For the casual healthcare consumer, a trip to the Emergency Room, hospital, or even a routine check up can be confusing or possibly intimidating. It can be a challenge even for the seasoned patient. Advanced technology, medical terms, procedures, wires, tubes, pills, and injections all contribute to a disconcerting experience. Although the healthcare professional has your best interest at heart, it is very possible that the care provider you are working with is assuming you understand what is happening to you. As a partner in your own care you have a right to ask questions, notify your healthcare team if something does not seem correct, and actively participate in your treatment plan.
There is much written about empowering the patient, advocating for yourself, and putting the patient first. However, it is naive to think that this is easily done, especially during a time of vulnerability and sickness. Communication is the key to reduce confusion and fear. In Malcolm Gladwell’s book, “Outliers”, he describes the concept of mitigated speech (as originally presented by Ute Fischer and Judith Orasanu). Understanding how mitigated speech impacts communication can contribute to improving the quality of the responses or reactions you receive from your healthcare professional.
Mitigated speech is the act of choosing your words to describe a situation or ask a question in a manner that reduces confrontation or attempts to convey respect. In my role working with patients, I have seen mitigated speech by patients and family members very often. In this article, I will adapt the model described by Gladwell to the healthcare setting. By being mindful of the words you are choosing, and speaking with intent, a greater clarity will emerge.
There are six styles of mitigated speech:
Command – this involves no mitigated speech. It is the clearest method of conveying a thought or concern. “Doctor, I am not going to take that pill. It makes me feel sick.”
Obligation Statement – The earliest sign of mitigation in speech. This may be done to soften a statement, possibly to show respect or avoid confrontation. “Doctor, I think I am not going to take that pill. We should consider how it makes me feel.”
Suggestion – Further mitigated and less to the point. “Doctor, perhaps I shouldn’t take that pill. It might make me sick.”
Query – At this point the patient is indicating that the healthcare professional is in charge of the situation and does not communicate the concern at all. “Doctor, do you really think I should take that pill?”
Preference – Again, not communicating the real issue, and leaving the healthcare professional unsure why the patient is considering alternatives. “Doctor, I think it would be better if I took a different pill.”
Hint – This has the largest degree of mitigation and is exceedingly unclear regarding the true intent of the patient. “That pill sure looks big to swallow.”
Being aware of style of speech and level of mitigation can be the first step towards combating confusion in the healthcare setting. In extreme cases it can save you from serious medical errors. If you suspect that you employ these mitigation strategies it may help to practice a different style with people you engage with everyday; consider delivering commands to the grocery store attendant. You can always employ the assistance of family or friends to observe your speech for mitigation and comment on how you could have been more direct. Culture often plays a significant role in how concerns are communicated and how mitigation is used. If this is a factor for you, consider having a close friend or family member advocate for you until you are more comfortable with the idea.
Have you mitigated your speech before? In what circumstances? Were you able to over-come a high level of mitigation to be able to more clearly communicate your concerns? If so, please share your experiences!
1. Gladwell, M. (2008) Outliers, The Story of Success. New York, New York: Back Bay Books.
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