Rx for Patients: Bad Words Can Have a Good Effect

Stephanie Pappas

Date: 28 September 2010 Time: 03:14 AM ET

Health care worker wearing face mask.
CREDIT: © Arekmalang | Dreamstime.com

Stuck in the hospital? Go ahead, drop an expletive or two – it might make you feel better, according to a new study.

Swearing can provide an emotional catharsis and even a bonding opportunity between doctors and patients in hospitals, according to the research article, published in the September-October issue of the journal Psychosomatics. But, the authors caution, certain obscene language — especially ethnic or sexist slurs — is never a good idea.

"Swearing always has to be used very tactfully, because it is a very intense communication," said study co-author Daniel Zimmerman, a staff psychiatrist at Bellevue Hospital Center in New York. "It can easily scare or overwhelm."

Zimmerman decided to write the paper after meeting a psychiatric patient whose constant use of obscenities and ethnic slurs made treating him almost impossible for the hospital staff. In that case, the obscenities were a barrier to care (the patient was transferred as soon as the staff could find a safe place for him to go). But dirty language can sometimes hint at a patient's diagnoses, Zimmerman said. People with Tourette Syndrome, for example, may swear involuntarily, and some types of brain damage can cause people to speak only in spontaneous utterances like curse words.

Zimmerman and his co-author drew on their own medical experience to collect case studies of hospital profanity. They came up with eight vignettes, some fictionalized to combine elements of multiple case studies into one, each illustrating a different aspect of the use of dirty words. Sometimes, the attitudes behind the bad language were harmful, as in a situation in which a male resident made sexist remarks about a female superior.

At other times, however, doctors used what might be considered unprofessional language to build bonds with patients. In one example, an angry patient told her doctor she was "furious" with her treatment. He responded that he could see why she was "pissed off." His acknowledgment of her feelings helped the patient open up to the doctor about personal problems she was having, the researchers wrote.

In another case study, an unemployed blue-collar patient displayed bitterness toward his doctors for knowing "jack-shit" about his life and telling him what to do. One doctor realized he needed the patient to see him as an ally, not an authority figure. So he responded, "Gosh, I know just how you feel. I'm a doctor-in-training, and my boss always orders me around. Believe me, I'm not just some asshole who's here to get his kicks telling you what to do."

By speaking to the patient at his level, the researchers wrote, the doctor gained the man's trust. It's a method that requires doctors to respond to the patient's cues and carefully consider how helpful the offensive language might be, Zimmerman said. In some cases, he said, there are reasons to let dirty words slide.

"Often patients who come to a psychiatrist have very strong emotions that they're having trouble expressing," Zimmerman said. By using strong language, he said, "a psychiatrist working with those patients can provide a lot of relief by allowing them to express themselves and to feel understood."