When Delivering Bad News, It’s All About ‘You’

By Tiffani Sherman
July 25, 2017

The way doctors use a simple pronoun can be the difference between a patient’s acceptance and rejection.

You might want to start paying attention to how someone uses the pronoun “you.” New research shows people often use the word in a generic way in very specific situations.

“We became interested in this by observing that people seemed to use generic ‘you’ when talking about their own experiences, and oftentimes negative experiences,” says Ariana Orvell, the lead researcher and a doctoral candidate in social psychology at the University of Michigan.

Generic use of "you" enhances psychological distance, which can help people cope in certain situations.

“It’s everywhere. It just seemed to be a ‘hidden in plain sight’ way of talking. We didn’t know why people were using it.”

To explain the concept of generic “you,” Orvell uses the example of the phrase, “When you lose someone, you suddenly learn to appreciate every day,” which makes a normalizing statement. Contrast that with, “When I lost my mother, I learned to appreciate every day,” which is a specific statement.

Orvell says generic use of the word enhances psychological distance, which can help people cope with and draw meaning from certain situations. “It isn’t just me; it’s how anyone in this situation could deal with a particular event,” she says. “Having more space from a negative experience helps them facilitate meaning.”

Another example Orvell gives comes from a podcast where she heard a victim of sexual assault talk about her experiences and use the phrase, “when it happens to you.” In this and other cases, people were using a word typically used to refer to other people when referring to themselves.

“We were curious as to what function [the generic ‘you’] was serving and why people were using this,” she says.

Ariana orvell

Ariana Orvell

>Her team’s research showed the generic “you” referred to norms, where a specific “you” referred to preferences. The question “what do you do with a hammer?” is generic, while the question “what would you like to do with a hammer?” is specific.

“Generic ‘you’ is tightly linked to norms,” Orvell says.

The generic question leads to responses such as, “you pound nails.” The specific question could get a response like, “I would like to put up pictures.”

What could this mean to physicians? It’s something Orvell hasn’t tested yet, but she has some theories. “We think that if physicians are giving a patient a difficult diagnosis, using a generic ‘you’ can help normalize the experience, that would be our hypothesis,” she says.

Orvell uses an example of a conversation in which a doctor must tell a patient he needs to begin dialysis. Using the generic “you” by saying to a patient, “You will adjust to the time constraints of the dialysis and soon it will just be a part of your life,” has a normalizing impact, making it sound like that effect has happened to others and it will happen to the patient.

On the other hand, if the doctor says, “You will need to adjust your schedule so dialysis will be a part of your life,” is more targeted and specific and could sound negative and forceful instead of supportive.

It’s a subtle difference, but one that could have a big impact on the patient.

“Casting it as something that is shared among other patients can help normalize the experience,” Orvell says. “We think there is something powerful about the generic ‘you.’ ”

Tiffani Sherman is a freelance journalist based in Florida. 

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