r/emergencymedicine • u/wiredentropy • 1d ago
Discussion What is the single best communication pearl you’ve stolen from another physician?
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u/arbitrambler 1d ago edited 1d ago
If the patient presents with a complex history or if the patient is anxious or they are elderly, I sometimes pull up a chair and sit closer to them at eye level while taking the history.
Even though the format or my questions don't change much, it creates the perception of singular attention and empathy. The amount of time you take also doesn't change much.
This is followed by the standard spiel of "my primary job is to rule out potential life/limb threatening scenarios and 60% of the time I'm unlikely to give you a diagnosis."
Overall leads to pleasant interactions and hassle free discharges, mostly!
Edit: one of the busiest Consultants I worked with in gen med would do this with his ward round in the stroke unit. It was impossible to get a hold of him at times due to having additional roles of the head of the medical department and also being on a couple of other committees. But when he did the rounds, it felt like he spent a significant amount of time with patients, even though he didn't!
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u/RunBrundleson 1d ago edited 1d ago
Sometimes fast is slow, and pulling up a chair and listening to a patient who is going to tell us a whole lot is going to be quicker than trying to rush them or not give them the attention they are expecting. I spent 30 minutes listening to a woman tell me about her very much non emergent back pain. She didn’t even want narcotics, she just wanted to tell someone about her pain. I was able to discharge her immediately afterwards and she was completely satisfied with her care. Had I tried to rush it or ‘fix’ her problem I would have likely ended up keeping her for hours and probably admit her.
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u/absolutevandal4 EM Social Worker 1d ago
I feel this way as a social worker. Sometimes just committing to listening to them talk for a little bit is more therapeutic than trying to rush and get to the actual problem
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u/Every_Cantaloupe_967 1d ago
There’s strong evidence that sitting creates a perception you stayed longer too.
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u/paramedTX Paramedic 1d ago
I almost always kneel when talking to my patients ( as long as their floor isn’t nasty.) After 30 years I’m surprised my knees still let me! No one likes someone hovering over them while speaking.
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u/moleyawn RN 1d ago
ive also found that sitting down and talking to my patients, especially peds, helps a lot with IVs and other scary procedures.
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u/Acceptable_Reply7958 1d ago
In residency, an attending once told me "build an environment around you where you don't need to yell. If you can run a quiet code where people trust you and listen for your direction, it will be far better for everyone"
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u/InsomniacAcademic ED Resident 1d ago
At the end of my intern year, we had a cardiac arrest from one of the chemo infusion centers roll in with the rapid response team. Between the ED team and the rapid response team, there were a lot of people on this room and it was loud. My attending piped up, “let’s use noise discipline please” and everyone quieted down. I’m a huge fan of the phrase because even when said loudly, it is less likely to be perceived as aggressive than phrases like “quiet down”.
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u/kawugiri 20h ago
Sounds like ex military. We used to say that a lot.
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u/InsomniacAcademic ED Resident 17h ago
He is shockingly not ex-military, but I would not be surprised if he got it from someone else who was current/former military
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u/Acceptable_Reply7958 1d ago
Also, after every miscarriage I always say "please know there is nothing you did or didn't do that caused this. This happens all the time and I am so sorry it happened."
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u/Brilliant_Lie3941 1d ago
Love this. I say something similar and I think it's helpful for patients to hear it.
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u/Acceptable_Reply7958 1d ago
I think if we can provide any comfort during a challenging time, than we are doing our job
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u/OldBrownDog 1d ago
This is so highly underrated. I am about to graduate, and I hate working resus shifts with a couple of my attendings because they just don't know how to manage a room/code and every sick patient is a disaster. The gawkers that occur at every single code/trauma/etc are also annoying
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u/PhiledelphiaSidecar 1d ago
“I will come back when you are ready to be more appropriate”
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u/tokekcowboy ED Resident 1d ago
I put up with a lot. I think we all do. But on the very rare occasion that I do walk out of a room because of a patient attitude, they tend to be better behaved when I try again.
