Opening Remarks

\"eeerik_estrada\" I was never too good at opening lines. \”Hey baby, you come here often?\” \”What\’s your sign, beautiful?\” No, that\’s not me. Perhaps that is why I didn\’t date much. Now, however, I must be good at opening lines. My job depends on my ability to talk to my patients and get them to talk to me. Sometimes it goes well, other times it doesn\’t.
For example, sometimes I walk into a room with a person looking ill and out of habit I ask them \”how are you doing?\” Obviously not well, since they are in my office, right? But out of habit, they usually respond, \”Fine, how are you?\”

Sometimes it is the patient who initiates. Last week I had several patients say to me, \”Doc, you look more stressed out than I am.\” I really didn\’t feel that stressed on that day. It made me very self conscious about what non-verbal message I was sending. I try to avoid saying things like, \”You look tired today!\” I may say it, but only after I have talked to them for a bit.

\"fatalbert\" I have also had patients comment on my weight, which has gone up and down. One lady was somewhat rude and said, \”My word, Doctor, you look pregnant!\” I was so taken back by her forwardness that I had a hard time gathering myself for the conversation. I suppose people feel that I put them on the scale, so I am fair game. I have more than once had some people say that I look like I have gained weight only to have a subsequent room tell me that I must be losing. I try to take it in stride as best as I can.

One of my favorite things people say to me is: \”Don\’t come near me, Doc. You don\’t want to catch what I have!\” I give them a quizzical look and say, \”It\’s really somewhat normal for a doctor to be around sick people.\” Why would you come to the doctor and then have them stay away? I guess they are being polite, but it is somewhat humorous when that say it.

Another common encounter is with the impatient patient. They are checking their watch and wondering what took me so long. If they confront me as to what took me so long, I usually try to disarm them and say something like, \”Well, I was really trying to avoid seeing you. My nurses kept harassing me, however, and I had to give in and see you.\” I do this if I know the patient well enough. Otherwise I will say, \”You got in the slow check-out line in the supermarket. It just happens some days – we can\’t predict how much time each visit will take, but regardless, I will always give you the time you need.\” They seem happy with that answer.

\"e84f96d7d4dbabbfc42c431a31a86491\" In general, however, I try to enter with a compliment. If it is a baby I am seeing, I will say something like, \”hey there cutie!\”, or \”Hey beautiful!\” I also like to say \”Hi there, skinny\” to the particularly chubby baby. For adults, I will try to find something to compliment. My elderly ladies are very pleased when I compliment what they are wearing. In general, my African-American elderly ladies still believe you should dress up to come to the doctor. I like that.

Some patients have built their world around their medical condition. To them, their way of getting attention is to highlight their problems. To these people, I am always finding something good to dote on before they can complain. If I can give them some attention for reasons other than their sickness, perhaps some day they will come in without complaints. That is my dream for them (albeit far off).

I get about 90% of my information for decision-making from my discussion with my patients. History is always more important than physical. Saying the right things at the start will make that job much easier.

Besides, I don\’t really want my patients to \”come here often.\” My goal is to keep them out.

25 thoughts on “Opening Remarks”

  1. I am guilty of telling my doctor he looks tired but I’ve know him 35 years. The doc that is doing my heart ablation on the other hand looks about 100 lbs overweight but I’d never say anything to him about it. He’s in the business, he knows the risks. Nice blog…ciao

  2. I am guilty of telling my doctor he looks tired but I’ve know him 35 years. The doc that is doing my heart ablation on the other hand looks about 100 lbs overweight but I’d never say anything to him about it. He’s in the business, he knows the risks. Nice blog…ciao

  3. (I loved this) โ€œWell, I was really trying to avoid seeing you. My nurses kept harassing me, however, and I had to give in and see you.โ€ You know what I think of the rude pt.

  4. (I loved this) โ€œWell, I was really trying to avoid seeing you. My nurses kept harassing me, however, and I had to give in and see you.โ€ You know what I think of the rude pt.

  5. Love the blog. I found it through grand rounds this time around. I am an aspiring healthcare provider, although I haven’t chosen whether I want to pursue NP/Midwife or OB/Perinatologist. I hope it’s alright if I link to you from my blog. And stuff on my cat is the best.

  6. Love the blog. I found it through grand rounds this time around. I am an aspiring healthcare provider, although I haven’t chosen whether I want to pursue NP/Midwife or OB/Perinatologist. I hope it’s alright if I link to you from my blog. And stuff on my cat is the best.

  7. Thank you so much. I look forward to haring more of what you are doing. It is always fine to link.
    Rob

  8. Thank you so much. I look forward to haring more of what you are doing. It is always fine to link.
    Rob

  9. Very interesting. I admit I am often guilty of being the seemingly impatient patient. Your comments would go a long way in disarming me, because I normally feel like, I had to wait “all this time” only to feel rushed through my appointment so the doctor can move on.
    For me the feeling is usually that the doctor is overbooked and that is the reason for the delay and not because each patient is getting the attention the need. Maybe I just need to find someone with better examination room manners.

