Subtle word choices can significantly impact patient-clinician communication, study finds
New research highlights how small changes in clinicians’ language can affect patient outcomes, from diagnostic accuracy to treatment adherence.
The art of patient communication has long been recognised as a crucial element of effective healthcare. Now, a comprehensive review published in JAMA [1] has shed light on how subtle variations in clinicians’ word choices can have far-reaching effects on patient encounters and outcomes. The study, conducted by Jeffrey D. Robinson, PhD, and Douglas J. Opel, MD, MPH, offers insights into the power of language in medical settings and provides practical recommendations for healthcare professionals.
The impact of open-ended questions
One of the key findings of the study relates to the way clinicians solicit patients’ concerns. The researchers found that task-focused, open-ended ‘Wh-questions’ (e.g., “What can I do for you today?”) resulted in significantly longer problem presentations from patients, averaging 27 seconds compared to just 12 seconds when clinicians used requests for confirmation (e.g., “Sounds like you’re uncomfortable?”).
Dr Robinson and Dr Opel note that these longer presentations often included more discrete symptoms and led to higher patient satisfaction with clinicians. Interestingly, the study advises against using the seemingly open-ended question “How are you?”, as it is not always understood as a medical query and can result in shorter problem presentations.
Setting the agenda
Another crucial aspect of patient-clinician communication highlighted in the study is agenda setting. The researchers found that most patients bring more than one concern to primary care visits, yet only 18% of clinicians’ agenda-setting questions appeared early in visits, with a mere 2% positioned immediately after patients’ problem presentation.
The study emphasises the importance of early agenda setting, recommending that clinicians engage in this process immediately after the initial problem presentation. This approach can help address patients’ additional concerns more effectively and prevent them from emerging late in the visit, which can compromise how well they are addressed, if at all.
The power of “something” over “anything”
In a particularly intriguing finding, the researchers discovered that subtle differences in wording can significantly change outcomes when soliciting patients’ concerns. An experimental study involving 224 patients and 20 primary care clinicians found that asking “Is there something else you want to address in the visit today?” was significantly more likely to elicit unmet concerns compared to asking “Is there anything else you want to address in the visit today?”
The “something”-formatted question resulted in 90.3% of patients giving an affirmative response, compared to just 53.1% for the “anything”-formatted question. The researchers explain that linguistically, the word “some” subtly sets expectations for “Yes”-type answers, whereas “any” sets expectations for “No” answers, biasing responses in those directions.
Explaining diagnoses
The study also found that the way clinicians present diagnoses can affect patient responses. Patients of clinicians who explained the evidence for their diagnoses (e.g., “I can feel the pulse in your foot, so there’s no circulation problem”) had longer responses to diagnostic statements and responded with more agency compared to patients of clinicians who asserted “bare” diagnoses (e.g., “You have an ear infection”).
This increased agency, in the form of communicative participation during visits, was associated with enhanced patient satisfaction and reduced feelings of hopelessness, particularly in the context of serious diagnoses such as breast cancer.
The presumptive approach to interventions
Perhaps one of the most surprising findings of the study relates to the presentation of interventions, particularly in the context of vaccinations. The researchers found that in certain clinical situations, close-ended statements are more effective than open-ended ones.
In a cross-sectional study of 111 recorded health supervision visits, 74% of parents verbally agreed to recommended vaccines for their children when clinicians used a presumptive, close-ended statement (e.g., “Sara is due for 3 shots today”). In contrast, only 4% agreed when clinicians used a more collaborative-seeming and participatory open-ended statement (e.g., “What would you like to do about Sara’s shots today?”).
The study suggests that the presumptive format sets vaccination as the default, leveraging cognitive biases that make it difficult to reverse a decision that appears to have already been made. However, the authors caution that this approach should be limited to scenarios where there is a high degree of certainty that interventions are of low risk and high benefit, to avoid potential conflicts with patient-centred care principles.
Conclusion
The study concludes by emphasising that simple changes to word choice can significantly improve diagnosis, patient satisfaction, and adherence to recommendations. By using task-focused Wh-questions, early agenda setting with a “something else” question, explanation of evidence behind diagnoses, and appropriate use of presumptive vs participatory formats, clinicians can enhance the effectiveness of their patient interactions.
Reference:
- Robinson, J. D., & Opel, D. J. (2024). Word Choice and the Patient Encounter. JAMA. Advance online publication. https://doi.org/10.1001/jama.2024.15857
