Dr. Wendy Harpham was 36 years old and a successful physician who prided herself on her empathy. Then she was diagnosed with cancer. Seeing things from the other side showed her how difficult being a patient can really be, and how much clinicians’ words impact how patients feel and what they do.
Through multiple recurrences of cancer and, decades later, a diagnosis of a rare blood disorder, she became an expert in helping clinicians communicate effectively during time-limited visits – and in helping patients hear what doctors say in helpful, hopeful ways.
In her new book Clinical Communication , Dr. Harpham from Dallas, shares personal stories to illustrate a patient perspective on clinicians’ words that help and those that unwittingly cause distress.
“Just like a medicine, clinicians’ words can help or harm,” she explains.
The burden of being a ‘good patient’
According to Dr. Harpham, a first visit for a medical concern is not the first step for those patients. Many wrestled with fear, self-doubt and decisional paralysis before making the appointment.
At doctor visits, a simple greeting can become complicated. For example, Dr. Harpham didn’t know how to answer when a nurse greeted her with “How are you?” at an appointment. She was unsure whether to report her physical symptoms, such as the exhaustion with any exertion, or the anxiety and sadness she has been dealing with. Or should she project confidence, to be taken seriously and be a model patient?
“I stammered, frozen with uncertainty,” she recalls. “Different sides of me competed to answer, leaving me tongue-tied.”
Dr. Harpham says this kind of exchange captures the psychological tightrope patients walk – balancing honest reporting with their needs to maintain hope, appear competent, and not be seen as difficult.
Her advice to doctors is to be specific, asking “How have you been feeling since we last spoke?” or “What brings you in today?”, to remove ambiguity. Dr. Harpham reminds patients that “doctor visits are not social visits.”
Speaking to apprehensive patients
Dr. Harpham sympathises with challenges of today’s healthcare due to advances in medicine: doctors have more to discuss and less time to discuss it. She argues that brief expressions of compassion can improve the care they provide and help patients respond in helpful, hopeful ways.
“Words have the power to comfort and inspire patients living on the front lines where the pain is felt and the pills are swallowed,” Dr. Harpham explains. “No matter how medicine changes, nothing can diminish the healing potential of well-chosen words.”
When patients report new symptoms after delaying out of fear, she suggests doctors build connection with compassion: “Coming in is difficult. I understand trying to give it time to go away. I’m glad you are here today. Now let’s see what we can do.”
For false alarms, she suggests: “You did the right thing. Better a false alarm than a missed opportunity.”
Dr. Harpham also delves into the fraught area of discussing conditions with a poor prognosis. Insights and tips for clinicians help patients too, she suggests, by guiding them to healthy ways to process the truth and manage uncertainty.
When breaking bad news, she appreciated doctors who prepared her first: “I wish I had better news for you today,” or “This is going to be difficult for me to say and, I expect, difficult for you to hear.” She says such warnings, delivered calmly, communicate both sorrow and competence, which patients need when their world is changing.
One of Dr. Harpham’s most surprising insights as a patient involves waiting for test results. Rather than hoping for good news, she encourages patients – and doctors – to hope for ‘accurate news’.
‘Good news’ sets up a binary: results are either good or bad. Accurate news, however, provides the information needed to make wise decisions and respond in helpful ways. It honours the complexity of medical reality, where partial responses and stable disease all carry meaning. And it helps patients manage the uncertainty while waiting for results.
“More than I hope for good news, I hope for accurate news – however long I have to wait,” she says.
Advice for doctors
For a wide variety of common scenarios, she models phrases and approaches that show compassion and foster trust needed for effective communication: