08 August 2008

Things Not To Say

Things you can say which will reliably discomfit your patients:

For patients who will need surgery:

  • "There's no cure for what ails ya except cold hard steel."

For patients upon whom you are performing a procedure:
  • "Oops"
  • "What the hell is that?"
  • "Hold still, I'm going to try something."
  • [To Nurse] "How does this gadget work?"
  • "I've never done this before, but I'm pretty sure I can pull it off."
  • "Now this may hurt a little . . . actually it's going to hurt rather a lot."

For patients with a medical diagnosis:
  • "There's Good News and Bad News. The Bad news is you have [X]. The Good news is that it's you and not me."
  • "Everybody's got to die sometime."

Now, I've never said (most) anything on this list, but I have a wicked mind and have thought about it on many occasion. I'm sure you have thought about it, too. Feel free to add suggestions in the comments.


  1. Actually heard being said to my neutropenic patient with a high fever:

    "Well, I called infectious disease to see if they can think of any more antibiotics to add or figure out what on earth you have."

  2. Some of my favorites (and I've used these as jokes to calm patients before. Sometimes, shock humor works):

    (When the patient asks how long you've been doing X procedure)"Not on an actual person, but I've read all about it, so I think it'll be fine."

    "I'm going to go over there for a second. If you need anything, just scream."

    (while drawing blood) "I'm sorry if I seem nervous. I quit drinking yesterday, and I've never drawn blood from twins before."

  3. I've had a few patients joke with me using the Holiday Inn Express, "I'm not a....., but I did stay at the Holiday Inn Express last night". You can fill it in with "I'm not a plastic surgeon, but........" or "I'm not an ER doc, but........."

    If you're getting ready to do a procedure (draw blood, start an IV, suture, surgery), it's probably not a good idea to say "I'm all thumbs today."

  4. Respiratory therapists say this often, "I'm going to suck your lungs out."

  5. When looking at a large, swollen, hard lump on my wrist I had a small town country doc say, "I think I've seen something like this before. I don't remember what is...Hmmm...I could lance it for you."

  6. How about...

    "Not to worry Mr. Jones, all bleeding stops."

  7. After walking into an ER exam room the other day with patient present, a resident said to me, "good, you're gloved-up, but DON'T touch anything...this is incredibly contagious...you DON'T want this!"

  8. McCavity--I have never heard the twins one before and my coffee nearly shot out my nose. Nice!
    I am not even going to try and match that.

  9. During Surgery "Now where does this thing go exactly?"

    or "Where is all that red stuff coming from?"

    "Ooops! Was that important?"

  10. "I know what to do, I've seen this on 'ER' before!"

  11. "Sir, your lab results came back and the good news is... you are not pregnant..."

    "I'm sorry, but you are at a teaching hospital and can not avoid being treated by a resident."

  12. Hi, new reader here. love the blog. Anyway, to prep the story, my dad is also an ER doc.
    My brother-in-law Jared told me once had had some sort of "nodule" on his chest, that he opened a cupboard door and bumped it with the corner of the door, and it swelled up and was painful (I have no idea what it was that he had, this is just how he explained it). He went in to see my dad, who told him he needed to drain it.
    Jared told me he (honestly) appreciated it when my dad told him, "I'm not going to lie to you, this is going to hurt."

  13. Yeah,
    I actually am very fond of "This part is really going to hurt. It will not be your best day ever, but you'll feel better when I'm done."

    Particularly with regards to lidocaine and abscesses.

    The patients seem to enjoy it. Weird.

  14. Whilst doing a minor surgery on a patient's face exclaiming "Oh man, this just goes from bad to worse. It's really terrible now".
    I was referring to the radio which had been playing terrible music all afternoon and the Backstreet Boys just came on.
    My patient was rather alarmed however.

  15. Was on the wrong side of "whoa, that's not what I Expected to find!"
    during a knee surgery that they'd done with an epidural, and me wide awake.
    (tured out to be a good thing ...got an apologetic laugh and explination. I've never let him forget it either)

    My husband got, from a neurosurgeon
    "Everyone has to die sometime, heck, I could walk outside and get hit by a bus!"

    (um, yeah, and we've got one friend that works for Greyhound and one that works for the city bus system ....)
    His other line was "Well, since you don't have xrays from years ago, for all I know he was born this way" (ok, so we're lying that he had polio?)
    We never went back to him.

  16. You forgot "WTF is THAT?"

  17. Great post and responses.

    Here's my story. When I was in college I stupidly chose to have my ears pierced because they would do it for free at the student clinic, though without anesthesia (big mistake--don't ever agree to that). When I came back in a few weeks to have the piercing stud removed, the nurse began to work on one ear. Suddenly her hand slipped, I felt this searing pain, and she began to exclaim, "OH, NOOOO!"

    I kept say, "What?? What is it?? What happened?!?" I couldn't see because it was on the side of my head and there was no mirror.

    But all the nurse would say was "OH, NOOOO!"

    Very frustrating to be the patient in that situation.

  18. Those were more like; " Things you don't want to hear during your vasectomy."

  19. My GP was removing a number of skin tags from my back and I asked him how he would know if he'd numbed them all. He chortled "you'll let me know".

    What could I do but laugh along with him?

  20. To another doctor, with the patient, awake, in the middle of a procedure:

    "How come you always get the interesting ones?"

    Yeah. I was the patient. The last thing I want is to be medically interesting.

  21. Prior to nasopharyngoscopy, I did actually say to the nervous woman who asked me if it would hurt:

    "Not hurt, but it's uncomfortable.

    You're lucky you live in Canada because you really wouldn't want to PAY to have it done."

  22. Fantasized about but never said or done: "Sorry, was I supposed to lubricate that Foley first?"

    Actually said (but didn't do): "What I'd like to do is take this really wide tape and stick it to your arm and peel it off real slow...in the wrong direction" This was after the patient asked me to tape their IV heparin line to their armband so it wouldn't pull on the hair on his arm. I usually do this anyway, but the patient who asked me had (once again) claimed 7/10 chest pain in the ED, and left our floor to go smoke before the Cardiology team saw him.

  23. As said by a male nurse at the ER as they lanced my boil #7, baseball-sized, which had burst under the skin (my fault):
    "Oh my gawwwd."

    Apparently he had not seen a boil of this size lanced before.

    Unfortunately I wanted to see this sucker drained, but I was distracted. It's not uncommon to use SEVERAL emesis basins to drain a single large boil. See videos on Youtube.

  24. Smart ER docs lance a boil with a suction tip held right next to the scalpel. As soon as the skin is open you suck out all the pus. That way it's a lot neater, and you don't have nearly as much stench.

  25. Good thing to say to a patient while repairing a laceration:

    "Don't worry, all bleeding eventually stops....."


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