\”He gave me the look,\” the patient said to my nurse as he walked out of the exam room.
My nurse laughed and said, \”I had a feeling you\’d get it today.\”
What were they talking about? \”What look? I didn\’t know I had a look!\” I asked my nurse.
The patient tipped his chin down and looked at me over his glasses. My nurse laughed, pointing at the patient, \”That one! Exactly! You give that look to me too!\”
I was mystified. I don\’t like lecturing people or acting like their parent. Patients do no harm to me when they gain weight, don\’t take their medications, or eat a lot of Little Debbies. My job is not to get them to do everything I say, it is to give them enough information and motivation to do it for themself. I am the coach; they are the ones who have to go out on the field and play. I may be disappointed when they mess up, but it\’s not my job to patronize them and wag my finger.
So I was vexed when I learned about \”the look.\” I\’m honestly not sure how much of it is just a product of a guilty conscience on the parts of my nurse and the patient, but there is usually at least a grain of truth in this kind of revelation. I do know that I mysteriously intimidate new employees at our office. The longer-standing ones think this is funny – realizing the softie I really am.
I\’m also not sure if it is so bad that they don\’t want me to look at them over my glasses. I have had patients (and probably employees) assume my silence on an issue was a tacit approval. \”He never told me I shouldn\’t smoke,\” \”He never said I needed to lose weight.\” I\’ve had people use my lack of lecturing as an excuse to continue behavior they already know is bad for them.
I also never told them it was bad to hit themselves in the head with a hammer. I hope that omission isn\’t resulting in head trauma.
I saw another patient recently, who said to me before I could sit, \”I am sure you noticed I gained 6 pounds. Christmas and Valentine\’s Day were bad for me.\” I hadn\’t had the chance to check the chart, but returned a remark about how there is a clear correlation between eating too much and gaining weight. I could tell he had a guilty conscience, so I didn\’t say anything more.
As I wrapped up the visit he asked me, \”Aren\’t you going to say something about the six pounds I gained?\”
I smiled, realizing that he was expecting \”the look\” from me. I told him that it was not good to gain weight and then looked at him over my glasses.
We\’ll see how much power it has.
I was shocked beyond belief recently when a morbidly obese freind of mine told me no doctor has ever once mentioned her weight! She was about 275 pounds and 5 foot nothing when the adoption agency she was working with to adopt a baby told her she needed to lose weight. The adoption agency and NOT a doctor! My friend is a bit of a hypochondriac and is in one doctor's office or another at least once a month. In all those doctor's offices over all these years of obesity never once was her weight mentioned. (Same GP for 15 years!) She figured it wasn't an issue or they surely would have said something. Yes, that's stupid on her part, but I'm shocked that no doctor ever mentioned her obesity. Please speak up, if you're one of those doctors who never says a word about a patient's weight.
As for The Look — my husband employs this tool on me. We have never “fought”. We've disagreed a few times. And a few times I've been a bit of a squeaky wheel. When I've been ridiculous or illogical or he just thinks I'm wrong, he gives me The Look. I would MUCH rather have the look than a lecture, ugly words, or condemnation. The Look says “don't be silly” without offending me. The Look says “I love you too much to fight with you.” It says, “I'm going to walk away now while you go somewhere and calm down.” It's funny: his Looks make me a better person. Different dynamic, I know, but I've learned a Look is worth 1,000 words!!
Hah! I got that “look” from my oncologist yesterday. I told him I was going on a field trip with my son to SF, and he gave me the look and wrote down, “admonished patient to not overdo it.” Then told me what he wrote. 🙂
Funny thing is, I asked him whether it could be harmful three weeks ago and he said it was up to me if I felt up to it. I guess he didn't chart that. 🙂
Sometimes I think you physicians give conflicting information to patients. My doctor yesterday wondered out loud if working (part-time) was a good idea for me. But, he said I could and wrote the note for me to go back. If he really thought I shouldn't, he never made that clear to me. Like you, he doesn't want to make my choices for me, and rightly so. But, I've never been through chemo before and had no idea I'd be facing anemia, breathlessness or exhaustion. My second chemo I still felt normal and could only make my decision based on that, not the future.
I suppose the key is understanding what your patient doesn't know, and for the patient to make it clear what they want. That is a very hard thing to do in a short amount of time.
I'm glad I found your blog, it's great to hear things from the doctor's perspective. Mine is here http://butdoctorihatepink.blogspot.com
The “look” does help in situations like this but I find when a patient actually brings up the weight, they usually want some advice. Perhaps next time ask what he or she would find helpful…how you can help. Weight is a sensitive issue, as you know, and it takes bravery for a patient to bring the issue to the attention of a physician. I have a hunch that last patient was hoping for some tips and not just “the look”.
Nope. He already knew what to do. His wife next to him knew what to do as well (she gave him a worse look that I ever could). He knew why his weight was up and simply wanted me to wag my finger at him a little.
When I was first told that I give “a look” , it bothered me too. I have made a kind of peace with it though. There are things probably best left unsaid, but that should still be communicated. I'm not responsible for how someone interprets my look, but if I don't mind if I provoke some thought.
As a nurse who trains physicians and staff on EHR, I probably give a LOT of looks.
Great post! I had to laugh at the end, when you gave your patient what he wanted by giving him “the look.” Whether it has any power or not, I'm sure he found it comforting. It sounds like you're really attuned to your patients–something we all appreciate from our doctors.