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u/nytnaltx Physician Assistant 1d ago
Few and far between, but probably about once a year a patient will say something that makes me want to lose my cool completely. This is a good line. I usually say something like “you are being very disrespectful,” and depending on the way they respond to that I will either continue the conversation or walk out.
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u/joshuabrogers 1d ago
And how is everyone related here?
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u/adoradear 1d ago
I usually ask “who are the people who are here with you today?” Gives me a few baselines - do they speak English? Are they demented? And (of course) who the people actually are.
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u/larskristofer ED Attending 1d ago
Yep - same. I ask the patient and it works well to facilitate introductions. I hadn’t realized that I was subconsciously using it as an assessment. Good call!
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u/larskristofer ED Attending 1d ago
Exactly - never assume. There’s a lot of age gap relationships or various aged children or just good friends caring for one another that we can assume are other things.
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u/caffeine-hopital "The real doctor will see you shortly" 1d ago
Oh I definitely witnessed the WORST kind of assumption some time ago. I was in a different ED than the one I work in, in the clothes of the patient for the occasion. For context, we’re in southern Europe.
An ambulance arrived, with a white woman on the stretcher, and a younger, black woman following behind the EMTs.
For gods know what reason, the security guard at the entrance thought that asking the EMTs “is the young woman the patient’s [professional] caregiver?” out loud was an acceptable question. The girl answered herself “I’m her daughter”.
I was fucking livid and based on the sighs, all of the people in that waiting room were. What the fuck bro
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u/larskristofer ED Attending 1d ago
Regarding goals of care - “I always want to make sure we’re doing something for your loved one and never anything to your loved one.”
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u/stillinbutout 1d ago
The ED is really good at two things: stuff that will kill you fast like strokes, and stuff that is easy like stitches. Everything else will need treatment somewhere else
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u/BunniWhite 10h ago
"The ed is really good at making sure youre not dead or dying within the next 24-48 hrs. This is why we tell you to come back if things get worse. Right now you dont qualify for admission to the hospital but things change over time so watch out for xyz"
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u/Adrunkopossem EMT-A 1d ago
" Just because they are screaming does not mean they are insane or on drugs. People do sometimes scream for other reasons" A paramedic to a cop
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u/sesgo805 1d ago
Former ER and CathLab RN here.
My crew and I were setting up for an angiogram of STEMI patient and doc walks in and steps up to the procedure table to introduce himself. The patient says, “Oh wow, I’ve never had an oriental doctor before”. Doc pauses for a second and calmly says, “An oriental is a rug, I’m Asian, Korean to be exact”.
Me and the boys were in stitches the whole case.😂
Eleven minutes door to ballon.
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u/Less-Economics-3520 1d ago
The uncomfortable silence when patients are rude or aggressive. I also do it for consultants acting that way.
Let them say their piece and don’t say anything until it becomes awkward and they speak to fill the silence at which point respond “ I was just making sure I gave you all the time you need.” Usually they realize they’re being an asshole and start behaving. The awkward silence is like a reset button.
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u/Alaska_Pipeliner Paramedic 1d ago
"You sound just like my mother." Great way to deescalate angry assholes. It does a couple things: makes people laugh ergo breaking tension, the angry party likely had a rough childhood so it creates a bond, and its such a bizarre statement people stop to process what I just said. Btw my mother is a saint and I had a kick ass childhood.
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u/DunkFunk ED Attending 22h ago
Lol i use this too. It has been met with mixed results, but it does feel great to say.
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u/Cybariss Physician Assistant 1d ago
Sit down if possible when doing your history and your discharge discussion. Patients perceive that you spent more time with them.
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u/DownvoteForGrammar 1d ago
I've been doing this so long that I feel uncomfortable standing over someone to take a history. Commit to the sit was someone's quality improvement project years ago so my department has a glut of rolling chairs. A rare example of a useful QI project.
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u/Tony_The_Coach 1d ago
thats such an urban myth
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u/Danskoesterreich ED Attending 1d ago
In my experience, the stool is one of the most important tools. You get down to their height, and you look less rushed. Patients really appreciate it.
