Doctors' use of euphemisms and their impact on patients' beliefs about health: an experimental study of heart failure.

Doctors often use a range of euphemisms as a means to facilitate communication in the consultation. The present experimental study aimed to assess whether GPs use or avoid the term 'heart failure' and to evaluate the relative impact of the term 'heart failure' versus their preferred euphemism on patients' beliefs about the illness. This two part study involved a cross sectional survey of GPs and an experimental study of patients' beliefs and was based on one General Practice in a semi-rural area of the UK. For the first part, 42 GPs completed a questionnaire about their preferred terms to describe symptoms of heart failure. The results showed that GPs rated the majority of euphemisms as preferable to the term 'heart failure'. Their preferred euphemism was 'fluid on your lungs as your heart is not pumping hard enough'. For the second part, 447 patients completed ratings of their beliefs about a condition, which was described as either 'heart failure' or the GPs' preferred euphemism. Patients who received the condition described as 'heart failure' believed that the illness would have more serious consequences for their life, that the problem would be more variable over time and that it would last for longer and reported feeling more anxious and depressed than those who received the condition described using the euphemism. GPs are encouraged to be open with their patients and to respect their experience. The choice of language, therefore, presents a dilemma for doctors. The term 'heart failure' may be in line with the current climate of openness but may evoke a more negative response from the patient. In contrast, a euphemism may be less open but more protective of the patient's experience. This study suggests that the area of heart failure may be one where GPs may chose to compromise openness for the sake of the patient's experience and that this fear of upsetting the patient is well founded.