Editor’s Notebook: The Power of Language


January / February 2006

Editor’s Notebook

The Power of Language

For many, each morning at the 17th Annual National Forum of the Institute for Health Improvement (IHI) in December began with a few tears. The tears came in response to plenary speakers — primarily Dr. Donald Berwick, President and CEO of IHI, and Steven Lewis, United Nations secretary-general’s special envoy for HIV/AIDS in Africa — and to the power of language.

I was so taken with the power of the words Lewis chose, I started writing them down as he spoke: tentative, lovely, grotesque, infuriating, dark, scary, pugnacity, feisty, obscene, quizzical, inexplicable, and again, lovely. He described the socio-economic impact of the HIV/AIDS epidemic, as well as the work of extraordinary individuals who are making a difference, even if only for one individual or family at a time. That’s why “lovely” shows up twice. Lewis’s message gained power from the inclusion of hope and transcendence in a story filled with words of despair and fury.

Berwick titled his talk “Power” and focused on what he calls “Band-Aid Power.” That phrase comes from Berwick’s daughter’s anatomy class at Yale University Medical School and it stands for the power of honest, unguarded, personal connections between physicians and their patients:

The message is, “Show up.” “Bring all of you here.” The meeting of two human beings — two complete human beings — has a power to heal that distant, defended relationships cannot have.

After urging physicians “never, never, never” to forsake technical expertise or ethical standards, Berwick emphasized that the power of healing has everything to do with Band-Aid Power:

Always heal. Healing depends on honest, open disclosure, conversation, shared tears, and offers and promises to do absolutely everything in our human power… healing can’t occur in a context of denial, mutual recrimination, silence or self-defense. It can’t occur without deep introspection, apology, shared grief and eventually, somehow, trust.

Berwick’s domain is healthcare, but his message is universal. “Power” reminded me of an article published in The New York Timesjust 2 days earlier, about a master class conducted by singer Barbara Cook. She encourages students of musical theater not to hide behind technique and fa¡ade, saying, “Your own humanity is your pathway to artistry.” Artistry is connection and is enhanced by discarding personal defenses that prevent communication. Urging her students to avoid artistic posturing, Cook reassured them, saying, “You are enough.”

Later at IHI, I talked with James Conway, IHI senior fellow and senior consultant at Dana Farber Cancer Institute in Boston. Commenting on a session he moderated, “The Patient Is In the Room: Patient and Family Stories Including Tragedy, Healing, Partnerships, and Improvement,” Conway said he thinks the key is “respect,” another word for what Berwick means by Band-Aid Power. What better way to show respect and care for others than to present oneself clearly and sincerely, without artifice, as a full partner in healing?

A DVD including the plenary sessions of Berwick, Lewis, and others is available at www.ihi.org.