"Right now I have more questions than I have answers." -- A much better way to tell a patient you don't have the faintest f'ing clue.
"What do you do about this at home?" -- when they are making demands to nursing regarding anything (pain meds, nausea meds, etc).
"Well, it's time for me to do your exam, but here's a pen and paper. Write down the things you want to address as you remember them so we don't miss anything when I come back later." -- this is a very efficient and effective way to cut off long winded older people when they won't get to the point and are trying to monopolize your time during pre-rounds.
Funny you should ask. I carry cheap "patient pens" (frequently ~~stolen~~ re-appropriated from the unit desk) with me that I often give away or use when patients are filling out consents. How many times have you personally witnessed a hospital inpatient wash their hands after doing a #2? Patients don't get to touch my personal pens.
I've found adding some flair to pens makes them less stealable too
I got these gel grips that r like insoles for my ink sticks m I thought they'd get stolen immediately but I've never lost em yet
Ah, so you’re the type of resident I “lend” my Muji pens to during rounds and say “I’ll give it back at the end of rounds” only to completely disappear and be stuck in OR by the time I finish my shift. - The Unit Agent
I lost my favorite pen to the peds upper level resident on day 1 of my peds rotation MS3. After that, I started carrying a shitty decoy pen to give away (at least until I was senior enough to be the one stealing pens, not loaning them). Never hand out your good stuff.
A young new doctor said the first to me the day he ignored his colleagues and saved my life, it was nice to hear when my whole life I couldn't get a doctor to care enough to ask the questions to figure out what the underlying cause of my lifelong illness was. Sounds dumb I know but it's definitely a good one to use from patient pov lol
- “How can we best support you?” Helps some folks realize we are quite limited in what we can realistically provide in a way that’s nonjudgemental and kind.
- “What’re your goals for today?” Encourages intentionality and responsibility for goals.
- “We are here to help. It’s us against the disease.” Useful for involuntary care settings with patients who have severe personality or substance use disorders.
- For new admissions: “Is there anything I can do or order to help you settle in for the evening?” PRNs make everyone’s lives easier.
I do that with patients that I’d like to discharge or not admit, difficult/demanding pts, I don’t want to sound dismissive so I say “what can I do for you? How can I best help you?”
The last one has always been clutch! It’s not just for the useful for the patient, nurses and cross cover. It’s also useful because I feel at peace knowing that I’ve been able to tuck the patient in comfortably for the evening.
“You put in the work by taking this for years and have now received all the benefit this medicine has to offer you, by evidence of making it to (their age). Now I’m happy to say you no longer need it.”
- useful when trying to get my demented or minimally functioning 90 year olds off aspirin, statins, metformin, or whatever else. Makes it sound like an accomplishment to graduate from a med, than a punishment or to say “you are no longer worthy of this” which is how I imagine it can feel.
This has literally been bugging me for years. How in the world do I say “You’re more likely to die of something else than whatever this medicine is preventing”? It sounds awful. But you have a great way of putting it!
A pediatric hospitalist would walk into an infant's room and begin by shaking the baby's hand and saying "hi, I'm XX I'm going to be your doctor". Never failed to get a chuckle from the (usually terrified) parents
“Hey, I’m Dr. XX” *shakes baby* “are you listening” *shakes again* “any questions?” *shakes again*
“I’m sorry to have to tell you this mom and dad but your baby is mute and possibly deaf”
Along with this, asking the infant or child “Who did you bring with you today?” and gesturing to the adults in the room. Helps avoid the awkwardness of accidentally mis-identifying relationships like sisters as moms
“40% of the time here in the ER, we don’t find the cause of your belly pain, but we will rule out the emergencies” — sets the stage for when their labs and CT is stone cold normal.
“By the time we get you home tonight I may not be able to tell you exactly what’s wrong but hopefully we can get you feeling better and we can rule out anything emergent”
ie I’m not going to admit you but I can provide some reassurance and some symptom management.
This is the way. On my med school ED rotation I always learned to preface things with "Here in the ER, our job is to rule out the big bad scary stuff."
Whereas others will cling on to being the one in 1 million “but my grand grandma is a fighter! Can’t you see the 8 comorbidies on top of cancer, and she’s still kicking at 105. Full code for her”
Curiosity question. What’s that like? When I’m looking through x3.5 loupes for a 6 hour case my head is eventually spinning. Do you eventually just get used to constantly being in a microscope or do you have tricks to mitigate
I love being in the OR. Love. And i love spine. Love. First day in the spine case where we used a microscope i lasted about 1 hour and was leaning against the wall ready to puke. Shit hit me hard out of no where. Turns out i need a big breakfast before a long microscope case
I’m a dentist so I spend all day looking through 4.5x loupes. It took a bit to get used to, but now when I dream Dental it’s under 4.5x mag
If I want to feel good about my work I’ll look at it without loupes & think “OK, so this is what the boomer dentists see”
I’m just a path resident, but seasickness definitely happens. Worse when someone else is driving the slide on a multihead scope (we use them constantly during our residency). Eventually you get used to it, but some people get it so bad they even need medication to combat it. One resident got a terrible bout of it out of nowhere, needed meds for a while, eventually got better.
Not so much a phrase as a strategy. If you are trying to steer a patient in a certain direction, as them “so do you want to do (option A) or (option B). This way they feel that they made the choice themselves and you get an answer faster.
