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Harpham, Wendy S. MD

doi: 10.1097/01.COT.0000388588.30338.dc

“Sugarplum, hold still!” a nurse says as she wraps a restraint around a patient's bony wrist.

On the other side of the bed, another nurse gently strokes the patient's forehead as the intern withdraws a mile-long needle from the patient's groin. “See, Sweetie?” she says, leaning closer to the patient. “That wasn't so bad.”

All-the-while, the resident is scanning the patient's chart and giving orders for STAT this and STAT that.

Frozen in my assigned spot at the foot of the bed, I am the ultimate med-student sponge soaking up every “See One.” Hearing how to address agitated patients fascinates me as much as seeing how to give orders and perform arterial sticks. And in no time at all, I am at the bedside of a different patient for a “Do One” with a 20-guage needle and terms of endearment.

Now fast-forward 10 years to my office. A feisty octogenarian sits perched on the end of my exam table, asking, “Honey, what do you think I should…” She abruptly interrupts herself, “Oh! Dr. Harpham, do you mind if I call you ‘Honey’?”

Fast-forward yet another 10 years, this time to my hospital room. I am nauseated and in pain. The night nurse, after giving me medicine and adjusting my bed, asks tenderly in her charming Scottish brogue, “Is that better, Luv?”

Sugarplum. Sweetie. Honey. Luv. What is the proper place for terms of endearment in modern medicine?

I've been thinking about this since coming across a burst of chatter on a health blog. One survivor writes, “I've had it with endearments from medical personnel. I plan (if I get up enough chutzpah) to have the following form filled out and attached to all my medical charts.”

Her proposal is short and sweet: “I wish to be addressed by nurses or staff as (blank). I wish to be addressed by physicians as (blank). You may also call me (circled ones are fine, crossed off ones may be offensive): …Hon, Honey, Dear, Sweetheart, Darling, Sugar….”



Despite the form's brevity, it offers patients two separate fill-in-the-blanks: one for physicians and another for nurses and staff. This two-pronged guideline makes sense because physicians play a different role and have a different relationship with patients than nurses or staff members.

That the blogger instructs patients to personalize the list of potentially offensive names also makes sense. Different terms of endearment bother different people.

Did the blogger follow through and share her feelings with her doctors and nurses? Probably not. When it comes to non-medical issues, patients often hide their anger or frustration, fearing repercussions on their care.

In defense of clinicians who use pet names, I believe most are motivated by wholesome efforts to comfort patients in distress. And in many cases it works perfectly. When I was hurting and alone in the middle of the night, the nurse's tender “Luv” calmed and comforted me beyond measure.

Some patients find 21st century medicine too impersonal. They yearn for expressions of warmth from their health care team. For proof, one needs only to scroll down below the blogger's diatribe and read a response from another survivor: “[My] doctors and nurses talk ‘at me, not to me,’” adding, “I'd love it if they would have said ‘Honey’ or ‘Dear.’”

Here's the problem: Sweet talk can be risky, whatever the clinician's intentions. Some patients feel disrespected or infantilized, as if being treated like toddlers or nursing home residents who drool and wear diapers. Terms of endearment can exacerbate the near-universal sense of loss of control experienced by cancer survivors, especially for patients who require assistance with their ADLs—but even for super-high-functioning patients.

A clinician's “Sugar” intended to show heartfelt caring may communicate just the opposite. Some patients wonder if it provides an easy way to hide that their doctor or nurse can't remember their name. Other patients feel compartmentalized with all other cancer patients and resent being stripped of their individuality.

Such fears can contain a seed of truth. Imagine a clinician who uses “Honey” judiciously and only rarely. Over the years, “Honey” may slip into more and more conversations until, one day, it becomes a habit. Routine use of “Honey” can make it easier to forget that the drowsy patient on a morphine drip or one with bits of breakfast on a chin is/was an accomplished musician or English professor, a successful small business owner or rocket scientist.

Please don't conclude, not even for a second, that terms of endearment have no place in modern medicine. Under the proper circumstances, such expressions of warmth can strengthen clinician-patient bonds in unique and profound ways.

Rather, I'm suggesting that clinicians first consider the potential risks. If your instincts drive you to use a term of endearment—or if one pops out before you think, pay attention to your patient's response. Then do what my patient did after calling me “Honey,” and ask if it's okay.

Was I comfortable being called “Honey” by my elderly patient? I remember telling her, “You can call me whatever you want, as long as you take your medications.” Our arrangement worked well for us.

Which segues perfectly to the litmus test for terms of endearment: “How will it affect your relationship?”

Factors that help you gauge the risks and benefits include your age, your patient's age, the local culture, the patient's family culture, how long you've known each other, your history together, and, of course, the specific situation.

Whatever the medical setting, your words can be like a medicine, bringing comfort to patients in distress. As with any other intervention, let Hippocrates be your guide when considering the use of terms of endearment: First do no harm.

© 2010 Lippincott Williams & Wilkins, Inc.
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