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.

1 Response to “One-Liners”

  1. 1 Jennifer Scott ARNP, FNP-BC May 29, 2010 at 6:15 pm

    I tend to ask very pointed questions to get the answers I’m looking for. If you just ask how are you doing, you may only get the “I’m okay” response which doesn’t tell us anything. I ask system specifics. This is how I train the nurse practitioner students that come to me. They are often amazed when I come out of the room after they are finished and find the real problem hadn’t been addressed. It’s a learned art. I like the diagnostic part of medicine. You cannot treat the patient based solely on their first complaint. Often it’s not really what’s bothering them. This unfortunately slows me down a bit but my patients appreciate the time and know that if they have to wait, it’s for a good cause.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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