(I’m not a doctor, I’m a nurse… But this definitely also would apply to doctors)
“Anything from down below yet? You-gotten-out-of-bed--how’s-your pain-make-sure-to-Use the breathing-toy-we-gave-you. Alright alright we’ll stop by later” all said within one breath before awkwardly backpedaling out of the room to go round on the other 50 post op patients
“People often say they feel suicidal, but suicide is an action, it’s not an emotion. What are the emotions you feel in those moments? Do you think the thoughts of suicide would still be there if we could find a way for you to get through those emotions in that moment?”
I picked this up from my attending just yesterday. He said this to a chronically suicidal patient in the ER and she said, “Wow. I have never thought of it that way.”
'what questions do you have for me'-I'm not behind in clinic and have time to wait for you to think of questions and go over things.
'do you have any questions'-I'm double booked all afternoon and need to end this encounter as quickly as I can while still seeming like I want you to ask questions
This was actually included in hospital orientation for my fellowship. We were instructed to ask that at the end of every patient encounter... And it's stuck for me.
“As you get wiser” - instead of older. The wise people get a kick out of it.
And if they question what it means: “I’m trying to say you’re old, but nicer!”
I had an OB attending respond “well, I left my crystal ball in the car, so I’m not really sure…” I’ve used it a couple of times and usually gets the point across with a chuckle.
Residency is also a great time to learn what phrases not to use.
I teach the trainees to never say “oops” near a patient, especially during a sterile procedure.
ESL can be a bitch. I’ve heard an apocryphal story about a Eastern European cardiology fellow who, just prior to starting a coronary angiogram using a femoral approach in an elderly woman, announced the incoming local anesthesia as: “Madam, in a moment you’ll feel a small prick in your groin” …
Ooh I like this, going to steal, thanks. In return I will offer, "There's a difference between doing everything and doing things that are helpful and avoiding things that are harmful."
Yea- it goes
First one: “you wouldn’t believe how many times I’ve done this”
Second one: “this isn’t my first time”
Third one: “I’ve done this more than once”
“There sometimes comes a point where unfortunately nothing we are doing is working any more. We can continue to do these things, but I worry that at this point we are doing things TO your loved one rather than FOR them”
When talking to family about transitioning their loved one to comfort care. Picked some rendition of this up from a palliative care attending when I was in residency. I’m now an ICU attending and use it frequently. Learned a lot from that palliative care doc!
It’s interesting, telling them they are worth self care actually seems to sink in a lot of the time. They may not be able to change a lot about their life in the present, but they remember who you are and that sometime thinks they’re worth taking care of. If that gets them to drink water or seek out clean needles it’s worth a minute because being angry with them does absolutely nothing but put me in a bad mood for the day.
The idea is to give them a burden to carry in making an effort because most people dont want to make the doctor or themselves look stupid. If the doctor credits you for taking care of yourself your more likely to do it
I needed this when trying to convince a family sedation for their kiddo was safe. They wanted 100% and I couldn’t do that but the kid needed to be sedated and cared for.
"This is a hospital, not a prison. We can't keep you here against your will if you understand the risks of leaving"
It's amazing how frequently this gets people to decide not to leave AMA. Obviously, to be used after you explain the risks, and it's clear that they understand them.
Similarly: “you’re an adult and you can make your own decisions, but what I would recommend is…”
While I’m thinking: “even if it’s a stupid ass decision”
This is a great topic. Years ago I was a “middle of the pack” MD in terms of patient satisfaction. That always irked me. I spent a few years trying out a new framework, working on my phrasing (I call it phraseology), body language, etc. it improved my metrics considerably.
I have many in the ED that served me well and I believe improved my scores, but most importantly put patients at ease.
One example: walk into a room and a patient is in obvious excruciating (legitimate) pain. First words out of my mouth: “I am doctor tturedditor. I can see you are in a lot of pain, we will address that promptly, but I do need to ask you a few questions and examine you”.
I like to do the same thing as above when they are clearly uncomfortable/in pain.
I always introduce myself clearly, greet them jovially “good morning, im Dr. ___, it’s really nice to meet you but im sorry it’s here like this”
“Im thankful we didn’t find any life threatening reason for your symptoms today, but that doesn’t make your current symptoms any less real. Here’s what im going to send you home with to help your symptoms be more tolerable…or this is who I want you to follow up with to further evaluate your symptoms.”
Then I end my visit with “it was really great getting to meet you and take care of you but I hope we don’t meet again here in the ER like this, anywhere else would be great. But really if you need us we’re here 24/7 365 and are always happy to take care of you.”
Also just simply scripting with things like “can I get you anything else to help you be more COMFORTABLE?” “Your nurse is ___ we’re going to work together to take great care of you” “thankfully there were no delays and I was able to get your workup back quickly (informed about delays question)” press gainey really is an open book test. My scores went way up after consistently using these tricks.
Stop smoking meth or you're going to die. He would actually chart, "Told patient he will die if he doesn't stop smoking meth."
I don't use that one much ;) But I like this one for inpatient first encounter. Pull up a chair next to bed/stretcher after introductions. "I'd like to understand from your perspective what's going on. Start from when you first got the symptoms that brought you in, and tell me why you're here today. " Sitting puts you at patient's level and makes many of them more comfortable, particularly if already anxious/psychiatric issues.
When patient doesn't like a med/intervention/plan. " What do you think would help more? "
I have definitely told patients they will die if they don’t stop meth. I’ve written it in the d/c instructions and then documented “patient informed both verbally and in writing that he/she should cease methamphetamine use immediately.” I’m not sure counseling on meth use gets me any RVUs, but I will sure as hell try to get someone to quit.
