Authors identified specific words and phrases physicians should avoid when communicating with seriously ill patients, according to a perspective published in Mayo Clinic Proceedings. The clinicians defined these "never-words" as single words or phrases that not only lack benefit but also may cause emotional harm and accentuate power differences in clinical contexts.
The perspective found commonly used clinical phrases such as "there is nothing else we can do," "withdrawing care," and "do you want us to do everything?" can disempower patients and impede shared decision-making. The authors provided specific alternatives for each identified "never-word," emphasizing that avoiding these terms is more than semantics—it enables collaborative, values-based decision-making between clinicians and patients.
Evidence-Based Communication Models
The perspective examined three validated communication frameworks: Cleveland Clinic's REDE model (Relationship: Establishment, Development, and Engagement), University of Pittsburgh's VitalTalk, and Henry Ford Health's C.L.E.A.R. Conversations (Connect, Listen, Empathize, Align, and Respect). These models incorporate the "ask-tell-ask" technique, where clinicians first assess baseline understanding, provide information, and then verify comprehension.
The authors identified several structural challenges affecting patient communication, including time constraints, large caseloads for multidisciplinary teams, the complexity of advanced therapeutics, and accelerated schedules for treatment decisions. They noted that higher-quality conversations can facilitate end-of-life experiences more aligned with patient preferences while potentially lowering costs.
Practical Implementation Strategies
The report proposed several strategies for improving communication, including integration into established medical courses, incorporation into professional development forums, and utilization during teaching rounds. Clinician-educators can integrate discussions of "never-words" into existing courses on difficult clinical conversations, helping practitioners identify and replace potentially harmful phrases. Medical groups and health systems can include these discussions in professional development sessions, where clinicians review words they've used that may need replacement.
The clinicians recommended that faculty use teaching rounds to examine conversational habits and model more thoughtful language in real-time. They emphasized the importance of mentors demonstrating how to correct communication missteps, suggesting phrases like, "I'm sorry, that came out wrong. Would it be ok if I begin again?" The authors also recommended using side-by-side comparisons of problematic phrases and their alternatives during team huddles or meetings to facilitate discussion.
The authors noted that having thoughtfully prepared phrasing readily available can help clinicians maintain true decision-making partnerships with patients, even under time pressures. They emphasized that dedicated communication skills training increases clinicians' sense of self-preparedness and likelihood of initiating essential conversations. The perspective highlighted that while direct statements may sometimes be appropriate—such as telling a long-term patient's family member "he is dying" when built on an established relationship of trust—the same words could be harmful when used with unfamiliar patients or families.
This perspective was authored by clinicians at Henry Ford Hospital's Department of Pulmonary and Critical Care Medicine in collaboration with Texas A&M University's Mays Business School. The authors reported no competing interests.
