We all know the language we use in various aspects of our life can have big impacts on the messages we are trying to convey. Certain words mixed with the body language to match, can convey anger, happiness, love, gratitude, or frustration. However, how much do we think about the subtle impacts of language on the messages we are trying to convey? Have you ever observed your friend, partner, son, or daughter act like a different person in the presence of different friendship groups? Yes, we all do it unconsciously, having an inbuilt radar to navigate social norms and expectations.
A few years ago, my workplace at the time - Kieser, invited a guest speaker to give a talk on the DiSC model of human behaviour. The premise of this model is that everyone is a blend of 1-3 styles – dominant, influential, conscientious, and steady. The key take home point that I have often reflected upon since, was that when you are trying to communicate with someone to convince them of a certain point, it is not your style that is important, it is theirs. Take for example, those type A personalities that would often fall into the ‘D’ category. They are often leaders; outgoing, ambitious, and competitive. The messages that they take on board are direct and to the point, delivered with confidence. Unlike an ‘I’ category who appreciates some small talk or banter, they do not like beating around the bush. Someone that falls into the ‘I’ category likes a bit of camaraderie, some preamble. They want to be asked how their weekend was. So, in the context of communication it does not matter what category I fall into, I need to adapt to suit the person I am talking to. After all, it does not matter what you know if you cannot communicate it.
Now in the context of health practitioners, what we say to patients can have massive impacts on the outcomes we are trying to achieve. Personality traits, such as those outlined in the DiSC model need to be taken into consideration. This can be inferred by a skilled practitioner during the patient’s history taking but it starts from the minute you greet them. This is because it is important to establish rapport with the patient. Clinicians understand this and so do patients. This is a whole topic in itself, which is very much supported by the research. But what is also important is the fact that what clinicians say can have a longer lasting impact than one might think.
One of the common things I say to patients is that ‘I will never tell you that you never be able to do X because of Y. ‘X’ can be running, swimming, playing golf – whatever the goal a patient has. ‘Y’ is the injury or condition that they are presenting with. Why do I never say this to patients? Because by telling someone they cannot do something because of Y, then often they will not be able to do it. The number of times that patients have come to me and said, I was told I would never do X again, is more than I can count. I have had cases where a patient says that they have been told they will never walk again or that they will be wheelchair bound by a certain age. This is not to say that the clinician did tell them that, or that the patient is lying. More so, it is that messages can be distorted at the time and over time as well. What we say as clinicians can have well-meaning intent but often, mean something quite different to the patient.
Barker, Reid and Lowe (2009) looked at exactly this, using focus groups, made up of people with and without a history of low back pain and various practitioners including physiotherapists, chiropractors, GPs and osteopaths. The words that they looked at are shown below. Matt Low surmised what they found in an excellent table that breaks down how these different words with similar intent, can have different impacts and meanings for the patient.
For example, the term ‘acute’ to a patient may mean localised to a particular area. To some it could mean quite mild pain while others thought the term meant more severe pain. On the other hand, health practitioners use the term to describe recent pain lasting less than six weeks. ‘Chronic’ pain can hold similar confusion, which I have described in my previous blog on pain. It is a term that often conjures up thoughts of enduring, high levels of pain, whereas the real definition of chronic is pain that lasts longer than three months. Another common example is when patients come to me saying that they were told it was ‘wear and tear’ in the joint, with the corresponding impression being that there is not much that can be done about it. Conversely this actually just happens as we get older but doesn't necessarily mean that you will have pain from it. Think of it as 'wrinkles on the inside.' I could go on with examples, similar things happening with words such as instability, out of alignment, disc bulge, slipped disc etc but you get the idea.
So next time, as a therapist, think twice about the words that you use. As a patient, I encourage you to speak up if you do not understand something or want to check that your understanding of what they meant, is indeed correct.
Barker, K., Reid, M., Minns Lowe C.J. (2009) Divided By A Common Language? A Qualitative Study Exploring The use Of Language By Health Professionals Treating Back Pain. BMC Musculoskeletal Disorders: 10, 1-10.