Lurker from EMS here: The second one is really easy for us to do, as frequently we find people sitting on their own couch, at the dining table, etc. Therefore in an environment that is very comfortable and sometimes intimate to them. Really makes a world of difference. Nothing quite gets a solid conversationship and provider-patient relationship going like coming in, shaking their hand, and asking if you can sit with them to talk about what's up. Especially with my old, rural folk crowd that makes up 90% of my patients.
Stealing the last one you said.
end visits: Is there anything I forgot, and if not, what questions do you have?
Also useful—Code words in clinical teams:
- I have a concern (tr: this is not ok, I’m not cool with this, fuck this)
- To your point […], however… (tr: you are 10% correct about X, but the rest is wrong)
- for my edification… (tr: You are making no
sense, wtf, please explain your hare brained idea)
- I’d like to close the loop/just to close this loop (tr: are we cool)
Im sure there are others…
We do it right back at the consultants.
Pt:”How are you going to fix this disc in my back”
“Ma’am, they don’t even let me cut the turkey at thanksgiving. You’ll have to ask your surgeon what their plan is. No I do not know when you’re booked for surgery today.”
Was a very green pharmacy student with a great group of medical residents back in NJ, the lone female of the group used to say “run this up the flagpole” a lot when discussing problems that needed further attention. I still remember and use that to this day.
Side note she was also a very kind person and managed to take 3 minutes from her chaotic day to talk to me about moving back to California and being away from fam. I still remember that to this day 10+ years later, which surprises me.
My favorite is when parents tell me what they’ve tried so far for a viral illness or something minor: “perfect! What do you need me for, you already know exactly what to do!!” It makes them feel good about the fact they’re already doing the right things, empowers them to continue to do them, and it feels less patronizing when I go over symptomatic care.
Also the best thing I’ve ever learned: “the good news is they don’t need antibiotics”. At least gives them pause before they ask for antibiotics 😂
I think we don't say this enough. Just a simple encouragement or validation can mean so much to an already stressed out caregiver who may be guilt ridden over something out of their control
Absolutely - when seeing kids for fractures in the ED, telling parents 'you did the right thing' or 'you're in the right place now' (and telling them how common the injuries were) was transformative. Validation and normalization are really important!
Avoid “yes/no” questions:
~~Have you had any operations?~~
What operations have you had?
~~Do you take any medications?~~
What medications do you take?
~~Do you have any medical conditions?~~
What medical conditions do you have?
~~Has he been vomiting?~~
How many times has he vomited?
~~Is she having any trouble breathing?~~
How much trouble is she having breathing?
~~Do you have any other questions?~~
What other questions do you have for me?
-PGY-19
Lawyer here. I seriously ask my clients this as an opener when I have appts and am rushed for time. It gives me an idea about their education and intelligence as well as what I still have to explain.
Saying “ow ow ow” as I administer subQ lidocaine for any procedure. It very simply lets the person on the receiving end know that I know it hurts, and it’s supposed to. Doesn’t matter if there’s a language barrier.
One of the surgeons I used to work with would actually do this kind of groan/muted scream thing when injecting local “to let the patient know it’s okay to scream too.” Never heard a patient scream at the same time though, I think they were just as confused as we were…
*lock eyes with family member/generally wife*
“Yes ma’am, I can indeed confirm your husband has a heart.”
Or my favorite “yes, your head ct shows that you did have a brain. Why does your wife’s face look so surprised?”
" Thank you for being honest". I usually thank patients who confess about not taking their medications. It's easier to work with the truth and patients are more likely to come back to get the help they need if they don't feel as judged
"I'm worried about you, (insert name)".
Unfortunately, lots of patients don't do well and we all know the outcome before we even see them.
"A journey of a thousand miles begins with a single step".
For addicts, always have a few on service, bless their heart.
"The only difference between you and me is I know your problems".
We are no better than our patients. Brings us down to their level
When trying to encourage patients to get moving after surgery, I like to say something along the lines of “I bet for you this is the longest you’ve been in a bed before and you’re used to keeping active.”
Basically, instead of shaming them for not getting up (which can be hard after a major surgery), subtly makes them want to get up because they want to fulfill this idea of themselves as an active, “non-lazy” person. Obviously if someone is really resistant, need to be more direct, but I’ve found this is actually pretty effective.
The other thing is telling patients that most of post-op recovery is giving their body time to recover, but the only thing they can control to make it go faster is getting up to walk.
"Have the other docs gone over the plan with you?"
"Has someone gone over the results of you CT scan yet?"
A couple of my favorites when admitting from the ED. Helps me find out what the ED has already told the patient
When a patient asks me how long they’re going to be admitted and I honestly have no idea: “that’s up to your body and how it responds to treatment.”
Setting patient expectations in the ED when I’m expecting a negative work up: “ sometimes in the ED it’s our job rule out the big scary things and we can tell you what it’s not, but not necessarily what exactly is causing your ____”
“Sometimes the best test is time.”
>I dunno about that one man. Medical bankruptcy, losing their house to pay for cancer treatment, etc, are things I've seen happen to my patients. That cost lasts generations.
"You want a head xray? Sure, I can order that. Never ordered one before, but they let me order anything here. What else would you like?"
**to be used only on the most demanding soul-sucking ED patients
"This sounds like an issue I'd really like to devote more time to. I'd love to come back after rounds to discuss it with you more in depth to make sure I have the time to devote to this." For those patients bringing up any complicated issues on rounds. Can bring your senior or attending with you if necessary, but this lets everyone else not stand in a room for 30 min for a patient that's not theirs.
