If it Quacks like a Duck, Tell the Patient it's a Duck

June 13, 2017

Article

The words we use as clinicians to describe illness to our patients should be precise, the meaning unequivocal. Our blogger shares a case in point.

Patients’ perceptions of the severity of their disease is often directed by the words they hear from their healthcare providers.

Case in point, I saw a patient today who was told a year ago that his blood sugar was “a little high” and that he should “watch” his diet. He does not know how high it was at the time, and he “thought about” watching his diet, but since he felt well and it didn’t sound urgent, he didn’t follow through. Fast forward to two days ago. He is admitted for abdominal pain. It turns out he has appendicitis. His labs show that his glucose is over 300. Appropriately, an HbA1c was ordered and it was 10. I get a consult request that reads (eyes rolling) “Pre-diabetes; HbA1c of 10. Will need close monitoring.” I go to see the patient. I tell him why I am there, and he says “Doc, everyone is pussyfooting around it, just tell me, do I have diabetes?” So I tell him, “Yes, definitely” he has diabetes, that it is a serious disease and he needs to take care of it now. He said, if he had only known sooner, he would have taken this more seriously a long time ago.

Granted, he probably truly fell into the pre-diabetic range a year ago. At least, I hope so. But he should have been asked to follow up. He should have been told that if he does not follow through with lifestyle change he would most likely progress to type 2 diabetes.

Conversely, I have had many a patient call in a panic because their “thyroid numbers are out of whack” or “off the charts” or some other hyperbolic description of what is often a mild abnormality.

I don’t expect physicians from other fields to know the minutiae of endocrinology. I certainly will not claim to know enough about dermatology, for example, to know which skin lesions need a biopsy. But, I do know enough to tell a patient that if they have a mole that is changing, they need to seek attention for it right away.

Physicians need to help patients keep the proper perspective on the disorders they have. It will both ease anxiety and encourage patients to take appropriate action.