Patients Say Clinician Swearing May Boost Motivation in Physical Rehabilitation

Swearing in a clinical setting sounds like a recipe for complaints, but a new study suggests many physical rehabilitation patients see it differently. In an exploratory survey published in Frontiers in Rehabilitation Sciences, researchers found that more than half of rehabilitation patients reported that their clinician used swear words during treatment, and most of those patients described neutral to positive effects on their motivation, self-confidence, and adherence to therapy. Not a single patient in the study said the swearing was unprofessional or offensive.

The research team, led by Nicholas B. Washmuth of Samford University and The University of Alabama in Huntsville, together with colleagues from clinics in the United States, the United Kingdom, and Canada, set out to answer a question that has rarely been tested with real patients: when a clinician swears, do patients actually care? Swearing is a nearly universal feature of human communication, with surveys showing that 58 percent of people report swearing sometimes or often, over 70 percent of adults frequently or occasionally hear others swear in public, and 57 percent of employees acknowledge swearing in the workplace. Yet in healthcare, the impact of clinician swearing on patients has remained unclear, with limited evidence pointing in conflicting directions.

Earlier studies offered mixed signals. In one set of experiments on physician communication, patients rated doctors who swore lower in satisfaction, expertise, trustworthiness, and approachability, yet the same patients also perceived the swearing physicians as more human and relatable, and many said they would still choose to see that doctor again. In mental health settings, a survey of 50 patients whose therapists had used swear words found overwhelmingly positive responses: 92 percent said therapists should be able to swear around their clients, 80 percent reported that the swearing helped their therapeutic relationship, and over 88 percent described an explicitly positive experience. Case reports in physical therapy showed similarly mixed but generally acceptable patient reactions, with neither patient in the cases finding the swearing offensive or unprofessional.

To build on this sparse evidence, the team conducted a cross-sectional, mixed methods, retrospective study with 57 physical rehabilitation patients, 34 females and 23 males, with a mean age of 40.39 years. Patients were recruited from two physical therapy clinics in Alabama and one chiropractic clinic in Ontario, Canada, over a 10-month period from August 2024 to May 2025. Each patient completed an anonymous 14-item survey on the day of discharge, a timing choice designed to ensure accurate recollections and reduce social desirability bias, since patients were no longer receiving care and had nothing to gain from flattering their clinicians. The survey assessed experiences, perceptions, and attitudes toward clinician swearing, and the full instrument and dataset are available in an Open Science Framework repository.

The quantitative results were striking. Thirty-one patients, or 54.39 percent, reported that their clinician used swear words during their sessions, and among those who swore, 61.29 percent did so more than once per visit. Among the 31 patients who experienced clinician swearing, 61.13 percent said it increased their motivation, 58.06 percent reported improved self-confidence, and 51.61 percent said it supported their adherence to treatment. No patient reported that swearing decreased any of these outcomes. Furthermore, 54.84 percent agreed or strongly agreed that the swearing was patient-centered, and 64.52 percent said it improved their rehabilitation experience, while 80.65 percent disagreed or strongly disagreed that it was unprofessional and 96.77 percent disagreed or strongly disagreed that they were offended.

The researchers also tested whether swearing frequency, dichotomized into high, more than once per session, versus low, once per session or less, predicted patient outcomes using logistic and linear regressions. Patients in the high-frequency group generally reported greater motivation, self-confidence, and adherence than those in the low-frequency group, but the confidence intervals for these effects were wide and included null values, reflecting the small sample size and limited statistical power. The only statistically significant finding was that high-frequency swearing was associated with higher ratings of patient-centeredness, B = −1.00, 95% CI (−1.95, −0.05), p = 0.04, though the authors emphasize that even this confidence interval spans a wide range. Because the study was exploratory and underpowered, the team deliberately emphasized descriptive statistics and confidence intervals over p-values, noting that hypothesis testing with p-values can be unreliable in underpowered studies.

The qualitative side of the study used cognitive network analyses, processing patients’ open-ended responses into single-word terms and building networks that depicted important concepts and their associations. When asked when it is appropriate for a clinician to swear, patients focused on the impact on the therapeutic relationship. Swearing was judged acceptable when it served to motivate, encourage, or affirm progress, when it built rapport and comfort, and when it expressed empathy, humor, or solidarity. One patient described appropriate swearing as motivational, affirming, and complimentary, while another said it depended on the relationship the clinician had built with the patient. These responses align with sociolinguistic findings that swearing can reduce social distance, signal shared identity, and communicate authenticity.

When asked when swearing is inappropriate, patients centered their answers on individual patient characteristics. Many highlighted age, noting that swearing should be avoided with young children and with older adults, reflecting generational differences in tolerance of taboo language. Others emphasized patient comfort and consent, with one respondent saying swearing is inappropriate if the client is not comfortable with it and another if a patient has explicitly stated so. Patients also cautioned against swearing directed at rather than with the patient, swearing in frustration or anger, and swearing during serious clinical conversations. Notably, a subset of patients rejected clinician swearing outright, responding simply with never or always inappropriate, underscoring that while many patients view swearing as conditionally acceptable, it remains unacceptable for others.

The authors interpret these findings through the lens of established rehabilitation science. Motivation in physical rehabilitation is increasingly understood as dynamic and shaped by social and environmental factors, including the clinician’s interpersonal style, and clinicians perceived as kind, welcoming, and genuinely engaged can positively influence patient motivation. Swearing, when used appropriately, may contribute to a relaxed, authentic clinical atmosphere that fosters rapport and communicates solidarity. Self-confidence, which commonly declines after injury and is strongly associated with functional outcomes, can be restored through verbal persuasion, and swearing during encouragement may deliver a more intense and emotionally resonant form of that persuasion. Adherence, closely tied to the therapeutic alliance, may benefit when swearing injects humor and informality into sessions, making rehabilitation feel less sterile and more engaging.

Importantly, the study suggests that swearing may operate more as a threshold effect than a dose-response effect. Higher frequency did not reliably increase perceptions of unprofessionalism or offensiveness, and frequent swearing was actually linked with greater perceptions of patient-centeredness, but the presence of swearing itself, rather than its frequency, may drive patient perceptions. The authors also note that different swear words carry different levels of impact, which were not measured in this study and could complicate simple frequency effects. The team offers practical recommendations: when in doubt, don’t swear; use it sparingly and with purpose; align with patient preferences; never swear in anger or at the patient; and prioritize authenticity. The researchers caution that the findings are preliminary, underpowered, and context-dependent, and they call for preregistered, confirmatory studies with larger, more representative samples across diverse clinical settings before swearing can be recommended as a clinical strategy.

Subject of Research: Patient perspectives on clinician swearing during physical rehabilitation

Article Title: Do patients give a damn? An exploratory study of patient perspectives on clinician swearing during physical rehabilitation

Article References: Mercer, A., Meakins, A., St. Martin, R., Trummer, G., Geoghagan, L., Muscha, K., & Washmuth, N. B. (2026). Do patients give a damn? An exploratory study of patient perspectives on clinician swearing during physical rehabilitation. Frontiers in Rehabilitation Sciences, 7, Article 1719743. https://doi.org/10.3389/fresc.2026.1719743

Image Credits: AI Generated

DOI: 10.3389/fresc.2026.1719743

Keywords: swearing, physical rehabilitation, patient perspectives, therapeutic alliance, motivation, self-confidence, treatment adherence, patient-centered care, communication, physiotherapy, patients, give