my post on FB, the most hurtful comments they received were by and large from female doctors. They were insulted about their weight, about their inability to conceive, and other areas of particular sensitivity to women.

  2. ohhh…that so strikes a chord…to this day, i wonder if my father might have recovered from his stroke if a very callous nurse hadn’t said to him, “mr. frazier, you’re never going to be any better than you are right now.” up to that point, he was feeling hopeful, according to family members who were with him as he managed to eat food again, even laugh…a few days later, he was in a coma…i think he gave up! health care professionals have a huge responsibility that is often overlooked…and this is a perfect example.

  3. I remember a woman PA who told me I was being vain when I asked about some clear bumps I had on my nose, along with a rough patch of skin. It wasn’t just what she said, but the tone and body language that went along with it. I felt awful for bothering her with my (for lack of a better word) image issues. It took me over 7 years to finally see someone else because all that time, I felt like asking was *stupid* and that I was *only* worried about my vanity.

    Turns out the bumps were just fibrous tissue that could be lasered off, but that rough patch of skin turned out to be basal cell carcinoma. By the time doc was done digging it out, the entire side side my nose was covered in stitches that look like a jagged lightening bolt.

    As the scar is still very new and I can’t help but see it every time I look in the mirror, I often find myself wondering if I would have been treated differently by that Physician’s Assistant, would I have sought different treatment sooner? Would the scar be smaller?

    Even asking that in my mind, I’m still reminded that I’m feeling vain and that makes me feel very small.

  4. As a consumer of health services, a birth professional and advocate – I too often have experienced comments that not only can be painful to the receiver emotionally but can also impact desire to attain future care or lessen positive outcomes because of lack of support, sensitivity, safety, real encouragement. I have said for years a woman is more than her uterus in the childbearing years. That she is a whole being physically, emotionally, spiritually with her own needs, desires, path. This statement can apply to any aspect of health care. We are PEOPLE not statistics, body parts or any sub grouping. As a labor support person I help women and her partner advocate for themselves and their baby. They are PEOPLE. Saying to someone “you get no badge of honor for a desired natural birth” is wrong, to say “Oh well I didn’t think you could birth ANYWAY, you are just so small.(on the way to the OR)” Is a devastation on many women leaving a wake of brokenness, tears, fear and anger that she will bring into her mothering, wifing, partnering, etc. Our words MATTER. Encouragement should never be a back handed insult, blaming the listener, or look at the bright side like in Dana’s writing that a hysterectomy would have been that permanent birth control. REALLY how about oh you already have three kids, why would you want more or it is God’s way to a mother who has had a pregnancy loss. Our words count. Words CAN and DO deep harm not like the proverbial sticks and stones line says. If you as a health care provider is not willing to listen, observe and not just speak at your patients, perhaps research is your true calling. Health care providers you have more power than you know in your words, I beg of you not to use them flippantly as weapons of deep destruction. Use them to HEAL, isn’t that the basic premise of your work? If you wouldn’t say it to your best friend, mother, sister, loved one… do not say it to a patient. Who is a PERSON.

    1. “If you as a health care provider is not willing to listen, observe and not just speak at your patients, perhaps research is your true calling.”

      I second this.

  5. When I had my very first pap smear and exam- during my first pregnancy- I didn’t know the doctor and was scared to death anyway. As he was putting on the gloves, he asked me what I was hoping for. I told him as long as the baby was healthy I didn’t care, but that I just had a feeling it was a boy. As he snapped the glove on his hand, he looked me in the face, from between my legs, smiled and said ” I like little boys- and big girls.” I was so mortified that all I could do was lay there and try not to cry. I have never been able to go to another male doctor since then. I’ve had a lot of doctors make a lot of insensitve remarks to me- pregnancy related or not- but that one set the tone for major trust issues when it comes to medical care, for me.

  6. Words are so powerful. They can heal, and they can harm, and they can show us what is wanting to be seen, felt, and cared for. I find that the words that are most hurtful are the ones that speak to–or poke at–something that is unhealed in me, or something that is unhealed in the speaker, or both.

    As a nurse, doula, yoga teacher, songwriter, a woman who experienced a traumatic surgical birth, and the mother of a baby who spent a month in the NICU, I have seen the many ways that words can heal and hurt. Especially in the wild world that is healthcare. My son’s primary nurse at Egleston was an amazing example of the healing power a nurse can exact with her words. She helped me to find my mothering instincts when my son was connected to endless tubes and lines. She reminded me that these were the first days of my mothering, and encouraged me to rest, to eat well, to drink well, and to enjoy the little things like changing diapers. She expressed kindness and love to Teo and our whole family, taking photos and bringing her own family in to meet us. The photo album she created of those first weeks will be cherished forever. On the other hand, there was a nurse who I had to “fire” at Egleston because of the way she spoke to me, saying that she was going to throw out my breastmilk because there was too much of it. Under the best circumstances, words can hurt, but under duress, words can cause undue stress and wreak havoc on a precarious balance. In my case, I was recovering from a Csection, sleeping on a chair, hunching over my intubated child all day, and getting up every 3 hours to pump. I was wrecked physically and emotionally, and doing the very best I could to keep it together. The idea of throwing out that milk, the only thing I could directly do for my child–it was too much.

