These “Don’ts” and “Do’s” aren’t hard-and-fast rules, but guidelines to help you think about how using language thoughtfully can best help a patient (if you are a health care professional) or loved one. I offer these tips in classes hospice and palliative care volunteers and professionals.
Don’t say, “I know how you feel.’’ The truth is, you don’t know how the person feels. Telling them you do robs them of their unique experience; it diminishes their feelings, especially their suffering.
Do say, “I can’t imagine how you feel. Tell me what it’s like.’’ This honors the person’s individual experience and offers them the chance to talk about their feelings.
Don’t say, “It will all be okay.’’ Chances are, it won’t be okay, at least not the way we usually think of “okay.’’ In fact, things could get worse.
|Photo: Hollis Walker|
Do say things like, “It seems like you are experiencing a lot of big changes in a short period of time.’’ Let them tell you what that’s like.
Don’t ask, “How are you today?’’ This simple question we all usually ask each other can be wearying to the sick person, who has to constantly report medical/health details to nurses, doctors, family members, friends. It keeps the focus on their illness.
Do say, “How are your spirits today?’’ or, “How is your energy today?’’ which encourages focus on the mind and heart as well as the body. We are not trying to distract them or deny their illness, but to give them a break, if needed, from that focus.
Don’t talk about “healing” or “recovery,” being “better’’ or “worse.’’ Even the dying often feel they must pretend to family and friends that they are getting better, keeping a positive attitude. You may be the one person with whom the patient feels safe enough not to pretend.
Do accept whatever the patient offers about his/her thoughts and fears about illness and/or death. You need not agree. Say, “That makes sense to me,’’ or “I can see how you would feel that way.’’ In effect, you’re telling the patient he or she is not crazy; their ideas and feelings are acceptable and normal.
Don’t expect the patient to feel, speak or act the same way on each visit, and don’t feel you need to pick up where you left off in your last conversation. Leave last week’s deep topic alone unless the patient brings it up again.
Do let the patient be who they are today: happy or sad, hopeful or angry, vulnerable or shut down. Often a patient who has been particularly vulnerable on one day will later feel very exposed, and withdraw a bit the next time. Let it be okay.
Here are some proven ways to learn to communicate better with people who are sick or dying, whether you are a health care or mental health professional or a lay person trying to offer comfort to someone you love.
Before each meeting your patient/loved one, spend a moment in prayer or contemplation. Breathe deeply for a few moments. I usually say something like, “May I leave my own baggage, my own story, outside the door today. May I listen deeply and honor the humanity of this person. May I keep my mouth shut unless I have something to offer that will be of use to them. May I bring the best of myself into the room and be as real and vulnerable with them as they are with me.’’ Know that there is no perfect way to communicate with another person. The great Swiss psychiatrist Carl Jung said that we heal by who we are, not what we do. Come with good intentions; know you will make mistakes sometimes; forgive yourself when you do, apologize if needed, and give yourself credit for willingness and effort. Here is a four-step process for active listening, or “sacred listening,’’ as I call it:
(1) Encourage the patient to talk freely. Make eye contact and stop busy behavior. Focus on the patient. Don’t agree or disagree. Use open-ended (not yes/no) questions to prompt them. Ask, “How did the visit go with your granddaughter?’’ rather than, “So, did your granddaughter come after all?” Use noncommittal words with a positive tone of voice to encourage them to continue. Say, “Uh-huh,’’ “I see,’’ “That’s interesting,’’ “Then what happened?’’ “Tell me more.’’
(2) Restate the facts. Show that you are truly listening, and clarify for them what they have said to you, by repeating what they have said in your own words: “So, she told her mother she was coming here, but then went out with her boyfriend instead?’’ [If they say, “No, no, that’s not it,’’ just calmly accept that and say something like, “Oh, I guess I didn’t hear you right. What really happened?’’]
(3) Reflect the patient’s feelings. Use the same or similar language as they did to show you understand how they felt. “So, you got pretty angry when she didn’t show up,’’ or, “That really made you feel sad and unappreciated.’’ Be accepting and nonjudgmental, no matter what. If a patient says, “I feel like never speaking to her again. Why should I?’’ Imagine your way into their unstated feelings: “I imagine you feel very sad about that.’’
(4) Summarize and affirm. “So, let me see if I understand what happened. You were really looking forward to your granddaughter’s visit. She told you and her mother she was coming, and then she didn’t show up. This hurt your feelings so much you just want to give up on her.’’ Before you leave, thank the patient; after all, they have taken a risk in sharing very personal information with you. “I really appreciate you telling me about this; it helps me understand what you are going through.’’