Dumb things I've said to patients

November 5, 2004

I thought I was saying the right things. Then I realized how pointless my timeworn words were.

I'm so used to giving my patients my standard advice, that sometimes I don't think about what I'm saying. Too often, it comes back to bite me. Here are some of my faux pas . . . and my improvements. Thankfully, I'm learning.

"Go home and take it easy," I said to the young woman. She had a nasty upper respiratory infection and looked terrible. As I watched her round up her three young children who had been destroying the exam room, I realized what a stupid thing I'd just said. Telling a mother of young children to take it easy is like telling an airplane pilot to avoid heights. She gave me a look that confirmed that thought.

"Do you have family members who could help with the children?" I amended. "Or neighbors?"

"Don't worry," I said. Mrs. Concern had come in for her regular exam because she was afraid she had cancer. She was agitated about her husband, too. And she fretted that her children might get into trouble in school. Some people are natural worriers, and unless sedated, they will always be anxious. Telling these folks to stop worrying threatens to take away a tangible target and replace it with an unknown, and possibly more frightening fear.

Rather than a negative "Don't worry," I should have encouraged Mrs. Concern to organize her problems and plan a constructive course of action for each one. For example, she could suggest that her husband get a screening physical. She could meet with her children's teachers to reassure herself as to their welfare. Unfortunately, though, worriers will always find something to be distressed about.

"Avoid stress," I counseled Bill Payer.

That was part of the advice I gave to try to bring down his mild hypertension. He was stressed about his job, his financial commitment in buying a home, and supporting his young family.

"Could you get a different job?" I asked.

"Not one that would pay enough to cover my mortgage," he said.

We talked about his job stress, and determined that it would be possible for him to stop shift work-his biggest grumble-and work the day shift. He'd take a drop in pay, but if he refinanced his house, the lower monthly payments could offset the lower income.

While this situation had a solution, not every stressful situation will. It's more effective for me to help the patient learn how to manage his stress. Exercise, meditation, or taking up a hobby may help. The goal is for the patient to get away from the stress-inducing environment for even a short time and focus on something enjoyable.

"Take one tablet every six hours for the next 10 days," I said.

Norman Street was 18 years old. He had strep throat, the treatment for which is penicillin every six hours for 10 days. This has historically been the way to treat this particular infection. Norman nodded his head brightly, signifying intended compliance. But I knew that the chances that he would fully comply were slim indeed.

Better to be realistic, I thought. I tore up the prescription and wrote one for a slightly more expensive medication that used a twice-a-day dose for 10 days. It's a pity we don't have a once-only pill that could be taken under office observation!

"Your insurance should cover this." What I really mean is that I think it would be very sensible for the insurance company to cover a blood pressure monitor so that my hypertensive patient could check his own blood pressure. This would more accurately monitor his real life blood pressure without the time-consuming trips to the office, and the insurance company paying for visits. Not surprisingly, the insurance companies don't always do what I think they should. But I still keep saying it.