    Another nurse whose words made a huge impact on me is a friend/yoga student who is also a lactation specialist. She came over about 6 weeks after Teo’s birth, when I was still struggling with breastfeeding. He had just pulled his NG tube out the night before, and we were having our very first successful day keeping all feedings down. She took one look at my house, which was littered with medical supplies, and encouraged me to put away everything that reminded me of the hospital. To spend at least 3 days skin to skin with my tiny baby, pretend like he was just born, don’t cook, don’t have any visitors, just rest and eat and drink and breastfeed. It was a huge turning point. I thought I needed more lactation advice, more professional input, but what I needed was to sink into being Teo’s mom and caring for him from that place, rather than fear. Her words are forever etched in my memory.

    I could tell many stories of poorly-chosen words spoken to birthing women, but the ones that really stick with me are of course the ones that were spoken to me by my own trusted midwives and nurses. The one who said, “You can’t have a baby with your pants on” when I chose to keep them on upon initial arrival in triage. Later, when the decision to head back to the OR had been made, she said, “Guess you have to take your pants off now!”. Another nurse kept repeating the words “brain damage” like a mantra, thinking that I was being noncompliant when I took a moment to process what was happening. My midwife had entered the scene after decisions had already been made, and would not weigh in on them at all. She just said “they want you to have a csection” and dropped the strip on the pillow below my face. Later, she had an argument with the nurse over me–while freshly in recovery from the surgery. I have some other unwavering resentment against this midwife because she never once checked in with me again. And the next day, the other midwife in the practice stood against the back wall of my room, with arms crossed over her chest, and said, “how far did ya get?”. Meaning, how many centimeters before going in for surgery. Then she said “well, you have a 60-80% chance of having a vaginal birth in the future” and walked out as if she didn’t want to catch the csection cooties. Lastly, the doctor who performed the csection was someone I had never met. He was callously chatting about the smell of bacterial vaginosis while delivering my child. Yup. That kind of thing tends to stick with you.

    With time and the healing I have done since then, I can really see where all of these words came from. I can imagine that those nurses, who were experienced, had seen some bad outcomes in their time. They were in emergency mode, and only meant to direct the energy toward saving my baby’s life. Survival and wellness are two different things, but you’ve got to survive in order to get well, so I am unspeakably grateful for the healthcare providers who saved Teo’s life. The midwife at the birth probably had her hands tied in terms of liability, and the midwife on the second day was probably making a (sloppy) effort to plant the seed that VBAC is an option. The doctor was making small talk to lessen the tension in the OR. I have heard worse in the OR, for sure, and once again, he saved my baby’s life. I’ll also give him credit for a very neat scar 🙂 In the moment, I couldn’t say any of this because I was so very scared and vulnerable. I have processed all of this a lot, as you might imagine. I wonder, however, if they have, if they make it a priority to keep looking inward, to keep healing the past to maximize the potential that they have to do good for their patients. Or maybe they think it is enough to provide the path to survival.

    That is really the core of this discussion. Healthcare is generally aimed at survival–and it should be said that it is amazingly powerful in that arena. How many of us would never have the chance to have this discussion without it? Some members of this field are willing and able to go beyond survival, and to bring compassion, mindfulness, respect, self-regulation, forgiveness, and love to their work. Some are not. Some simply do not. For whatever reason.

    I personally am committed to cultivating and maintaining peaceful and healing communication in my personal life and professional life. It takes work, and I am not always successful. Part of the work is cultivating understanding and compassion for others who are successful less often. Wish me luck!

  7. All I can say is WOW!!! If anyone has done any research on the placebo effect, they will clearly know the power of words. We are humans capable of logic and reason and, we have feelings! What make the situation that much more damaging is that fact that health care workers are seen as authority figures which actually induces a light state of hypnosis. To make a long store short, they speak it into our reality.
    There is something to be said about education and there is also something very powerful about positiveness. In my childbirth class, we focus on the power of our own minds (using hypnosis) and also the power of words. Words are so powerful and sometimes we do not even realize to what depths. Dana, I’m so sorry you went through this and so thankful that you were in the frame of mind to dismiss these comments.

  8. Working in the childbirth community for a couple years I have seen WAY too much of this, not only from OB/GYN’s but from other professionals in the field.

    Language is a big thing, it can make or break the relationship with a provider. There is no superiority because you may have M.D. after your name… we are all still human. Women while pregnant and giving birth are the MOST vulnerable they will ever be… treat them with the nurturing they NEED, not like just another number.

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