patient communication Quotes

I told you I was sick.

There's a classic medical aphorism: 'Listen to the patient; they're telling you the diagnosis.' Actually, a lot of patients are just telling you a lot of rubbish, and you have to stop them and ask the pertinent questions. But, yes, in both drama and medicine, isolated facts can accumulate to create the narrative.

Patients know what patients want to know.

There is no suggestion box in the Psych Ward.

The nurses, I have already learned, are the ones who give us the answers we’re desperate for. Unlike the doctors, who fidget like they need to be somewhere else, the nurses patiently answer us as if we are the first set of parents to ever have this kind of meeting with them, instead of the thousandth.

And I have always told the patients when I talk to them. When they come around and say, 'What will you have to drink? Oh that's right you don't drink.' Just speak up and say, 'Of course I drink. But I just don't drink alcohol.'

More than one skillful physician has said that if one asks the right questions, the patient will make the diagnosis for you in his or her own words.

One of the first things we teach medical students is to listen to the patient by taking a careful medical history. Ninety percent of the time, you can arrive at an uncannily accurate diagnosis by paying close attention, using physical examination and sophisticated lab test to confirm your hunch (and to increase the bill to the insurance company).

"There are one or two elementary rules to be observed in the way of handling patients," he remarked, seating himself on the table and swinging his legs. "The most obvious is that you must never let them see that you want them. It should be pure condescension on your part seeing them at all; and the more difficulties you throw in the way of it, the more they think of it. Break your patients in early, and keep them well to heel."

The psychiatric interviewer is supposed to be doing three things: considering what the patient could mean by what he says; considering how he himself can best phrase what he wishes to communicate to the patient; and, at the same time, observing the general pattern of the events being communicated. In addition to that, to make notes which will be of more than evocative value, or come anywhere near being a verbatim record of what is said, in my opinion is beyond the capacity of most human beings.

But what physician has not had patients who don't make any sense at all? To tell the truth, they're our stock-in-trade. We talk and write about the ones we can make sense of.

It has oft been said that physicians make the worst patients, but it is the opinion of This Author that any man makes a terrible patient. One might say it takes patience to be a patient, and heaven knows, the males of our species lack an abundance of patience.

If you have a patient in a doctor's office who's just been told they have terminal cancer but there's this operation they could perform right now that might save their lives. ... They have a 90 percent chance of surviving the operation — if you tell them that, they respond one way. If you tell them ... that they have a 10 percent chance of being killed by the operation, they are about three times less likely to have the operation.

I talked to over two hundred patients and family members about their experiences with aging, serious illnesses, and the big unfixables. But I also spoke with scores of physicians, and especially geriatricians, palliative care doctors, hospice nurses, and nursing home workers. The biggest thing I found was that when these clinicians were at their best, they were recognizing that people had priorities besides merely living longer. The most important and reliable way that we can understand what people's priorities are, besides just living longer, is to simply ask. And we don't ask.

I have sat with countless patients and families to discuss grim prognoses: It's one of the most important jobs physicians have. It's easier when the patient is 94, in the last stages of dementia, and has a severe brain bleed. For young people like me - I am 36 - given a diagnosis of cancer, there aren't many words.

In order to really understand, we need to listen, not reply. We need to listen long and attentively. In order to help anybody to open his heart we have to give him time, asking only a few questions, as carefully as possible in order to help him better explain his experience.

I deny the lawfulness of telling a lie to a sick man for fear of alarming him; you have no business with consequences, you are to tell the truth.