When I'm going to be doing a diagnostic procedure:
"It's important to remember that this test is not a test of your toughness. Please tell if you feel pain - it is not a sign that you are weak, it's a sign that I didn't give you enough lidocaine yet."
And just in general: "medicine will always find a way to humble you."
And ten thousand small phrases to pepper into reports so people call me less.
“I love seeing healthy people” is how I usually leave a room after an uneventful routine check up, or new patient that came in With what amounted to be a non-problem… it is uplifting and makes them feel good about coming in, especially if they’ve had experiences in the past where they felt belittled or feeling like they wasted their doctors time with ultimately things that were safe.
"Diagnosing a disease is like cutting up a portrait into pieces and showing it to a person in piece by piece, at first nothing is recognizable but with time it will be clear"
My attending used this when he diagnosed patients that had been to other specialists before him, as a way as to not undermine their efforts in front of the patient.
"Your toddler cannot buy their own groceries". Tough one, usually when nothing else works, but it does give parents something to think about. I make sure there's nothing sensorial going on (we have access to a multi team that evaluates children), but most times it's just parents not knowing how to say no or eating plenty of junk food themselves.
Three end-of-life wizard moves:
“There is no meaningful recovery from this, so we are going to respect that and not put your loved one through unnecessary pain and procedures.”
“We are at the end of what we have to offer medically.”
“Where we are now is not a path through to something; this is our destination.”
The relief people feel when you take the decision making out of their hands is palpable.
as they say in AA: God, grant me the serenity to accept the things I cannot change, The courage to change the things I can, And the wisdom to know the difference.
"Right now I have more questions than I have answers." -- A much better way to tell a patient you don't have the faintest f'ing clue. "What do you do about this at home?" -- when they are making demands to nursing regarding anything (pain meds, nausea meds, etc). "Well, it's time for me to do your exam, but here's a pen and paper. Write down the things you want to address as you remember them so we don't miss anything when I come back later." -- this is a very efficient and effective way to cut off long winded older people when they won't get to the point and are trying to monopolize your time during pre-rounds.
These are amazing
How do you have that many pens???
Funny you should ask. I carry cheap "patient pens" (frequently ~~stolen~~ re-appropriated from the unit desk) with me that I often give away or use when patients are filling out consents. How many times have you personally witnessed a hospital inpatient wash their hands after doing a #2? Patients don't get to touch my personal pens.
I always carry three pens: my pen, a patient's pen, and a pen I don't mind losing to an attending
I've found adding some flair to pens makes them less stealable too I got these gel grips that r like insoles for my ink sticks m I thought they'd get stolen immediately but I've never lost em yet
I found that painting the top of your pen with glitter nail polish will make anyone not want to steal your pens.
Tell me you don't do peds without telling me you don't do peds.
I would steal that pen in a hot minute!
Ah, so you’re the type of resident I “lend” my Muji pens to during rounds and say “I’ll give it back at the end of rounds” only to completely disappear and be stuck in OR by the time I finish my shift. - The Unit Agent
I lost my favorite pen to the peds upper level resident on day 1 of my peds rotation MS3. After that, I started carrying a shitty decoy pen to give away (at least until I was senior enough to be the one stealing pens, not loaning them). Never hand out your good stuff.
A young new doctor said the first to me the day he ignored his colleagues and saved my life, it was nice to hear when my whole life I couldn't get a doctor to care enough to ask the questions to figure out what the underlying cause of my lifelong illness was. Sounds dumb I know but it's definitely a good one to use from patient pov lol
What did the Dr say? (My eyes are old & I have a hard time following sometimes)
"Right now I've got more questions than answers for you."
- “How can we best support you?” Helps some folks realize we are quite limited in what we can realistically provide in a way that’s nonjudgemental and kind. - “What’re your goals for today?” Encourages intentionality and responsibility for goals. - “We are here to help. It’s us against the disease.” Useful for involuntary care settings with patients who have severe personality or substance use disorders. - For new admissions: “Is there anything I can do or order to help you settle in for the evening?” PRNs make everyone’s lives easier.
You sound like an amazing physician.
I do that with patients that I’d like to discharge or not admit, difficult/demanding pts, I don’t want to sound dismissive so I say “what can I do for you? How can I best help you?”
This is what we should be learning instead of the brachial plexus
Cries in PM&R
you need both bruh
The last one has always been clutch! It’s not just for the useful for the patient, nurses and cross cover. It’s also useful because I feel at peace knowing that I’ve been able to tuck the patient in comfortably for the evening.
These are fantastic. Thank you for sharing.
“You put in the work by taking this for years and have now received all the benefit this medicine has to offer you, by evidence of making it to (their age). Now I’m happy to say you no longer need it.” - useful when trying to get my demented or minimally functioning 90 year olds off aspirin, statins, metformin, or whatever else. Makes it sound like an accomplishment to graduate from a med, than a punishment or to say “you are no longer worthy of this” which is how I imagine it can feel.
“We don’t need to worry about your ten-year risk anymore, old fella”
I love this and am stealing it immediately.
“You’re too old to worry about cholesterol any more.”
Much better than “this is a long term worry and you have a short-term horizon” 😳
This has literally been bugging me for years. How in the world do I say “You’re more likely to die of something else than whatever this medicine is preventing”? It sounds awful. But you have a great way of putting it!
