It's going to be okay
When patients see a doctor for anything other than a well checkup, they expect to end up with something. A prescription or test, perhaps. Any recommendation, even just an over-the-counter solution or dietary advice.
It takes more confidence, which comes from more experience, to tell someone they're fine (and going to continue to be that way) than to tell them they need surgery.
Many doctors don't feel comfortable enough with their assessment or knowledge to say that it will be fine in due time, but they don't want to admit that. So they order a test or start a medication (often the one the patient came in asking for).
If you know it'll be okay, just tell the patient that. Some tips:
- Empathize but don't patronize. If they ask you if it looks swollen or red, and it definitely doesn't, don't lie. Admit you don't see it, but you can see it is bothering them greatly and admit they know their own (body part) better than you do
-Suggest they keep a symptom journal, and have a friend or loved one who they trust to be completely honest with them to judge whether they think it looks swollen, red, etc.
- Try not to sound dismissive
- Sit down next to them. Get on their level
- Tell the patient they are welcome to get a second opinion
- Offer them a follow-up visit in a little while, which has two major benefits (it'll help them see you aren't just blowing them off, and if you're wrong and it turns out it WAS cause for concern you can learn from your mistakes). They may not even take you up on it, but simply offering it can make them feel much better.
- If you suspect that the patient is experiencing non-organic pathology (i.e. "supratentorial", influenced or amplified by their altered perception of reality) don't be confrontational. Don't expect them to accept you saying "it's all in your head." And don't just blow them off, either. Take the time to explain supratentorial pathology with your chosen style of explanation. Granted, you won't always have the time for that... but as long as you don't just walk out saying "you'd be better off seeing a psychologist" it's at least not the worst thing you can do.
What they don't expect is to hear "its not a problem" or "it'll be fine."
They may have spent time researching this issue they're experiencing, and certainly took time out of their day to come see the doctor (likely more time than the doctor thinks). They wouldn't do that if this wasn't a problem, right?
Not always. Plenty of patients show up with complaints that are harmless, or may resolve on their own in the near future without any intervention.
It's hard to offer the patient nothing but reassurance. "It's going to be okay" is cheap (free) and may be true, but it's often challenged with "So what should I do about it?" or "Aren't you going to order any tests? What if it's something else?" or "How can you be sure?"
It can be embarrassing for any doctor who isn't an expert in that field to struggle to try answer these questions, or worse, to admit they don't know.
It's hard to offer the patient nothing but reassurance. "It's going to be okay" is cheap (free) and may be true, but it's often challenged with "So what should I do about it?" or "Aren't you going to order any tests? What if it's something else?" or "How can you be sure?"
It can be embarrassing for any doctor who isn't an expert in that field to struggle to try answer these questions, or worse, to admit they don't know.
These challenges are good questions, but doctors don't always have the time nor patience to answer them all, I think, and may frequently just give in and order un-indicated tests, or suggest a remedy or medicine with questionable efficacy, despite often knowing that the condition is either nothing or will improve in due time.
It gets the patient out of your hair and out the door but it's frequently the wrong answer. What if that test finds some incidental lesion and the patient now spends even more time and money chasing down a "whole bunch of nothing"? Or what if the patient suffers a bad side effect from the medication? Neither of those can happen with simple reassurance.
It takes more confidence, which comes from more experience, to tell someone they're fine (and going to continue to be that way) than to tell them they need surgery.
Many doctors don't feel comfortable enough with their assessment or knowledge to say that it will be fine in due time, but they don't want to admit that. So they order a test or start a medication (often the one the patient came in asking for).
If you know it'll be okay, just tell the patient that. Some tips:
- Empathize but don't patronize. If they ask you if it looks swollen or red, and it definitely doesn't, don't lie. Admit you don't see it, but you can see it is bothering them greatly and admit they know their own (body part) better than you do
-Suggest they keep a symptom journal, and have a friend or loved one who they trust to be completely honest with them to judge whether they think it looks swollen, red, etc.
- Try not to sound dismissive
- Sit down next to them. Get on their level
- Tell the patient they are welcome to get a second opinion
- Offer them a follow-up visit in a little while, which has two major benefits (it'll help them see you aren't just blowing them off, and if you're wrong and it turns out it WAS cause for concern you can learn from your mistakes). They may not even take you up on it, but simply offering it can make them feel much better.
- If you suspect that the patient is experiencing non-organic pathology (i.e. "supratentorial", influenced or amplified by their altered perception of reality) don't be confrontational. Don't expect them to accept you saying "it's all in your head." And don't just blow them off, either. Take the time to explain supratentorial pathology with your chosen style of explanation. Granted, you won't always have the time for that... but as long as you don't just walk out saying "you'd be better off seeing a psychologist" it's at least not the worst thing you can do.
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