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Sit Down!:  Studies have shown that patients perceive that physicians spend greater time with them when physicians sit down in the exam room than when physicians stand throughout the patient encounter, even when the encounter times are identical.  Get in the habit of sitting to interview each patient; it does not necessarily slow you down, but the patient will likely feel better cared for than if you stand for the entire encounter.

“Point to it with one finger”:  We all tell patients to do this when they confuse us with diffuse symptomatology but, next time you are injured, try to localize your pain to a single spot.  You may be surprised how difficult this can be.  Nonetheless, it is confusing for us when patients magnify their symptoms in hope of attracting your attention.  A classic example is a patient who claims his “entire leg is numb.”  Our reaction is that this is a non-anatomic complaint, and therefore we assign the patient a high porcelain titer.  Try to remember that even though the patient’s worst numbness may be in his great toe web space, the remainder of the dermatome will have some numbness in it and it does overlap several other dermatomes.  In addition, the patient may well feel that you are unlikely to be impressed if he tells you that the only place he is completely numb is in his great toe web space!  You may find that including the patient in your diagnostic effort by telling him that you need to know where he is “most numb” or “most painful”, etc., may be of great help.  

Cancer:  Remember that patients who come to the clinic with seemingly minor complaints may be most concerned that those “minor complaints” are signs of some dread disease, such as cancer.  Reassuring them of what “their disease is not” may be as important as telling them what it is and suggesting they take a little NSAID for it.  

“This isn’t like heart surgery”: Using this phrase can assist patients in understanding that, while degenerative orthopaedic conditions (such as osteoarthritis) are painful and limit function, they are rarely life-threatening.  Thus, surgical procedures to address these conditions are elective, and it is helpful if you assist the patient in reaching the understanding that he/she is, at least in part, responsible for making the decision about when to do surgery.

Appearance:  Your appearance may not seem to you to have any bearing on your effectiveness.  However, the patient is trying to judge whether you are a good surgeon from minimal data!  While the patient may not object to your sloppy appearance on a conscious level, subconsciously the patient probably wants someone with a clean, neat, and efficient appearance to be doing his/her cutting.  At some point your livelihood may depend on your ability to attract patients and your grooming will become very important to you! When you show up to clinic unshaven, in wrinkled clothing and with a coffee stained lab coat you are damaging the “patient attractivity” and thereby the livelihood (only the patients who can’t pay will still come) of the residency program that is supporting and training you.


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