Letters to the Editor - The Importance of One’s Choice of Words and Keeping to Reality During Patient Encounters

Editor’s Note: The Physician’s Perspective column from the April issue of Clinical Geriatrics, “The Importance of One’s Choice of Words and Keeping to Reality During Patient Encounters,” seemed to have an effect on many readers. Below are two letters that we received in response to this column. Regarding the second letter from Vicky Bach, RN, BScN, MSN, GNC(C), it is important to note that each medical and nursing school has its own curriculum and the approach to addressing communication issues with patients varies with each faculty and administration.

To the Editor,

I always look forward to Dr. Gambert’s monthly column in our very informative journal Clinical Geriatrics, and I wanted to add my thoughts on his column from the April issue.¹ Having been a registered nurse for 40 years with a specialty in geriatrics, I can relate to the comments made by the nurse discussed in Dr. Gambert’s column who was caring for the elderly woman. Unfortunately, use of the old adage “familiarity breeds contempt” may not be so inappropriate here, after, of course, deleting the word “contempt” and replacing it with something like “unprofessional behavior.” Becoming too familiar and comfortable with your professional surroundings can happen, especially if one is caring for elderly patients over many years.

While it is acceptable to call patients by their first names if they ask you to, names and terms of endearment that I sometimes hear professional healthcare workers use when speaking to patients, such as “dearie,” “sweety,” “honey,” “granny,” “pop,” “papa,” and so on, are not acceptable. We learn to use the proper titles for patients as part of our training, but somewhere along the way we tend to forget. Of course, there are sometimes exceptions. For example, I’ve been caring for an elderly Benedictine Monk for the past 10 years. I’ve always called him “brother” out of my respect for him, and he definitely appreciates it.

I’m glad that the nurse discussed in Dr. Gambert’s column had “new insight” and realized that she was using the wrong word, perhaps contributing to the patient’s confusion. I sometimes get mistaken for one of my patient’s five brothers, all of whom are deceased, but I immediately correct him in a kindly manner, informing him that I am his nurse. He once said that he appreciates the correction, and I know that if I were the patient, I would too. Keeping to reality IS always preferable.

Fr. Francis A. Flood, O.S.B, RN, MS
Newark Abbey
Newark, NJ
_____________________________________________

To the Editor,

I read Dr. Gambert’s column¹ with interest and completely agree with the need for maintaining the correct orientation of elderly patients who, due to physical and cognitive impairments, are often disoriented or need assistance with maintaining orientation. In an effort to keep patients calm, decrease fear, or save time, healthcare staff may “overlook” certain cues that indicate disorientation.

How is the medical curriculum dealing with these communication errors? Is it considered an important part of the curriculum, and, if not, what is being done to correct this? Why do we continue to see this type of treatment of elderly—and all—patients? In my own practice, I consider communication to be important and I model this and teach this at every opportunity. I believe that it is the fast-paced environment of the hospital, ageism, and a failure to recognize good communication as an important part of patient care that lead to errors in communication.

Vicky Bach, RN, BScN, MSN, GNC(C)
Clinical Nurse Specialist Medicine Program,
Fraser Health Authority
British Columbia, Canada

Reference
1. Gambert SR. The importance of one’s choice of words and keeping to reality during patient encounters. Clinical Geriatrics. 2011;19(4):8.