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Some patients “hang” on every word a doctor says. They listen carefully because what the physician says has major implications for them. Physician mystique gives patients the impression that this person is more knowledgeable than they, and what they say is gospel. Patients appear to be listening, but they often hear only bits and pieces of what is said. They fix on one or two comments, which become an obsession. They don’t hear the rest of the message. Such comments can have a huge impact on a patient’s psyche’ and influence them in the wrong direction. False hope, excitement, despair, hopelessness, overt depression, or a complete alteration of one’s life often result from “something the doctor said.”

Many magazine articles have listed the 10 or 20 comments doctors should never make to patients. To me, most of them are obvious, but amazingly people still tell me their doctor made one of those comments to them. I have incorporated comments listed in these articles with some I have heard from patients over the years. There are quite a few of these because physicians are poorly trained in interpersonal interactions (can you believe that?), and usually emulate a physician they admire. Some doctors know what to say, but many do not!

Below is my list of “Things a doctor should never say to patients:”

“There is nothing wrong:” Saying this to a patient who has real symptoms instills uncertainty and doubt, and certainly damages the doctor-patient relationship. The patient loses faith and trust in the doctor. What the doctor should say is “I know you’re hurting, but I can’t find a reason. Let’s do some tests to see if we can find the cause.”

“You’re just getting old:” That’s a brush off diagnosis if I ever heard one. Everyone gets old, but that should never be used to cover for the lack of inquisitiveness or diagnostic intelligence.

“You better get used to it:” This says I’ve done everything I can do to solve your problem, but have failed. I have nothing more to offer…sorry…now live with it! What a warm, reassuring attitude!

“I’ll be the doctor here; you let us worry about that:” This says what the patient says is unimportant and the doctor doesn’t care about his/her opinion. What the doctor says is the only answer. Besides, how could an uneducated, unsophisticated regular human possibly have the intellectual capacity of the doctor?

“I think I read about this as a medical student:” You talk about instilling faith and trust. For the doctor to admit the patient has something rare and barely remembers it doesn’t bolster confidence. 

“I need to get the medical students:” Oh, my goodness! What’s wrong with me? Do I have cancer? Is it something rare or fatal? I’m scared.

“I know exactly what’s wrong!” Sure you do, you charlatan braggart. Over-confidence sets you up for getting knocked down.

“I’m afraid I have some bad news:” What a way to begin a conversation. Mr. Optimism! The patient is disarmed immediately waiting for the bomb to explode. 

Surgeons are particularly guilty of communication blunders. They famously say:

   “No surgeon would want to touch you! Your problem is overwhelming.

   “I think we got it all!” There’s a good chance for a cure for your cancer only to have it recur

        6 months later. This gives false hope.

   “The cancer is in remission!” At this moment the tests don’t show anything, but the patient

        mistakenly thinks “I’m cancer-free.” This also give false hope.

Being overly pessimistic and unrealistically optimistic are major faults of surgeons. Just as soon as you say you’ve “got it all,” or you’re in remission, it’s almost certain a recurrence will happen.

Then there’s the grand-daddy of all comments:  OOPS!  

That’s the second worst thing a doctor can say!

 The worst thing a doctor can say to a patient:

“YOU HAVE SIX MONTHS TO LIVE!”  Six months to live? How does the doctor know that? He doesn’t. He has no idea how long the patient will live. Yes, he knows the statistics for the disease, but there’s a 100% chance his prediction will be wrong. The doctor has made a bold statement that is certain to be inaccurate. People are all different and respond differently to treatment. Patients react to a comment like this in one of two ways: One, they fight like heck to stay alive, doing everything possible to beat this disease..or..Two, they become depressed and withdrawn and give up. They’re going to die in 6 months, so why do chemo or radiation!

Other inappropriate comments that slip into conversations occasionally are promising, or guaranteeing, something to a patient that you’re not able to deliver, or blaming the patient’s insurance, or Medicare, for not permitting a test or discharging the patient from the hospital before they’re ready. Denigrating the hospital or nursing staff in front of the patient is a release of feelings by the doctor, but a divisive message to the patient. Everyone (physicians, staff, hospital, insurer) is working together to take care of the patient and get him/her well. Making unkind comments about the staff and hospital only further lessens patient confidence. 

Being polite, caring, honest, and tactful when speaking with patients is the best approach. Don’t make rash predictions or promises you can’t keep. Show compassion, patience, and understanding. But, especially, be very careful not to say….OOPS!

References: I referred to many lists found by Googling. I didn’t list them. The idea was sparked by an article in Medical Economics online. 

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