Words Matter: Describing Major Medical Treatments.

Abstract

How many times have we heard from patients’ families that “they would want everything done”? However, once they see what “everything” means in the health care world, their response is frequently “but we didn’t mean all of this!” Asking family members to make decisions about life support can be more or less difficult depending on how they understand the words used by the health care team in describing major medical treatments (MMTs). The article by Pecanac and colleagues describes their secondary analysis of a survey asking about decision-making related to MMTs. For example, they found that respondents perceived “life support” as different than “life-sustaining.”Respondents also describe the sense that the decision is binary—to institute MMT is life, to withdraw or not institute MMT is death. Clinicians know that the answers are never that clear. There are confounding variables with every patient and in every decision. Perhaps the questions and decision-making shouldn’t be based on discussion of therapies but rather should be based on a conversation about desired outcomes. We have framed ethical conversations with “what would the patient want?” as criteria for decisions about therapy. Perhaps the question should be “what outcomes would the patient want?” This would help us, as clinicians, to describe MMTs in ways that are more consistent with how patients and their families understand and make decisions.