by Charly Miller, EMT-P

This page was originally published in's September, 1999 issue.

Everyone in EMS - prehospital and inhospital providers - habitually uses two "Evil Words." I've often wondered why frequent use of the Magic Words - please, good and thank you - is so often disdained, while redundant use of the Evil Words remains completely unnoticed.

I discussed Evil Word number one, the "T-Word" - TRY - in Part 11.
Now, Evil Word number two: the "O-Word" - OKAY.

OKAY is an "Evil Word" for three reasons:

1) All of us are trained, from our earliest memory that "OKAY" is a LIE.

Imagine you're itty-bitty again - taking your very first, unassisted steps. Before this special moment, Parent held your hand as you toddled about, precariously learning to walk. But now, Parent has let go of your hand. You're suddenly walking without assistance!

Wow! I just walked alone!

Very proud of yourself, you take another couple of steps, wobbling quite precariously! But, you regain your balance. Recovering from that fright, you revel in your accomplishment!

Wow! I'm hot!

You launch another spurt of steps, but this time, you loose your balance and dive-bomb your great big head into the linoleum kitchen floor.


You're screaming in pain and fright, shedding great, big, crocodile tears! Have you been seriously injured by this fall? No. So, what is Parent's immediate reaction?

Parent picks you up, bounces you, pats your padded bottom and says,

"Oh Honey, you're OKAY! Everything's OKAY !"
What?! This scared you to tears, and it really did hurt when your head hit the linoleum! This was not, "OKAY!" So, you learn that: in times of pain and fear, OKAY is a LIE!

Throughout our entire life, OKAY-is-a-LIE experiences occur whenever something hurts or seriously scares us. Thus, when a care provider tells a patient, "It's OKAY," the patient immediately considers OKAY a LIE.

Since OKAY is a lie, it doesn't reassure anyone. In fact, OKAY increases patient anxiety, pain, and stress. After all, if it really were OKAY, would we be there? No! We're speaking to a patient because something BAD happened.

An "OKAY" emergency simply does NOT exist!

2) Okay is the medical equivalent of "um," "er," "uh," or "and." A garbage word that serves no purpose and negatively effects patients.

We've all heard lecturers who's every other word is "um," "er," "uh," or "and!" Such garbage words are uttered by uncomfortable speakers to fill space when they're nervous addressing a group or unsure of what to say.

How do you respond to these speakers? Do you have enormous difficulty staying awake? Frequent use of "um," "er," "uh," "and" likely lulled you into Snooze-Ville. Additionally, your brain possibly turns off the speaker, switching channels to something else. Instead of listening, perhaps you're compiling your grocery list or a million other things!

Since OKAY is the medical equivalent of "um," "er," "uh," "and," it effects patients even worse than these garbage words effect an audience.

Habitual OKAY use fills space whenever we feel uncomfortable - uncomfortable with a situation, with silence, or when we're unsure of what to ask or say next. Okay communicates our discomfort. Thus, OKAY increases patients' discomfort.

In hospitals, medical clinics, doctors' offices, or on emergency scenes, care providers too-frequently utter OKAY when addressing a patient. It's a bad habit that's been perpetuated for years.

The next time your partner's talking to a patient, or the next time you watch a patient being cared-for in the ED, listen for the "o-word!"; You'll be stunned and amazed how often OKAY is uttered - even within a single sentence!

The more often a patient hears OKAY, the less the patient listens. Okay redundancy lulls the patient into wondering about how long it'll take to get back to work, or where his lawyer's phone number is, or what all these OKAY-users are hiding from him!

3) OKAY? implies a choice.

When used with a question-inflection, OKAY? implies asking permission. But, since we usually use it as space-filling garbage, we rarely intend to be asking permission.

"I'm gonna start your IV now, OKAY?"

If an injury or illness requires an IV, we don't' want to offer a choice about it! Legally, patients do have a "choice." But, it's our job to explain the need, and then find something else to give them a choice about while we get their IV started. [As explained in the Foundation of Patient Communication - Parts 8-10]

Accidentally using OKAY? sets us up for ARGUMENTS.

"No, it's not OKAY! I don't want an IV!"

Arguments are negative events. Arguments increase a patient's stress, anxiety, and pain, and decrease a patient's ability to cooperate with, or positively respond to treatment.

Okay use must be completely stopped before it can be controlled.

Like any other bad habit, breaking the OKAY habit isn't easy! You must have help. Share this article with a partner - then help each other break the "O-Word" habit.

First, you must STOP saying it. You must go five consecutive work-shifts without ever uttering the "O-Word." (Substituting, "All Right?" won't fly! Same bad habit - different words!)

You'll immediately discover you don't even notice yourself saying OKAY! Thus, each partner should perform a kind of "penalty-buzzer-cue" for the other. When you hear your partner say OKAY, make your penalty buzzer sound.

Since your patients will notice this behavior, you must explain the "game." (If you don't, your patient will suspect that something is terribly wrong every time your partner says, "ding", or the like!;)

"I'm learning to stop using the word, 'Okay!' It's a bad habit, and my partner's helping me break it."
This reinforces your OKAY-breaking focus. It also entertains your patient - she/he may even get into the act by "dinging" or "beeping" you en route to the ED! This is a positive thing!

Your efforts will be significantly improved if you train yourself to replace OKAY with a "Magic EMS Word" such as: Please, Good, or Thank You.


Step One: You must go five consecutive shifts without ever saying OKAY before going to step two! Unfortunately, you'll quickly realize it takes several shifts before you're able to go one shift without saying the darn "O-Word." Because of this, it's important that you positively reinforce successes, rather than negatively penalizing yourself for failures.

Reward yourself as often as possible! Devise a half-shift reward ... a full-shift reward ... a double shift reward ... and so on. When you've been sans-OKAY for four consecutive shifts, but screw-up during the fifth - Hey! Give yourself the half-shift reward, and start over!

Step Two: Once you accomplish five consecutive shifts sans-OKAY, you may resume using OKAY - BUT! only when you WANT to offer a "choice!" You and your partner must still periodically perform a penalty buzzer for garbage-use of OKAY. But, at least you'll know your habit is coming under control. Stay with the program! Your garbage OKAY use will soon dwindle to nothing!

Controlling your "O-Word" use will improve your overall communication skills. You will:

And you'll have loads of fun penalty-buzzing other, clueless, care-providers!

Controlling your "O-Word" use will dramatically improve your medicine, improve your patient's response to treatment, and give you a wonderful sense of accomplishment.

If you wish to, Email's Editor with your feedback:
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"Feedback About The Foundation of Patient Communication - Part 12"

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