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u/AceAites ED Attending 1d ago
There's actually evidence of this and you can ask ED leadership when comparing NIPS scores if they have conducted internal studies on this. The results may surprise you.
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u/Tony_The_Coach 1d ago
its all a conspiracy from the satisfaction industrial complex. some dweeb with a clipboard can follow me around and audit my sitting time
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u/AceAites ED Attending 1d ago
There’s zero reason for that to happen and admin prob saves more money on chairs if this weren’t true.
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u/Acceptable_Reply7958 1d ago
This might be a big ask, but during every shift, I started compiling a list of the patients I was worried about or something felt incomplete on. The next day, like 10-15 minutes before the shift started, I'd call them and check in on how they were doing. They were virtually ALL really pleasant phone calls and patients were delighted to hear from me. It helped me a lot as a young attending to understand better consequences of my decisions and it helped relieve me a lot about the people I'd discharge that I was second guessing. It also just made me feel a lot more content around my job. I've gotten a fair amount of thank you notes from patients in my career and I really attribute it to these phone calls.
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u/DunkFunk ED Attending 1d ago
I tell them that their bloodwork / imaging is 'reassuring' and dont say 'normal' unless there are absolutely 0 abnormalities. It avoids having to explain mild variations in lab values and chronic imaging findings or anatomic variants.
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u/Comprehensive-Ebb565 ED Attending 1d ago
Your evaluation today in the emergency department is focused on testing for things that need immediate attention or a stay in the hospital. This is the first round of evaluation for complaint X, many people need additional rounds of evaluation by clinic doctors in follow to help determine what may be causing your sxs today.
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u/Chuggerbomb 23h ago
"so what changed that made you come in today rather than last week?" Or "so what was the deciding factor today that tipped you over from managing at home to coming to the ED/calling an ambulance?"
A significant chunk of patients will visibly realise that maybe having knee pain for two weeks then turning up to the ED was a stupid idea.
A smaller, but perhaps more significant,chunk of patients will then tell you about another much more concerning symptom that developed suddenly today despite having not mentioned it until this point.
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u/Zestyclose-Rip-331 ED Attending 21h ago
I was at a dinner party and was having a conversation with some dentists. The conversation drifted to general dentists doing braces and implants, which are procedures generally done by dental sub specialists (I.e., orthodontics, oral surgery). A general dentist said “I dabble in some orthodontics.” And, the oral surgeon said something along the lines of, “Take my advice here. Don’t dabble in anything. Either, be an expert or refer.”
Since we are in EM and we prepare to do a lot of HALO procedures as well as overlap with a lot of other specialties (e.g., peritonsilar abscess drainage, fracture reduction, cardioversion, etc.), I love that advice. I tell it to my residents all the time. For example, I have heard residents joke that reducing a distal radius fracture is just a simple tug. I disagree with that mindset. We are not orthopedic surgeons, but we are/need to be experts in most closed fracture reductions, given how often we see and treat fractures. Doing our best for patients, means not dabbling in but being an expert in all that we do for/to them.
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u/Sad_Sash Nurse Practitioner (Rural ED, but at least we have CT) 1d ago
Always sit down when talking to the patient, it demonstrates you’re focused on them and not rushed.
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u/sunnshyne86 1d ago
“We don’t want to expose you to any unnecessary radiation” - said when pt is upset about XYZ not being ordered. The patient is usually receptive once they think that we are trying to protect them from potential side effects.
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u/CountryDocNM ED Attending 17h ago
For parents of kids w/ head injury that don't meet criteria for head CT, I'll literally pull up PECARN on my phone or laptop and show them the line about "risk exceedingly low, generally lower than the risk of CT-induced malignancies" and if needed explain what "CT-induced malignancies" means. Never had a parent upset I didn't scan their kid's head after that.