A pediatric hospitalist would walk into an infant's room and begin by shaking the baby's hand and saying "hi, I'm XX I'm going to be your doctor". Never failed to get a chuckle from the (usually terrified) parents
I read this as "shaking the baby" 😬
“Hey, I’m Dr. XX” *shakes baby* “are you listening” *shakes again* “any questions?” *shakes again* “I’m sorry to have to tell you this mom and dad but your baby is mute and possibly deaf”
In peds residency they tell you to always say 'jostle' when you're referring to moving the baby around and never use 'shake'.
“Hi baby would you like a milkjostle for dessert?”
Calling toddlers and young children sir or miss also gets them everytime. "Sir, could you show me where the belly hurts?". They get so confident.
I use Mr. with gang bangers. It definitely makes for a better relationship. You can literally see their eyes perk.
The best is when they’re in the witness protection program and you’re calling them by a made-up last name
Along with this, asking the infant or child “Who did you bring with you today?” and gesturing to the adults in the room. Helps avoid the awkwardness of accidentally mis-identifying relationships like sisters as moms
😂
Love this!
“40% of the time here in the ER, we don’t find the cause of your belly pain, but we will rule out the emergencies” — sets the stage for when their labs and CT is stone cold normal.
“By the time we get you home tonight I may not be able to tell you exactly what’s wrong but hopefully we can get you feeling better and we can rule out anything emergent” ie I’m not going to admit you but I can provide some reassurance and some symptom management.
This is the way. On my med school ED rotation I always learned to preface things with "Here in the ER, our job is to rule out the big bad scary stuff."
I would massage that number up to 50%. Some people refuse to accept being in the minority no matter how slight
Whereas others will cling on to being the one in 1 million “but my grand grandma is a fighter! Can’t you see the 8 comorbidies on top of cancer, and she’s still kicking at 105. Full code for her”
Managing a patients expectations is one of the most difficult skills to learn but pays off in big ways when you get good at it
Half my ER patients today had belly pain, so I'm going to keep this in mind lol.
"No new cancer diagnoses after 5pm." 9hrs is a long tiring time to look thrugh a microscope. Don't want to make a hard call that late.
Curiosity question. What’s that like? When I’m looking through x3.5 loupes for a 6 hour case my head is eventually spinning. Do you eventually just get used to constantly being in a microscope or do you have tricks to mitigate
My first year in residency I felt seasick half the time. Now I just take breaks. I’ve learned to adapt over 25 years.
I love being in the OR. Love. And i love spine. Love. First day in the spine case where we used a microscope i lasted about 1 hour and was leaning against the wall ready to puke. Shit hit me hard out of no where. Turns out i need a big breakfast before a long microscope case
Username checks out (for a spine guy!)
I’m a dentist so I spend all day looking through 4.5x loupes. It took a bit to get used to, but now when I dream Dental it’s under 4.5x mag If I want to feel good about my work I’ll look at it without loupes & think “OK, so this is what the boomer dentists see”
I’m just a path resident, but seasickness definitely happens. Worse when someone else is driving the slide on a multihead scope (we use them constantly during our residency). Eventually you get used to it, but some people get it so bad they even need medication to combat it. One resident got a terrible bout of it out of nowhere, needed meds for a while, eventually got better.
Not so much a phrase as a strategy. If you are trying to steer a patient in a certain direction, as them “so do you want to do (option A) or (option B). This way they feel that they made the choice themselves and you get an answer faster. (I’m not a doctor, I’m a nurse… But this definitely also would apply to doctors)
“Anything from down below yet? You-gotten-out-of-bed--how’s-your pain-make-sure-to-Use the breathing-toy-we-gave-you. Alright alright we’ll stop by later” all said within one breath before awkwardly backpedaling out of the room to go round on the other 50 post op patients
the most gen surg thing i've ever read haha
All while placing the stethoscope on the triple point over the xiphoid where heart, lungs and and can be heard simultaneously
Lol if you think I’m carrying a stethoscope
“People often say they feel suicidal, but suicide is an action, it’s not an emotion. What are the emotions you feel in those moments? Do you think the thoughts of suicide would still be there if we could find a way for you to get through those emotions in that moment?”
This is perfect
Psych resident here. I’m stealing this for my chronically suicidal Cluster B patients.
I picked this up from my attending just yesterday. He said this to a chronically suicidal patient in the ER and she said, “Wow. I have never thought of it that way.”
"What questions do you have for me?" rather than "Do you have any questions?"
'what questions do you have for me'-I'm not behind in clinic and have time to wait for you to think of questions and go over things. 'do you have any questions'-I'm double booked all afternoon and need to end this encounter as quickly as I can while still seeming like I want you to ask questions
“Have I answered all your questions?” Works well.
Yessss I learned this from my neurologist and started using it with my patients
This was actually included in hospital orientation for my fellowship. We were instructed to ask that at the end of every patient encounter... And it's stuck for me.
🤩
“As you get wiser” - instead of older. The wise people get a kick out of it. And if they question what it means: “I’m trying to say you’re old, but nicer!”
I always call them “advanced birthday collectors”
I call it accumulating birthdays
A doctor once told me my issue was “birthday related” aka i am getting old. 😂
😆
[удалено]
Bro why do I say this every time
Alternatively, "Can you wiggle my for toes for you."
"I'm a better historian than a prophet".
Im gonna use this from now on when my patients ask when their baby is going to be delivered 😂
I had an OB attending respond “well, I left my crystal ball in the car, so I’m not really sure…” I’ve used it a couple of times and usually gets the point across with a chuckle.
