We Americans are proud of and passionate about the freedoms we enjoy. This issue has been difficult during the pandemic,further dividing us. If my freedom impacts you in a way you dislike, where does my freedom end?
Do we, as a society, have a right to impose rules that support the greater good when they infringe on others’ freedoms? In a recent radio broadcast, a linguist astutely reflected that a sustainable democracy requires that its members have empathy for others.
Again, how do we reconcile this requirement when we feel our own needs and beliefs are being ignored?
Another cherished freedom – freedom of speech - has also come under scrutiny within the last few months as we examine the insurrection at the Capitol. We hold dear and revel in our ability to say whatever we believe without fear that our government will arrest, jail, or execute us. We might believe in this First Amendment right wholeheartedly – until someone says something about us that is untrue and hurtful or that compromises our liberties, opportunities or livelihoods. While words may seem innocuous, simply an expression of what we believe, those words have impact, especially if we are in a position of authority. We are wise to consider what that impact might be, and whether those are words we want to speak.
As physicians, we are often in the difficult position of informing patients of serious conditions or possibilities. How we say those things often creates our impact. As a resident, sleep-deprived and chronically overwhelmed, I announced matter-of-factly to a patient’s family that the mortality of his condition was 70%. I cringe when I think about my insensitive and unskilled explanation, how I heightened their pain and squandered an opportunity to help them hold onto hope. We must also recognize that medical jargon is often misinterpreted. When hearing they have congestive heart failure, most patients fixate on the words heart and failure - and panic. This also occurs when patients are told they have venous insufficiency. Recently, a friend received the shocking diagnosis of metastatic cancer. While wanting to proceed with the recommendations of his new oncologist, he was still reeling from the tectonic shift in his life and overwhelming concerns for his family. Not recognizing that he was still having difficulty accepting his diagnosis, the palliative care team proceeded to discuss what would happen when his “organs shut down.” While responsibly informing him of what might occur, they failed to honor their responsibility to appreciate his current mental state and what he actually needed from them – reassurance, hope, and more sensitive language surrounding some of the potential difficulties.
Freedom of speech is the First Amendment for a reason. It is, and should be, our most cherished freedom. Yet, with freedom comes responsibility. To avoid inadvertently causing problems we will regret, we can first consider the responsibility we hold for our speech and choose our words judiciously. What impact do we want to have? Words do matter.
