1. Harpham, Wendy S. MD

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"Your test came back negative." On occasion that happy news elicits a sickening stomach-drop. That's because to some patients, invariably rookies at survivorship, "negative" sounds so, well, negative-i.e., bad and undesirable.


Words are cognitive reflex hammers. They trigger ideas and images that stir emotions, which in turn shape each individual's experience of the facts. In medicine, word associations can be healing. Throughout my Promace-MOPP chemotherapy, the image of the drugs mopping up my cancer cells helped me.

WENDY S. HARPHAM, MD... - Click to enlarge in new windowWENDY S. HARPHAM, MD. WENDY S. HARPHAM, MD, is an internist, cancer survivor, and author. Her books include

Unfortunately some terms can cause harm due to their meanings in non-clinical settings-even if totally unrelated to the patient's situation. The above-mentioned miscommunication about negative test results is no big deal. Any misunderstanding is quickly detected and easily resolved. But it's a serious issue when clinicians use words that unwittingly cause or exacerbate significant, persistent negative emotions, such as anxiety, embarrassment, or hopelessness.


This column explores two commonly used phrases that bother some survivors. I welcome your feedback and suggestions in my ongoing quest to find words with healing associations.


Normal Scans

A woman stands with both arms raised Rocky-style as she announces, "My doctors said my scans are clean. I am cleeeean!"


Around me, the audience erupts into applause and cheering. Most of it, anyway. A few hands are clapping more slowly than the rest. Might their owners, wearing a baseball cap or headscarf, now think their scans are dirty, polluted, or vulgar? Do they now see themselves as somehow unclean?


A popular alternative to "clean" is "N.E.D.," no evidence of disease. Indeed, many patients joyfully embrace their friend, NED. But remission can feel like a second-place win in a hard-fought contest. If so, NED focuses patients' attention on the limitations of the tests used to detect cancer. No friend at all, NED jumpstarts fear of recurrence, the "evidence" reminding patients why their oncologist won't say they're cured: cancer cells may be lurking below the radar.


Another standard alternative phrase is "clear scans," a linguistic twin to "clean scans." But unlike "clean," all the antonyms of "clear" are fairly harmless to patients in treatment. And "clear" has the advantage of bringing to mind the freedom and fresh start of a clear path and clear skies.


"Clear" doesn't work well, though, if scans show scar and/or non-malignant abnormalities, like cardiomegaly. To avoid confusion or miscommunications about the findings, clinicians can simply qualify: "Your scans are clear of cancer."


All that said, few sentences foster hope of achieving renewed health more than "Your...(cardiac output, platelet count, biopsy) perfectly normal." That's why, if reporting scan results that are normal in every way, "normal scans" remains my top choice.


Useful News

If things aren't going well, clinicians often preface the latest test results, diagnosis, or recommendations with a warning that they are about to deliver bad news. Doing so serves patients by gently preparing them for the verbal two-by-four about to hit them.


Without argument, patients know exactly what their physicians mean by "bad news." My concern arises from the fact that forever after patients remember vividly the label their physicians attached to that bit of news. And I can't think of a more highly charged and value-laden adjective than "bad," with its long list of negative connotations. Thus the phrase, "bad news," risks burdening patients by stirring unpleasant-and unhelpful-thoughts and feelings.


Consider for a moment patients' everyday challenge of parlaying requests for medical updates from friends and family. A patient's bad-news report, even if couched in the most upbeat terms, can cause others to feel uncomfortable and frequently elicits expressions of sadness, anger, or disappointment. It's no wonder that some patients begin to feel like they are bad news-an idiom for someone who is unpleasant and causing trouble. Or, often on a deeply subconscious level, that they are bad or are doing a bad job with their survivorship. "Bad" is a bad word.


An option I don't particularly like is to find other language to telegraph the punch and to strip "news" of all adjectives. For example, "This is going to be hard for me to say and hard for you to hear. I have some news...." That approach falls short because patients would reflexively fill the vacuum before "news," if not with "bad" then with another equally terrible or horrible adjective.


A different tack is to insert an adjective for "news" that taps into shared emotions, such as "disappointing" or "unwanted." Such words of compassion may strengthen the clinician-patient bond. But since those shared feelings typically arise in defeat, labeling "news" that way may also feed patients' sense of failure.


To avoid all negativity, the adjective "useful" fits the bill: "While difficult to say and difficult to hear, this news is useful news. It will enable us to talk about what's happening and help you make the best decisions for you."


What I like best about "useful" is how the positive connotations comfort and empower patients, if not right away then in the days and weeks to follow. The positive spin of "useful news" taps into the idea that the truth sets you free-even if upsetting when you learn it.


Healing Associations

Aside from the time and effort of finding alternative language, clinicians lose nothing by avoiding words and phrases with negative-and often irrelevant-associations. And they may gain much.


At the very least, clinicians' routine use of patient-friendly language may, on occasion, prevent a dropped stomach. At best, more healing words or phrases may help innumerable patients by preventing unnecessary distress; by stirring patients' courage, patience, fortitude, and hope; and by strengthening clinician-patient bonds. All good things.