Speak Up: 8 Words & Phrases to Ban in Oncology!

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A recent article in the Washington Post entitled “Twelve Things the World Should Toss Out”1 caught my eye as I read the Sunday paper. It was a collection of short essays by different guest authors—some whimsical, some serious—on the theme of spring cleaning, which asked the question, “What about a little spring cleaning for your brain, your country, your world?” The authors proposed different things that they thought we would all be better off without.For example, economist James K. Galbraith nominated “The Congressional Budget Office”; Karl Rove said “exit polls”; and Ed Begley, Jr. proposed “lawns” (you have to read the article to understand that one).It got me thinking that, as an oncologist, if I had to come up with something that our field should get rid of, it would be our language, or more specifically, the often imprecise, obscure, and baffling word choices that permeate our consultation notes and other communications. Now, I realize that if the genie granted me one wish for the field of oncology, I shouldn't waste it on my personal linguistic obsessions, so my answer should be something like “cancer,” or “patient noncompliance,” or “HMOs,” or the “sustainable growth rate formula.”It is not new information that we physicians often do not use language very effectively, tending toward jargon, imprecise word choices, and those repetitive inscrutable idioms embedded in our culture. Some of this language has gotten so engrained in our psyche that we probably don't even recognize that our meaning is lost on our audience of colleagues, referring physicians, or patients, or even worse, that our words may alienate or offend.Below are eight words, phrases, or themes that I propose we banish as part of our own spring—or summer—cleaning. And let me be the first to admit that I can find examples of all of these in my own writings!“Aggressive.” Yes, a 4 cm, Grade III, node-positive, triple-negative breast cancer is an aggressive tumor, but we sometimes forget that when patients read our dictations, that word is very frightening. Might we not convey that there is a high risk of relapse without an adjective that unnecessarily anthropomorphizes the tumor?“Aggressive” is also a poor word choice when applied to a physician. Some oncologists get labeled as aggressive (some I know cultivate this), which presumably means that they are more willing to recommend chemotherapy compared with others. This implies that more must be better, and we all know that is only rarely true. It must follow, then, that a non-aggressive oncologist is someone who is less willing to treat, and perhaps someone who suggests palliative care or hospice more readily, hardly an undesirable trait. Let's limit the use of this word.“OK?” I call this the Great Word of Medical Coercion, most often heard being used by housestaff or fellows on rounds and spoken in pseudo-interrogatory form (usually at the end of a sentence) when trying to convince a reluctant patient to undergo a particularly unpleasant test or treatment. Regrettably, this dialogue sometimes passes as informed consent.

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