Answers to patient questions may not always be simple

I used to get frustrated when patients, typically at the very end of a long visit for some other serious problem, would utter one-liners like “What can I take for headaches?” “How do I know if I have cancer?” or “Why can’t I lose weight?”

Now I have a one-liner, of sorts, myself in response to those types of questions. I usually lean back slightly, widen my eyes, nod and say:

“Now, that’s a big question that can’t be answered well in just a few words. There are even specialists in Boston who deal with nothing but that their entire careers. I could sit down with you some time and start working on it if you want.”

It is very important not to give off-the-cuff answers to questions that may seem casual. The patient may pop the question that way because of fear, or may not realize how complicated the question really is. The patient who asks for something for headaches may be the one with a brain tumor or an aneurysm, and the one who asks casually about weight may be on the verge of revealing a serious eating disorder.

A careless, quick or off-the-cuff answer, even to a seemingly off-the-cuff question, is neither therapeutic nor safe. It also devalues our profession. Not every answer we give needs to be lengthy, but every answer or intervention needs to be proportionate to the problem. A question about dandruff may be appropriately answered in a sentence or two, but certainly not a question about headaches or weight issues.

Making another appointment to deal with something the patient brings up at the last minute is not frivolous. It is good medicine. It validates the patient’s concerns and keeps the physician’s next several patients from waiting unnecessarily for the doctor to catch up.

A Country Doctor is a family physician who blogs at A Country Doctor Writes:.

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  • Anonymous

    So I could have done better when I told my patients that the cause of their distress, inability to lose weight, fear of cancer and lingering headaches was due to exposure to “fumes?”

  • IVF-MD

    CountryDoc, you hit the nail right on the head. So often, a patient undergoes an IVF cycle that was quoted to have a 50% success chance for her or even an IUI cycle that was predicted to have a 10% success chance for her. In order for a successful pregnancy to occur, everything has to go right, meaning a genetically perfect sperm must encounter a genetically perfect egg and the embryo find its way to implant in an optimized uterine lining. If it fails, the most common question/comment from the patient is “I just don’t understand why it didn’t work this time”

  • Doc D

    I agree. I can’t even figure out why they are bringing it up in this in just a couple of minutes, much less get into the substance of their concern.

    And if some patients would wonder why I care about their reasons for bringing it up, it’s because that’s frequently the key to how to proceed toward an answer (a family member with the same diagnosis, a newspaper article, a rising anxiety over their health in general, a fear they don’t want to acknowledge overtly, etc). Sometimes the “question” isn’t even the reall question they’re asking.

  • Molly Ciliberti, RN

    Thank you for realizing that in some cultures and for some people it isn’t polite to get down to your real concern until the very end. Often the thing they bring up at the end of their visit is something that is really bothering them but they are afraid to ask or embarrassed to ask. As I was about to go off duty from the ICU at 2300 I stopped to say good night to my patient, the Chief of Radiology, who had a stroke. As I was literally going out the door he said, “you wouldn’t have any advice on strokes would you?” We talked for 2 hours; he was so fearful and in his fear had forgotten everything he knew about strokes. He felt ashamed to have to ask. After he returned to work, he came to see me while I was on duty and thanked me profusely for listening and being there for him. I have never forgotten it.

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