Pragmatics of the Clinic: Framing Effects in Medical Communication

Abstract: What a speaker says in uttering a sentence will often differ from what they thereby communicate or convey. If a doctor tells a heart surgery candidate, “Five years after surgery, 90% of patients are alive,” the patient will be more likely to consent to the procedure than if told “Five years after surgery, 10% of patients are dead” (Thaler and Sunstein, 2008; Gigerenzer, 2014). While these sentences are semantically equivalent, they communicate different things in the clinical setting. The former, but not the latter, can serve to communicate a recommendation. Similarly, a recent study shows, while “You have a cancerous growth” is generally taken by the patient to have life-changing implications, “You have a carcinoma,” although technically synonymous, is not.

These framing effects, well-documented in both linguistic pragmatics and behavioral economics, can have a dramatic impact on how patients understand a recommendation or diagnosis. In this panel, we will discuss the ethical ramifications of this phenomenon, specifically as it arises in clinical scenarios. Among the issues we will address are whether forms of influence that seek to bypass the hearer’s rational deliberation – noneducative nudges (Sunstein 2016; Blumenthal-Barby 2021) – are ethically acceptable in the clinical context. This raises the question whether a neutral presentation of content is always feasible. If it is, should neutrality be the goal? If not, what are the responsibilities for health care professionals in communicating diagnoses or risks? Should guidelines for be designed to minimize confusion and misunderstanding?

Keywords: Clinical communication, Implicit recommendation, Framing effect