Thoughtful Communication Primer for Pharmacists

US Pharm. 2023;48(9):40-42.

ABSTRACT: Pharmacists are the most accessible healthcare providers in the country, and more patients are seeking clinical services implemented by pharmacists. Communication between providers and patients has always been an area for improvement in practice. With the introduction of new models of care, such as trauma-informed care, healthcare providers can improve their patient relationships and recommendations. New evidence shows that habitual or outdated health communication, such as fear-based and scare-tactic messages, negative or connotative communication, and dismissive language, is no longer effective with today’s changing patient populations. Best practices now turn to thoughtful alternatives to trigger words using empowering and positive language.

With over 48% of Americans taking at least one prescription medication and almost one in four people taking three or more medications monthly, pharmacists are the most-encountered healthcare providers in the country.¹ Evidence shows that pharmacists nationwide discuss medications and health conditions with over 140 interactions daily and over 141 million phone calls annually.^2,3 However, communication continues to be a primary area for improvement across all healthcare professions.⁴

A growing trend in healthcare communication and education is trauma-informed care.⁵ Trauma results from “an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.”⁶ Mental health agencies often describe three types of trauma: acute, chronic, and complex trauma.⁷ Chronic trauma is repeated, prolonged exposure to an emotionally harmful or life-threatening event, and complex trauma is exposure to varied and multiple traumatic events.⁸  

Trauma is often thought of as specific events, but anything that causes a heightened sense of fear, feeling of being overwhelmed, isolation, and helplessness can result in trauma.⁹ Certain words, phrases, tone of voice, inflections, or body language can prompt or trigger these feelings.¹⁰ A trigger affects one’s emotional state, often causing distress or altering actions, and trigger words elicit an emotional reaction or lead patients to feel a certain way.¹¹ The challenge for providers is that trigger words are personal to each individual and may not be as overt or evident as one might think.¹² Therefore, best practices are replacing fear-based and scare-tactic, negative or connotative, and dismissive language with positive and empowering alternatives.

Fear-Based and Scare-Tactic Messages

Fear-based language and scare tactics have traditionally focused on moralistic, exaggerative, and abstract messages that intentionally cause visceral reactions and vivid imaginings of the consequences.^13,14 These messages can be found in many areas of healthcare, such as smoking or substance use disorder, including such  messages as “smoking causes lung cancer,” “alcohol causes congenital disabilities,” and “opiates can cause overdose death.”¹⁵ Evidence in adults is mixed; however, in adolescents and young adults, the research shows that fear-based and scare tactics are not always an effective motivation.^15,16 Additionally, if a patient is triggered or becomes defensive by wording, phrasing, or imagery, the situation or behavior may worsen or not improve.¹⁶

Negative and Connotative Language

In healthcare, negative wording, phrasing, and connotative language are often not overt and may be linked to habit, implicit/explicit bias, personal background, and culture.¹⁷ Regardless of the origin or straightforwardness of negative language, evidence shows that it can perpetuate prejudice and trauma without regard to the provider’s true intent (see TABLE 1).¹⁸ A simple question such as “Are you male or female?” can be interpreted in several ways depending on the question’s tone, inflection, and placement. Negative language can be found when discussing or documenting weight, mental health conditions, substance use, socioeconomic situations, housing, and ability.¹⁹ Connotative language is used to express or have a connection to emotion and is often found in slang or colloquial terminology.²⁰ Connotative language that is indirect and does not utilize plain language can be perceived as or purposefully linked to triggering judgment, stigma, or bias.²¹

Dismissive Language

Another commonly found trend in healthcare communication is dismissive language. Dismissive language, also called medical gaslighting, makes patients feel as if their concerns are not warranting attention, are being minimized, or are ignored altogether.²² Phrases such as “it could be worse,” “relax,” “don’t worry,” “I’m sorry,” or “I understand” could have the intention of trying to make the person feel better; however, they are perceived by patients as placating and even patronizing.²³ Dismissive language leads to the patient not seeking preventative treatment, not following up with concerns, not following recommendations, not asking questions, and experiencing decreased overall confidence.²⁴

Empowering and Positive Language

Although fear-based, scare-tactic, negative, and connotative language may be used with good intentions or intended to persuade patients benevolently, these language choices can ultimately trigger patients and evoke trauma responses.²⁵ Best healthcare practices now encourage thoughtful alternatives to trigger words using empowering and positive language (see TABLE 2).²⁶

Conclusion

Thoughtful communication in healthcare is about allowing patients autonomy in their care, expanding representation, avoiding assumptions, and ultimately improving patient health outcomes through positive provider interactions. Using positive and empowering words not only improves patient satisfaction and reduces healthcare costs; most importantly, it also bolsters the physical and mental health of patients.

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