In every medical setting, hearing about the good things is just as important as hearing about the bad things. People who find themselves in front of a doctor usually do not have a choice. The process of getting a diagnosis may add up to an intensely stressful experience.
Research has shown that when you give a person a new diagnosis of high blood pressure, the person’s perception of how much time it will take to recover from an unrelated common cold actually increases (Mold JW, Hamm RM, Jafri B, 2000). Therefore, bestowing a new diagnosis may have harmful psychological consequences. And physicians may not be aware that giving a diagnosis may cause harm. After all, doctors are just doing their jobs.
We have all had some sort of personal experience as a patient. I had the experience of developing a tooth abscess, which required tooth extraction. Why is this happening to me? My dentist, the endodontist and the oral surgeon had all looked puzzled, shrugged and had no good answers. When I was a teenager I had had wisdom teeth extracted on that side, so probably – I assumed – it was from the trauma of that procedure making me susceptible to a fractured infection-prone tooth. Without thinking further, I had made up my own association and explanation.
Two years later, the same thing happened to the other side of my mouth. Although I was annoyed by this recurrence and knew it was manageable, I still thought: What is going on with me? When should I expect the rest of the teeth to be falling out? “You probably grind your teeth.” Was the closest explanation I got. In the waiting room at the oral surgeon’s office, it didn’t escape me that most of the people there were close to double my age.
While I sat in the chair during this second time around, the oral surgeon happened to point up to my CT scan showing the outline of the extracted tooth and casually mentioned that I had “good strong jaw bone”.
Who, me? Me, the lady with her teeth falling out prematurely has good strong jaw bone? I cannot tell you how happy I felt to have this small surge of hope flung my way. And the doctor might not have mentioned it at all.
In my retina practice, I was seeing a woman in her 70’s for a follow-up check after I had lasered her torn retina. Her own mother had had advanced age-related macular degeneration and was severely visually disabled at the end of her life. I looked down at her optical coherence tomography (OCT) scan of the macula and noted that it was pristine, not a trace of any tiny drusen that we see with macular degeneration. I leaned over to her and showed her the scan and said, ‘You know, you will probably never get macular degeneration in your life.’
She leaned back, her eyes widened, and she exclaimed, ‘This is the best news I have heard, ever!’ I could only imagine how this woman had witnessed her own mother gradually going blind from a disease, which in the past had been incurable. Until this moment she had lived with anxiety and uncertainty due to her perceived likelihood that she herself would also succumb to blindness.
Doctors have the ability to examine so many parts of a patient. However, a normal examination without any pathology might be rather unexciting for the doctor: There is nothing to treat here. I do not play a role here, because I cannot be helpful. Physicians must remember that the person they are treating very much cares about how healthy things are. As people and patients grow older, we take good health less for granted than during youth.
Doctors not only must focus on the diseased parts, but must also communicate news about how healthy and robust a part of the body is. It only takes a few seconds to say, ‘Your blood pressure is excellent today.’ Or, after doing a routine procedure one might try saying something that is obvious: ‘Everything went great. All the medicine is in now.’ It may be obvious to the doctor that all went perfectly fine, but people on the receiving end need to hear that positive confirmation, and feel a small sense of relief and even joy that all has gone well for them.
If you are an ophthalmologist, and you see the healthy sheen of a perfect retina during the fundus examination, try saying, ‘Your retina is looking awesome!’ instead of glossing over it. The person sitting there in the examination room, in the hospital bed, or wherever is hoping and wishing for some good news. People want to leave with something positive. We all want to hear something good, it keeps us going and gives people the strength to do more than if they feel labeled as a person with a disease.