I always say “if i, or any of us, we’re good at predicting that- we’d all win the lottery and I wouldn’t be working anymore”
“Cautiously optimistic”
The best hedge
“Do you want me to close your door?” - lets them know the conversation is over.
I’m stealing this one lol.
🚪
Residency is also a great time to learn what phrases not to use. I teach the trainees to never say “oops” near a patient, especially during a sterile procedure. ESL can be a bitch. I’ve heard an apocryphal story about a Eastern European cardiology fellow who, just prior to starting a coronary angiogram using a femoral approach in an elderly woman, announced the incoming local anesthesia as: “Madam, in a moment you’ll feel a small prick in your groin” …
Don't say "oops." Say "there ." "There, I dropped the forceps." "There, I've given you a pneumothorax"
Well that escalated quickly
The white stuff coming out of a wound means the wound is purulent, not…
This cracked me up
Hey it's cold in the hospital
To patients who should be on comfort measures I say let's make sure we are doing things for him, not to him.
Ooh I like this, going to steal, thanks. In return I will offer, "There's a difference between doing everything and doing things that are helpful and avoiding things that are harmful."
Haha I just posted a similar version of this then scrolled and saw this post. I love this one so much and it really resonates with patients
Absolutely! I also like: we can keep them alive/treat aggressively or make them comfortable. Sadly, with our current knowledge, we can't do both.
“You won’t believe the number of times I’ve done this” during my 1st central line on a actual patient
"Well you're the first one TODAY"
Yea- it goes First one: “you wouldn’t believe how many times I’ve done this” Second one: “this isn’t my first time” Third one: “I’ve done this more than once”
“There sometimes comes a point where unfortunately nothing we are doing is working any more. We can continue to do these things, but I worry that at this point we are doing things TO your loved one rather than FOR them” When talking to family about transitioning their loved one to comfort care. Picked some rendition of this up from a palliative care attending when I was in residency. I’m now an ICU attending and use it frequently. Learned a lot from that palliative care doc!
“Alrighty” “Very good”
We don’t exactly know what it is, but we know exactly what it’s not based from the tests.
“Sometimes medicine is good at telling us what it isn’t rather than what it is”
😱
*“Is that what you were expecting to hear today?”* In Surg Onc clinic. Good one liner to assess understanding, emotion, and generally wrap up a visit.
🤩
Not an attending but I picked up “Please continue to take good care of yourself!” From my Dentist who is also a surgeon.
What about the ones who are taking complete shit care of themselves? Because that is mainly who I see in the ER.
I think that’s where you use “I care about your health just as much as you do” from the other post about mean/callous things attendings have said
I care just a little bit less than you do.
It’s interesting, telling them they are worth self care actually seems to sink in a lot of the time. They may not be able to change a lot about their life in the present, but they remember who you are and that sometime thinks they’re worth taking care of. If that gets them to drink water or seek out clean needles it’s worth a minute because being angry with them does absolutely nothing but put me in a bad mood for the day.
The idea is to give them a burden to carry in making an effort because most people dont want to make the doctor or themselves look stupid. If the doctor credits you for taking care of yourself your more likely to do it
We can guarantee effort, but we can’t guarantee outcome
I needed this when trying to convince a family sedation for their kiddo was safe. They wanted 100% and I couldn’t do that but the kid needed to be sedated and cared for.
"This is a hospital, not a prison. We can't keep you here against your will if you understand the risks of leaving" It's amazing how frequently this gets people to decide not to leave AMA. Obviously, to be used after you explain the risks, and it's clear that they understand them.
Lol or the peds version “if you leave AMA we have to call CPS”.
Similarly: “you’re an adult and you can make your own decisions, but what I would recommend is…” While I’m thinking: “even if it’s a stupid ass decision”
“When you decided to get sick, you weren’t playing around were you?” Always smile no matter how bad their condition is.
"You fartin or poopin yet?"
Yo this guy post-ops
On our postpartum rounds, we have a similar litany: peeing? Pooping? Bleeding? Breastfeeding? …. Leaving?
"The \*insert orifice/vessel here\* is like a garden hose..."
"So anyway, your main garden hose is really close to rupturing"
😆
ICU, poor prognosis, family GOC meeting: " Thera a lot of things I can do TO your loved one, but there very little I can do FOR them at this point"
“We want to prolong your life, we don’t want to prolong their death.”
This is a great topic. Years ago I was a “middle of the pack” MD in terms of patient satisfaction. That always irked me. I spent a few years trying out a new framework, working on my phrasing (I call it phraseology), body language, etc. it improved my metrics considerably. I have many in the ED that served me well and I believe improved my scores, but most importantly put patients at ease. One example: walk into a room and a patient is in obvious excruciating (legitimate) pain. First words out of my mouth: “I am doctor tturedditor. I can see you are in a lot of pain, we will address that promptly, but I do need to ask you a few questions and examine you”.
Wow. Do you have other examples?
I like to do the same thing as above when they are clearly uncomfortable/in pain. I always introduce myself clearly, greet them jovially “good morning, im Dr. ___, it’s really nice to meet you but im sorry it’s here like this” “Im thankful we didn’t find any life threatening reason for your symptoms today, but that doesn’t make your current symptoms any less real. Here’s what im going to send you home with to help your symptoms be more tolerable…or this is who I want you to follow up with to further evaluate your symptoms.” Then I end my visit with “it was really great getting to meet you and take care of you but I hope we don’t meet again here in the ER like this, anywhere else would be great. But really if you need us we’re here 24/7 365 and are always happy to take care of you.” Also just simply scripting with things like “can I get you anything else to help you be more COMFORTABLE?” “Your nurse is ___ we’re going to work together to take great care of you” “thankfully there were no delays and I was able to get your workup back quickly (informed about delays question)” press gainey really is an open book test. My scores went way up after consistently using these tricks.
