How Our Words Can Influence Treatment ResultsWhich sounds worse: you have disc degeneration or you have some wear and tear on the discs? What about this: your MRI shows some signal loss at the L4-L5 disc level versus there is a narrowing of the disc space at L4-L5?
Medical terms used to explain diagnostic results of tests and imaging studies can have a profound effect on how a patient perceives his or her potential for healing. Focusing on repair and healing of disc problems rather than discussing ongoing damage may be a more helpful and positive approach in managing low back pain.
Labels and beliefs about those words are something health care workers may need to re-evaluate. As the results of this study show, messages regarding low back pain and how patients perceive the words health care professionals use have an important effect on their prognosis.
For example, when told that the cause of their low back pain was disc degeneration, some people interpreted that to means their spine was crumbling or collapsing. Use of the term wear and tear by the physician was used later by the patient to say that everything was wearing out.
The problem isn't just with the patients' interpretation of what they are told (or more accurately, what they "hear" from what they are told). Health care providers have their own beliefs about patients they treat and may unintentionally convey the wrong message.
There is even evidence that some of these beliefs are not consistent with current recommended guidelines for the care and management of chronic problems like low back pain. Patients are often strongly influenced by what their physicians, surgeons, therapists, and nurses tell them about their condition.
Medical reports from radiologists reading and interpreting imaging studies contain words like degeneration, which may have nothing to do with the patient's symptoms. There have been plenty of studies that show the severity of changes observed on X-rays often have no correlation to patient symptoms.
For instance, it has been observed that some people with what looks like severe degeneration of the spine have no symptoms whatsoever. At the same time, there are others who report excruciating pain with nothing seen on X-rays to indicate a problem.
In this particular study, patients with chronic low back pain were asked, What do you think is going to happen in the future? There were a wide range of responses indicating both hopes and beliefs. Patients used words like cure, permanent disability, crippled, and not going to get better to describe their expectations.
They gave explanations for their pain including getting old, overdoing it, and the back is going. By comparing what the radiologists' reports said with what the patients' were told by their physician or surgeon, it was possible to see that some of the patients' beliefs were from their own interpretation of what they were told.
What are the implications of these results for physicians, surgeons, and other health care professionals? The authors suggest that health care providers interpreting test results for patients need to take a closer look at their word choices.
It might be important for radiologists to use terms and language more carefully knowing that others may be speaking for them to the patients. Using words that focus on mechanical or degenerative aspects of the spine appear to give patients the perception that their prognosis is worse than it actually is. Using words that focus on healing, repair, and recovery rather than focusing on degenerative aspects of the spine may actually foster a better outcome in the long-run.
Tim John Sloan,BMBS, BMedSci(Hons), and David Andrew Walsh, FRCP, PhD. Explanatory and Diagnostic Labels and Perceived Prognosis in Chronic Low Back Pain. In Spine. October 1, 2010. Vol. 35. No. 21. Pp. E1120-E1125.
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