One-Liners

I used to get frustrated when patients, typically at the very end of a long visit for some other serious problem, would utter one-liners like “What can I take for headaches?” “How do I know if I have cancer?” or “Why can’t I lose weight?”

Now I have a one-liner, of sorts, myself in response to those types of questions. I usually lean back slightly, widen my eyes, nod and say:

“Now, that’s a big question that can’t be answered well in just a few words”, I say, then pause briefly and continue: “There are even specialists in Boston who deal with nothing but that their entire careers. I could sit down with you some time and start working on it if you want.”

It is very important not to give off-the-cuff answers to questions that may seem casual. The patient may pop the question that way because of fear, or may not realize how complicated the question really is. The patient who asks for something for headaches may be the one with a brain tumor or an aneurysm, and the one who asks casually about weight may be on the verge of revealing a serious eating disorder.

A careless, quick or off-the-cuff answer, even to a seemingly off-the-cuff question, is neither therapeutic nor safe. It also devalues our profession. Not every answer we give needs to be lengthy, but every answer or intervention needs to be proportionate to the problem. A question about dandruff may be appropriately answered in a sentence or two, but certainly not a question about headaches or weight issues.

Making another appointment to deal with something the patient brings up at the last minute is not frivolous. It is good medicine. It validates the patient’s concerns and keeps the physician’s next several patients from waiting unnecessarily for the doctor to catch up.