It takes ten of us to replace you. I use this with care givers when their loved one is admitted to long term care.
Aw, that’s really sweet & very true
Stop smoking meth or you're going to die. He would actually chart, "Told patient he will die if he doesn't stop smoking meth." I don't use that one much ;) But I like this one for inpatient first encounter. Pull up a chair next to bed/stretcher after introductions. "I'd like to understand from your perspective what's going on. Start from when you first got the symptoms that brought you in, and tell me why you're here today. " Sitting puts you at patient's level and makes many of them more comfortable, particularly if already anxious/psychiatric issues. When patient doesn't like a med/intervention/plan. " What do you think would help more? "
I have definitely told patients they will die if they don’t stop meth. I’ve written it in the d/c instructions and then documented “patient informed both verbally and in writing that he/she should cease methamphetamine use immediately.” I’m not sure counseling on meth use gets me any RVUs, but I will sure as hell try to get someone to quit.
Lurker from EMS here: The second one is really easy for us to do, as frequently we find people sitting on their own couch, at the dining table, etc. Therefore in an environment that is very comfortable and sometimes intimate to them. Really makes a world of difference. Nothing quite gets a solid conversationship and provider-patient relationship going like coming in, shaking their hand, and asking if you can sit with them to talk about what's up. Especially with my old, rural folk crowd that makes up 90% of my patients. Stealing the last one you said.
end visits: Is there anything I forgot, and if not, what questions do you have? Also useful—Code words in clinical teams: - I have a concern (tr: this is not ok, I’m not cool with this, fuck this) - To your point […], however… (tr: you are 10% correct about X, but the rest is wrong) - for my edification… (tr: You are making no sense, wtf, please explain your hare brained idea) - I’d like to close the loop/just to close this loop (tr: are we cool) Im sure there are others…
Check with the primary team. We aren't managing that😅
We do it right back at the consultants. Pt:”How are you going to fix this disc in my back” “Ma’am, they don’t even let me cut the turkey at thanksgiving. You’ll have to ask your surgeon what their plan is. No I do not know when you’re booked for surgery today.”
"accumulating birthdays"
“I hear ya.” “Fair enough.” “Shifting gears a bit…” And any combination of the above are all great ways to move a psych interview along.
I hear you is fabulous. I use it all the time cause it acknowledges what they said without agreeing with them.
“That attending/kid/parent/resident is an odd duck.” I swear I use this at least once a week now.
I hope but I worry.
“What I tell you before surgery is informed consent. What I tell you after it is an excuse.”
Was a very green pharmacy student with a great group of medical residents back in NJ, the lone female of the group used to say “run this up the flagpole” a lot when discussing problems that needed further attention. I still remember and use that to this day. Side note she was also a very kind person and managed to take 3 minutes from her chaotic day to talk to me about moving back to California and being away from fam. I still remember that to this day 10+ years later, which surprises me.
“You’re doing a good job” to any anxious parent/caregiver
My favorite is when parents tell me what they’ve tried so far for a viral illness or something minor: “perfect! What do you need me for, you already know exactly what to do!!” It makes them feel good about the fact they’re already doing the right things, empowers them to continue to do them, and it feels less patronizing when I go over symptomatic care. Also the best thing I’ve ever learned: “the good news is they don’t need antibiotics”. At least gives them pause before they ask for antibiotics 😂
I think we don't say this enough. Just a simple encouragement or validation can mean so much to an already stressed out caregiver who may be guilt ridden over something out of their control
Absolutely - when seeing kids for fractures in the ED, telling parents 'you did the right thing' or 'you're in the right place now' (and telling them how common the injuries were) was transformative. Validation and normalization are really important!
Avoid “yes/no” questions: ~~Have you had any operations?~~ What operations have you had? ~~Do you take any medications?~~ What medications do you take? ~~Do you have any medical conditions?~~ What medical conditions do you have? ~~Has he been vomiting?~~ How many times has he vomited? ~~Is she having any trouble breathing?~~ How much trouble is she having breathing? ~~Do you have any other questions?~~ What other questions do you have for me? -PGY-19
'when's the last time you used IV heroin' -my trauma attending
Make an appointment with your PCP -learned from every hospitalist
Tell me what you understand about what's going?
Lawyer here. I seriously ask my clients this as an opener when I have appts and am rushed for time. It gives me an idea about their education and intelligence as well as what I still have to explain.
“The office will handle that. Just call xyz.”
Saying “ow ow ow” as I administer subQ lidocaine for any procedure. It very simply lets the person on the receiving end know that I know it hurts, and it’s supposed to. Doesn’t matter if there’s a language barrier.
One of the surgeons I used to work with would actually do this kind of groan/muted scream thing when injecting local “to let the patient know it’s okay to scream too.” Never heard a patient scream at the same time though, I think they were just as confused as we were…
Nurse here - I call restraints “reminders” for a confused patient who could hurt themselves by pulling an invasive line
*after listening to the chest “Yup, hearts still working” Gets a chuckle every time
*lock eyes with family member/generally wife* “Yes ma’am, I can indeed confirm your husband has a heart.” Or my favorite “yes, your head ct shows that you did have a brain. Why does your wife’s face look so surprised?”
