Patients often viewed clinician swearing as motivating, authentic, and patient-centered, but researchers warn that what builds rapport with one patient could cross a line with another.
Study: Do patients give a damn? An exploratory study of patient perspectives on clinician swearing during physical rehabilitation. Image Credit: People Images / Shutterstock.com
In a recent study published in Frontiers in Rehabilitation Sciences, researchers examined patients' lived experiences and perceptions of clinician swearing in physical rehabilitation.
Can swearing strengthen the patient-clinician bond?
Swearing is a common aspect of human communication. Though often considered unprofessional and inappropriate, swearing has been associated with social, physiological, and psychological benefits. The bond between patients and healthcare providers (HCPs) is an established predictor of clinical outcomes, satisfaction, and treatment adherence.
Strategic swearing by HCPs may be a novel way to strengthen this bond, given swearing's social benefits. Yet the relationship between clinician swearing and patient outcomes is poorly understood, with studies suggesting both benefits and risks. Evidence also remains highly ambiguous in physical rehabilitation settings.
About the study
In the present study, researchers explored the lived experiences of patients with clinicians who swore during physical rehabilitation and examined their perspectives on clinician swearing. The study recruited patients aged 18 years or older from two physical therapy clinics in the United States and one chiropractic clinic in Canada between August 2024 and May 2025. Patients completed a 14-item survey on their discharge date.
The survey evaluated patients' experiences and perceptions of clinician swearing. It aimed to identify the contextual factors that determine whether swearing is perceived as inappropriate or appropriate. The researchers performed logistic regression analyses to assess whether the frequency of clinician swearing predicted patient-reported outcomes, such as treatment adherence, motivation, and self-confidence.
Linear regression analyses examined whether the frequency of clinician swearing predicted perceptions of swearing; that is, whether patients viewed swearing as patient-centered, unprofessional, offensive, or improving the care experience. Finally, we performed cognitive network analyses to assess qualitative responses.
When swearing seemed to help, and when it did not
The study cohort comprised 57 patients, including 34 females, with a mean age of 40.4 years. Thirty-one participants reported that their clinicians swore during rehabilitation sessions. Among these, three patients reported that their clinicians swore only once, while four, five, and 19 patients reported that their clinicians used swear words less than once, once, and more than once per visit, respectively.
Most patients reported that clinician swearing increased their motivation (61%), self-confidence (58%), and treatment adherence (52%). A majority also agreed, or strongly agreed, that clinician swearing was patient-centered (55%) and improved their rehabilitation experience (65%). Most patients disagreed or strongly disagreed that swearing was offensive (97%) or unprofessional (81%).
Patients in the high-frequency swearing group more often reported increases in self-confidence, motivation, and treatment adherence than those in the low-frequency group. More participants in the high-frequency group said swearing increased their treatment adherence (63%), self-confidence (63%), and motivation (68%) than in the low-frequency group.
The confidence intervals for these comparisons were wide and included null effects; therefore, the study did not establish that more frequent swearing produced better outcomes. Higher-frequency swearing was associated with greater ratings of patient-centeredness; however, the authors cautioned against overinterpreting findings from the small, underpowered sample.
Patients considered swearing appropriate when it benefited them, such as by improving motivation or emphasizing a point. Acceptability also linked to rapport and the clinician-patient relationship.
Patients perceived swearing as inappropriate if it was directed at the patient, used in serious conversations, or harmed the clinician-patient relationship. Patient comfort and age also shaped responses, and some participants said clinician swearing was never appropriate.
Context and patient preference may matter most.
The findings suggest that some patients perceived clinician swearing as helpful to aspects of physical rehabilitation, such as patients' motivation, treatment adherence, self-confidence, and overall care experience. Patients generally perceived swearing as appropriate when it increased motivation, rapport, or humor, and inappropriate when it disregarded patient comfort or was used in anger. Based on these findings, the authors proposed cautious recommendations for clinicians considering swearing in rehabilitation settings.
These include not swearing at the patient, not swearing when in doubt or anger, using it sparingly and with purpose, aligning it with patient preferences, and prioritizing authenticity. The study's limitations include its convenience sample, which may have introduced selection bias; a retrospective, self-reported design that is susceptible to social desirability effects and recall bias; and the possibility of over- or under-reporting patients' reactions to clinician swearing.
The clinicians who distributed the survey had already reported being comfortable with strategic swearing, which may have increased exposure to swearing in this sample and limits how broadly the 54% prevalence can be applied. The frequency analyses were also markedly underpowered, with only 19 patients in the high-frequency group and 12 in the low-frequency group.
The team did not investigate clinician tone, intent, or clinician-patient rapport before swearing, which could influence perceptions of swearing. Further research is needed using more representative, larger samples across clinical settings and healthcare domains. Overall, the findings suggest that clinician swearing can benefit some contexts but carries risks when used indiscriminately, and the authors caution that more research is needed before it can be recommended as a clinical strategy.
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