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u/BoardingSinceTuesday 9h ago
May not seem like much, but my attending told me when you ask a patient what brings them in, allow them to speak uninterrupted until they are done. Once they stop talking, you can ask your second question. Makes the patient not feel like you are rushing them.
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u/keloid Physician Assistant 1d ago
The physical exam is performance art, even if it's not going to change your workup or disposition.
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u/mufafa-lufafa 1d ago
It has changed my workout and dispo almost everytime I find something positive on a exam. Please don’t have this mentality. An exam is as good as a great history,
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u/keloid Physician Assistant 1d ago
I probably didn't do a good job explaining this- the lesson was not that the physical exam is not important, it's that how you do it and how you show it makes a huge difference in patient satisfaction. I could PECARN out 90% of pediatric head injuries based on the triage note and observation from the door, but I think an in-depth and showy neuro exam convinces the parents much more than my little calculator that their kid is okay and doesn't need to glow today.
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u/Over_Resist_9038 1d ago
Also just explain to the parents or patient what you’re doing/looking for is helpful. “I’m checking your strength on both sides and it’s normal, that makes me much less concerned for a stroke”
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u/m01L 18h ago
Spoken like a true American doctor, who has never had to work in a system without plentiful resources like the lab and medical imaging.
Maybe this will read as bias, but I’ll take a thorough physical exam from a Doc who got their training outside the US/Western world over “performance art” from a physician who isn’t confident in their physical assessment skills any day. I firmly believe this is why it took 3 doctor visits in 3 days for a new murmur and AAA to be noted. The third doctor was born in Eastern Europe and trained in India. He actually did an exam and knew what he was looking for and what it might sound/feel like when he found it.
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u/ubetchalife 22h ago
I used to be argumentative with people who were drug seeking however, a wise Physician one showed me his way which was to sit down, advise the patient that I am very concerned for their well-being and based off of their prior visits and review of the PMP I’m very concerned that they have a serious addiction problem, and that I have a social worker standing by who can come in and assist them with immediate admission to a treatment facility. After I began using this approach, I noticed that there was no further arguing or bickering about prescriptions and the patient couldn’t get out of there quick enough. they were visibly uncomfortable. completely changed my practice.
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u/microcorpsman Med Student 22h ago
So does that only clear them out, or have you gotten any to actually participate (or at least say they will) in recovery?
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u/m01L 18h ago
You’re a literal god if you have these conversations yourself without calling case mgmt or social work!
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u/ubetchalife 5h ago
lol, they are very rare now. I typically walk in with a tablet and the PMP pulled up. They are aware that we have this level of access now which has slowed the trend.
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u/Playcrackersthesky BSN 1d ago
“Sir, please do not confuse your Google search with my medical education.”
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u/the_silent_redditor 1d ago
I just hope he doesn’t walk by 2 mins later when I’m googling his symptoms…
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u/ubetchalife 22h ago
The seekers do not want help, we always give resources but they want to go. Those that come in looking for help get it.
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u/carydave 14h ago
Multimodal pain control is a godsend. “Here is a whole slew of (non-narcotic) pain meds for you!”
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u/Lepinaut 14h ago
One of my attendings told me “if you can’t dazzle them with brilliance, then confound them with nonsense”. Think about it every day.
Informed/mutual decision making only works if they can be reasonably informed. With my crowd, I tend to lean on the latter axis of his tenant.
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u/Ok-Code-9096 4h ago
I like to make small sketches when trying to explain something to a patient. It often helps the patient to understand why they are having their symptoms and they can also later use the drawing to explain it to their loved ones.
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u/Difficult_Resource_2 3h ago
An negativ example I heard from an young colleague once explaining the new found aneurism: „listen, I don’t want to scare you, but you could die at any moment“ patient got scared.
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u/Praxician94 Little Turkey (Physician Assistant) 1d ago edited 1d ago
“Just because we didn’t find anything emergent today doesn’t mean there isn’t something wrong, but we’ve got a good baseline here for your primary care provider or specialist to expand upon on.”
That right there is responsible for like 90% of my happy discharges with vague definitely somatic symptoms.