  10. Very interesting. I admit I am often guilty of being the seemingly impatient patient. Your comments would go a long way in disarming me, because I normally feel like, I had to wait “all this time” only to feel rushed through my appointment so the doctor can move on.
    For me the feeling is usually that the doctor is overbooked and that is the reason for the delay and not because each patient is getting the attention the need. Maybe I just need to find someone with better examination room manners.

  11. Tell you one thing, if my physician greets me with a “hey there cutie”, I ain’t getting anything checked below my belt.

  12. Tell you one thing, if my physician greets me with a “hey there cutie”, I ain’t getting anything checked below my belt.

  13. I never mind waiting if my doctor takes time with me. It’s when I’ve waited forever then I get rushed out that I get annoyed. Make me wait for 2 hours, for a 15 minute appt slot, then spend less than 5 minutes with me, and I don’t get to say 2 words … um .. hello?I saw a new doctor on Monday, she was something else … I felt like I’d stepped out of a tornado when I walked out of her office, it took me 2 or 3 hours to process what all had taken place.
    I wasn’t sure what I thought of her until I saw the eye doc she referred me to the next morning and he said “She’s something else isn’t she?”

    Ok, so it wasn’t JUST ME?

    I’ve decided I like her … I just wasn’t prepared to be the only tornado in the room ๐Ÿ˜‰

    (I’ve always said my mom was prepared for a whisper and I was born a tornado)

  14. I never mind waiting if my doctor takes time with me. It’s when I’ve waited forever then I get rushed out that I get annoyed. Make me wait for 2 hours, for a 15 minute appt slot, then spend less than 5 minutes with me, and I don’t get to say 2 words … um .. hello?I saw a new doctor on Monday, she was something else … I felt like I’d stepped out of a tornado when I walked out of her office, it took me 2 or 3 hours to process what all had taken place.
    I wasn’t sure what I thought of her until I saw the eye doc she referred me to the next morning and he said “She’s something else isn’t she?”

    Ok, so it wasn’t JUST ME?

    I’ve decided I like her … I just wasn’t prepared to be the only tornado in the room ๐Ÿ˜‰

    (I’ve always said my mom was prepared for a whisper and I was born a tornado)

  15. I often walk into a room on my first post op day of rounds. If the patient had a total knee, I’ll say something like:
    Well, your gall bladder looked terrible

    Or , how did the leg amputation go?

    Always a startle, but it gets their attention.

    One I enjoy is to ask the old guy in the hospital gown if the beautiful lady sitting next to him is his daughter. That always goes over well with the Mrs.

  16. I often walk into a room on my first post op day of rounds. If the patient had a total knee, I’ll say something like:
    Well, your gall bladder looked terrible

    Or , how did the leg amputation go?

    Always a startle, but it gets their attention.

    One I enjoy is to ask the old guy in the hospital gown if the beautiful lady sitting next to him is his daughter. That always goes over well with the Mrs.

  17. Dewd.
    We saw our primary care pediatrician today.

    It was because last week’s school conferences had the teachers rallying for upping H.’s meds. He is growing and larger than when he started on the tiny dose of Ritalin. Now they want him on bigger doses, twice per day.

    Our office visit? It went fine. We were all kinda on the same page.

  18. Dewd.
    We saw our primary care pediatrician today.

    It was because last week’s school conferences had the teachers rallying for upping H.’s meds. He is growing and larger than when he started on the tiny dose of Ritalin. Now they want him on bigger doses, twice per day.

    Our office visit? It went fine. We were all kinda on the same page.

  19. Happpy Heart Patient

    “In general, my African-American elderly ladies still believe you should dress up to come to the doctor. I like that.”
    Love your blog, and had to comment on this quote. I’m not elderly nor african american, but I always dress when I see my docs. (Guess I’m middle-aged!). To me it’s a sign of respect for your physician, and I’ve been appalled at the attire of some people I see in waiting rooms…like, what were they thinking. They say you get treated better when you look better, whether at the car dealer, shopping, or whatever.

    I’ve found it’s much easier for the docs to check pulses in your ankles (for us heart patients) when you don’t have to remove (athletic) shoes or socks. Besides, if you have great legs, why not go for it?

  20. Happpy Heart Patient

    “In general, my African-American elderly ladies still believe you should dress up to come to the doctor. I like that.”
    Love your blog, and had to comment on this quote. I’m not elderly nor african american, but I always dress when I see my docs. (Guess I’m middle-aged!). To me it’s a sign of respect for your physician, and I’ve been appalled at the attire of some people I see in waiting rooms…like, what were they thinking. They say you get treated better when you look better, whether at the car dealer, shopping, or whatever.

    I’ve found it’s much easier for the docs to check pulses in your ankles (for us heart patients) when you don’t have to remove (athletic) shoes or socks. Besides, if you have great legs, why not go for it?

  21. Diabetes Mine - the all things diabetes blog » Blog Archive » My Take: First Impressions, New Type 2 Implant, Test Strip Bidding War, and More

    […] Dr. Rob reports on the importance of a physician’s opening remarks. “Saying the right things at the start will make the job much easier.” Ya think?! […]

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