"I don't know." A patient may interpret this to mean that the physician lacks the necessary skills to properly care for him. In actuality, the physician may be expressing that the answer to the patient's health concerns is not yet known by medical science, and by proxy, the physician. "When I said that [phrase], people invariably thought they should find some doctor who does know. Now, when 'it' is known, but not by me, I say, 'I don't know, but I know who does. I will contact him/her and get back to you with that information.'" Deane Waldman, MBA, physician, author, and member of board of directors for New Mexico Health Insurance Exchange
"Everything is fine." Avoid this global statement, and any variations, even when patients ask if everything is OK. Instead, always respond with specificity. For example, "All of the tests we performed were normal." This helps establish realistic expectations for patients as to the limitations sometimes presented by medical testing. Plus, the added transparency builds a deeper level of trust between provider and patient. Linda Sloan Locke, MPH, certified nurse midwife and licensed social worker
Patients are busier than ever and so are physicians. There can be a significant time lag between the first signs and symptoms and actual treatment. When a physician questions the patient about this delay in treatment, the patient may interpret this as blame. Going forward, the physician should encourage patients to call the office, so that treatment options can at least be reviewed over the phone. Recognizing patients' barriers to treatment and providing treatment information over the phone or through the patient portal may prove more effective. "Why didn't you come to see me sooner?" Barbara B. Tobias, family physician, vice chair University of Cincinnati Department of Family and Community Medicine; medical director of Health Collaborative, a community health initiative of Greater Cincinnati
"Your lungs sound fine." The evaluation of a smoker's lungs provides ample opportunity to present and discuss the benefits of smoking cessation. If the patient is led to believe that her lungs are in good condition, despite the ongoing exposure to smoke and chemicals, she may assume that smoking isn't harmful. Feeling like there is no imminent threat because she's avoided damage or lung cancer thus far, the patient may be more reluctant to quit. VJ Sleight, MA, tobacco treatment specialist and author
"I'm sure it's nothing serious." Even when a patient's symptoms seem minor or insignificant from a medical perspective, they could be extremely troubling to the patient. So when a physician dismisses the symptoms or condition as inconsequential, usually a patient feels disrespected. While unintentional, the physician has missed a tremendous opportunity to show empathy and deepen provider-patient relations. Suzanne C. Fuchs, podiatric foot and ankle surgeon at Prohealth Care in New York
"I completely understand where you're coming from." While physicians should empathize with patients, it's impossible to understand their exact experience. Even when a patient presents as a textbook case, there are other factors at play that makes his particular situation unique. Socioeconomic disparities and readiness to learn are just two of the factors that heavily influence where patients are in their medical journey. Physicians should simply meet patients where they are, while seeking ways to improve quality of life. Assumptions that you understand exact patient experiences are best avoided. Lauren R. Cummings, registered nurse at Grady Memorial Hospital in Atlanta
With the abundance of information available on the Internet, the likelihood that patients will stumble across misinformation is a prominent concern. Physicians can empower and support patients by encouraging them to research their health conditions. However, it's critical that patients have access to credible information. So instead of directing them to the Internet in general, provide patients with a list of trusted medical websites. "Don't believe what you read on the Internet." Barbara B. Tobias, family physician
"Just learn to live with it." Stress has the potential to severely and negatively impact a patient's quality of life and prognosis, as well as hinder the healing process. And internalized stress is often what happens when a patient is informed she'll have to live with a condition long-term. The patient's emotional response can potentially trigger depression too, which only further complicates treatment plans and outcomes. Murray Grossan, ear, nose, and throat physician at Tower ENT in Los Angeles and author
"This treatment will definitely work." Never guarantee the outcome of any treatment. Providing probabilities and statistics is always a welcome practice, but issuing a blanket promise will quickly become problematic. Treatments have varying degrees of success, based on a multitude of patient risk factors and comorbidities. Physician skill also plays a role in obtaining specific outcomes, as with surgeries or injections, for example. There are simply too many variables that could disrupt an ideal conclusion. Wenjay Sung, physician and foot and ankle surgeon at White Memorial Medical Group in Los Angeles
"There's nothing else we can do for you." Even when treatment options have been exhausted, physicians still have more to offer. Comfort, support, or validation can assist a patient in their healing process too. Have the patient identify one or two health goals that relate to their illness or condition. In doing so, physicians will gain a deeper understanding of their patient, and may even find that a cure isn't the ultimate goal after all. Aligning clinical goals to those of the patient's goals will naturally lead to better outcomes and a strengthened patient-provider relationship. Barbara B. Tobias, family physician
Do not put a number on how long a person has to live. When giving a prognosis, use the terms days, weeks, months, or even hours, but never mention a specific number, like three days. Numbers are often inaccurate. And given the intense personal and familial dynamics common with terminal illnesses, these inaccuracies can prompt even more fear and uncertainty for all. "You only have days/weeks/ months to live." Barbara Karnes, hospice nurse, end-of-life educator, and author