22 January 2010

Friday Flashback

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.

Originally Posted 1 March 2006


  1. Have you ever noticed that when you have a list of "Things not to Say" in your mind, some of them slip out during conversation?

  2. I'm not really an E.D. Physician, but I DID stay at a Holiday Inn last night...

  3. actually, I often tell a patient that something I am about to do is "gonna hurt like hell." Digital blocks, reductions, and so on. but usually I explain why and make sure they understand before proceeding. in general the response is "it wasn't as bad as I expected."

  4. When he was five, my brother broke his right pinkie finger. It wouldn't set properly, and the doctor was disinclined to place pins since that might interfere with the further growth of the finger. He decided to try a then experimental procedure, and my brother went in frequently for checks to be sure things were healing as Dr. Wonderful thought it would. One day, while Bro was being examined by the orthopedist and a slew of residents and med students, one of them asked, "What is the cutoff date?" That question meant something very different to a five year old than it did to the medical folks. Dr. Wonderful quickly reassured Bro that noone planned to cut off his finger, then set the med student straight to NEVER ask that question that way in front of a patient again.

  5. I'd prefer to be told that it's going to hurt, especially if I'm speaking to an ob/gyn. I now dread the phrases "a little pinch" and "slight cramping". Just tell me that it's going to hurt, and be over as quickly as possible.

  6. To the 25 year old with portal hypertension, ESLD who is bragging about surviving the DT's to his buddies: "Congratulations, you will never see 26 and have become the complete loser your mother always dreamed of."

    OK, I didn't say it but so wanted to.

  7. "I promise...this won't hurt me a bit."

  8. Agreed with the others. One of my best medical experiences was a notoriously painful procedure. Why? Because the doctor was flat-out honest. No "this might pinch a bit" or "you may experience a little cramping." No, she actually said, "this procedure hurts like hell, but it only last a few seconds, so it's not really worth doing a local. Do you think you can deal with it for a few seconds?" I agreed I could, it hurt like every cuss word I've ever heard, and then it was over. Had she pulled the "this may pinch a bit" routine I might have hauled off and punched her.

  9. I actually had a dentist tell me, of an impacted wisdom tooth, "I think I can probably get it out." I left that office quickly and went to an oral surgeon.


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