I’m going to cut to the chase here: Doctors are not always good communicators. I do believe most of us are compassionate, and try to convey that. Still, we don’t always succeed, and as a profession we’re known for falling back on jargon such as “The findings on your X-ray were impressive,” or at times making patients feel rushed out the door as we try to keep up with our appointments for the day.

Sometimes, though, the issue cuts deeper than medical jargon or a harried energy. Sometimes doctors use language that comes across as insensitive, or judgmental, or even demeaning. Whether they intend to sound that way is neither here nor there. What matters is how the words make patients feel.

Recently, I read an interview that drove this point home. It’s with Dr. Svetlana Blitshteyn, a neurologist at the University of Buffalo, in New York, who is bringing attention to the impact doctors’ word choices can have on patients—particularly those who have complex health conditions such as long Covid, fibromyalgia, or myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Because we don’t yet know the exact causes of those conditions, or how to best treat them, patients often have frustrating experiences when they seek care. Unfortunately, that can include less-than-compassionate attitudes from their doctors.

What struck me in reading the interview is that Dr. Blitshteyn takes a very practical approach to the problem. She and a colleague have devised a list of “never words” that doctors should avoid, along with suggestions for more effective—and empathetic—alternatives. That’s important information that doctors can put into practice right now. And in my view, it’s equally useful for patients. You have the right to know how your doctor should be speaking to you.

To that end, I’m sharing some of Dr. Blitshteyn’s “never words” and pointers for better doctor-patient communication—along with my own thoughts peppered in. (The full list is part of an article published in the International Journal of Environmental Research and Public Health in February.)

• “Good news. Your test results are all normal.” To your doctor, this may seem like good news. But a patient who is suffering wants answers, and “normal” test results may actually be discouraging. I believe it’s crucial that we, as doctors, assure patients that we take their concerns seriously and are not abandoning them based on some test results. Dr. Blitshteyn’s suggested alternative: “The tests we have run so far are not showing any abnormalities, and the good news is that we have excluded certain conditions based on the results of these tests.”
• “You don’t look sick.” In my opinion, doctors should be well aware that patients can have the appearance of good health even when they feel sick. Observant doctors do put weight on how a patient “looks” (it can be a critical tool in the immediate term, such as in the ER). But we should not make statements that give patients the impression we’re doubting that they feel unwell based on their physical appearance.
• “At least it’s not cancer” or “Many people have it worse.” Sometimes doctors make statements that minimize patients’ suffering, particularly when they have “invisible” symptoms like fatigue and chronic pain. As a general rule, your doctor should not engage in disease comparisons, or make assumptions about your experiences and how they compare to other people’s.
• “You need to stay positive.” Your doctor might mean well in saying this, but it’s still problematic. It implies that you’re not allowed to feel bad—or, worse, that your lack of optimism is to blame for your ongoing symptoms. The article offers this (far more thoughtful) alternative: “I know it can feel discouraging to feel so sick, and especially for so long. We will work on this together.”
• “You need to lose weight/start exercising/get out of the house, etc.” I believe we should all try to lead a healthy lifestyle—but that can be easier said than done. If you feel unwell, it’s hard to be physically active and socially engaged. In addition, when a doctor speaks in this prescriptive way, it implies that a patient’s symptoms will be cured by a daily walk or shedding a few pounds. Instead, Dr. Blitshteyn recommends a more supportive approach: “When you feel better, we will work together toward a common goal of improved quality of life and a healthier lifestyle.”
• “Don’t confuse your Google search with my medical degree.” Defensive statements like this have become rather popular among physicians, according to the article. But when you have a chronic medical condition, or symptoms with no diagnosis, it’s only natural to do your own research. If you find information online and bring it to your doctor to discuss, in my view you’re doing the right thing. Your doctor should respond respectfully and be open to a conversation. If your doctor thinks you’ve stumbled upon “disinformation” about your health concerns, then he or she should guide you toward reliable online sources.

As I noted, Dr. Blitshteyn’s advice is geared toward doctors treating patients with complicated, less-understood medical conditions. But I think it’s relevant to anyone seeking medical care, including for more “ordinary” health conditions. Patients want to feel that their doctors not only are capable of making a diagnosis and treatment plan, but also see them as a whole person and are invested in their health. And that takes thoughtful communication.

So what do you do if your doctor’s communication skills are lacking? I think patients should always feel free to speak up—whether that means asking your doctor for clarification on something he or she said, or letting them know that your concerns have not been fully addressed. If you’re told, “Good news. Your tests are normal,” for example, you could continue the conversation by saying something along the lines of, “OK. What are the next steps we can take to figure out what’s going on?”

Chances are, you’ll get a positive response. Again, I believe most doctors do care and want their patients to sense that. That’s why doctors are writing about and discussing the importance of their word choices. It’s a good, and ongoing, conversation.