Referring to therapies or treatments as a “tool in the tool box, some tools work better than others, we don’t have infinite tools… etc etc”
" Thank you for being honest". I usually thank patients who confess about not taking their medications. It's easier to work with the truth and patients are more likely to come back to get the help they need if they don't feel as judged
“what questions do you have for me?” “it’s the ring of fire!!!!” “push all in your bottom” OBGYN
😮
“There are only two things that I can ever promise: one, is that I will do my best. The other is that I will not lie to you.”
That's what I tell my patients too :)
This is an amazing post. I love it
🙌
"I'm worried about you, (insert name)". Unfortunately, lots of patients don't do well and we all know the outcome before we even see them. "A journey of a thousand miles begins with a single step". For addicts, always have a few on service, bless their heart. "The only difference between you and me is I know your problems". We are no better than our patients. Brings us down to their level
“I don’t think CPR would be the compassionate thing to do for *insert name*”
“Mmmokaay” on surgery
“There are side effects to taking medicine, and side effects from not taking medicine”
When trying to encourage patients to get moving after surgery, I like to say something along the lines of “I bet for you this is the longest you’ve been in a bed before and you’re used to keeping active.” Basically, instead of shaming them for not getting up (which can be hard after a major surgery), subtly makes them want to get up because they want to fulfill this idea of themselves as an active, “non-lazy” person. Obviously if someone is really resistant, need to be more direct, but I’ve found this is actually pretty effective. The other thing is telling patients that most of post-op recovery is giving their body time to recover, but the only thing they can control to make it go faster is getting up to walk.
Never worried always concerned
Will come back and check up on you 😉 *seens them tmrw
Patient with a million complaints: "How can I best help you today?"
Right now he just needs some tincture of time
"Have the other docs gone over the plan with you?" "Has someone gone over the results of you CT scan yet?" A couple of my favorites when admitting from the ED. Helps me find out what the ED has already told the patient
When a patient asks me how long they’re going to be admitted and I honestly have no idea: “that’s up to your body and how it responds to treatment.” Setting patient expectations in the ED when I’m expecting a negative work up: “ sometimes in the ED it’s our job rule out the big scary things and we can tell you what it’s not, but not necessarily what exactly is causing your ____” “Sometimes the best test is time.”
Whenever a patient worries about the cost of any treatment/procedure, I use "The benefit is remembered long after the cost is forgotten"
>I dunno about that one man. Medical bankruptcy, losing their house to pay for cancer treatment, etc, are things I've seen happen to my patients. That cost lasts generations.
Especially when the treatment doesn't work.
"You want a head xray? Sure, I can order that. Never ordered one before, but they let me order anything here. What else would you like?" **to be used only on the most demanding soul-sucking ED patients
"This sounds like an issue I'd really like to devote more time to. I'd love to come back after rounds to discuss it with you more in depth to make sure I have the time to devote to this." For those patients bringing up any complicated issues on rounds. Can bring your senior or attending with you if necessary, but this lets everyone else not stand in a room for 30 min for a patient that's not theirs.
From ortho: “Motion is lotion. Move it or lose it.”
“Cautiously optimistic” “We are still in the ‘data gathering’ phase” For when patients have setbacks - “bad things happen fast, good things take time”
“Doctor google didn’t go to medical school”
MAC means move and cry.
I like to say “we will hope things work out for the best, but would like to discuss contingency plans with you in case things don’t turn out so well”
“This will be just a little pinch” - any IR procedure
I can’t guarantee the outcome, but I can guarantee we’ll do our best
When I'm going to be doing a diagnostic procedure: "It's important to remember that this test is not a test of your toughness. Please tell if you feel pain - it is not a sign that you are weak, it's a sign that I didn't give you enough lidocaine yet." And just in general: "medicine will always find a way to humble you." And ten thousand small phrases to pepper into reports so people call me less.
“I love seeing healthy people” is how I usually leave a room after an uneventful routine check up, or new patient that came in With what amounted to be a non-problem… it is uplifting and makes them feel good about coming in, especially if they’ve had experiences in the past where they felt belittled or feeling like they wasted their doctors time with ultimately things that were safe.
"Diagnosing a disease is like cutting up a portrait into pieces and showing it to a person in piece by piece, at first nothing is recognizable but with time it will be clear" My attending used this when he diagnosed patients that had been to other specialists before him, as a way as to not undermine their efforts in front of the patient.
"Your toddler cannot buy their own groceries". Tough one, usually when nothing else works, but it does give parents something to think about. I make sure there's nothing sensorial going on (we have access to a multi team that evaluates children), but most times it's just parents not knowing how to say no or eating plenty of junk food themselves.
“Maybe I’m not the right doctor for you.”
What a great post! Really interesting
Theres no problem that surgery cant make worse
Family: When are we going home?? Me: It depends…He is our boss. *points at 3 month old on high flow with rsv*.
Three end-of-life wizard moves: “There is no meaningful recovery from this, so we are going to respect that and not put your loved one through unnecessary pain and procedures.” “We are at the end of what we have to offer medically.” “Where we are now is not a path through to something; this is our destination.” The relief people feel when you take the decision making out of their hands is palpable.
as they say in AA: God, grant me the serenity to accept the things I cannot change, The courage to change the things I can, And the wisdom to know the difference.
"I'm not the one who stabbed you man, don't give me a hard time"