“Do you have any more questions..?” Every good doctor patient conversation ends with this question. But what if you don’t have an answer yet? At the beginning of my career I found myself rushing out the patient’s room because I didn’t want to answer any more questions.

Photo courtesy of IStockphoto.com

Common questions are:

• When will I be discharged?
• Is there a possibility I need surgery?
• Are you sure my operation will be tomorrow?
• Will my kidney function recover?
• Am I going to I survive this?

All of these questions are legitimate and the patient deserves an answer to them. Here are five ways to provide wise answers.

1. Give an honest answer.
   

   On the long run it will strengthen the trust of your patient in you if you give him an honest answer that he doesn’t like at this time. However, whenever possible you should provide hope and be positive.
   
   Here is an example:
   “No, I cannot promise that your kidney function will recover, but I’ll do everything in my power to raise the chances.”

   If on the other hand you give him the answer he wants to hear he will be happy for the night. But on the next day- you can count on that- he will tell everybody (your boss, the nurses, his relatives):
   “Doctor Zickler PROMISED me that I would be healthy/discharged today.”

2. Be one step ahead.

   Anticipate obvious questions and provide the answer. Many questions cannot be answered by you, you’ll have to ask an expert. Medicine is more complex than ever, which is mainly a good thing because more and more therapies can be provided.

   You will have to discuss the case with a consulting specialist or a doctor who is higher ranked than you.You can save a lot of time by anticipating your patient’s question:

   Example: A patient was sent to a CT scan, which shows a round lesion. Prior to telling your patient the result you should ask yourself what will the patient ask:
   He will ask: “What do we do now?” So you need to provide a plan:
   Does it require operation? Biopsy? Control CT scan? MRI?
   So prior to talking to your patient you should talk to a

   Radiologist (biopsy?)
   Oncologist (bronchial carcinoma?)
   Thoracic surgeon
   Your attending (to ask whether he agrees with the consult’s recommendations)

3. Use limitations in your answer:

   Question: “Will I need surgery?”
   Answer: “According to the surgeons, surgery is not required at this point of time.”

   You provided two limitations here:Number one: you are not in charge, the surgeon is. Number two: at this point of time: Tomorrow is a different day, and diseases are dynamic processes that can change.

4. It depends.

   Many questions cannot be answered at the time because more exams have to be performed. Also mention the possibility that the result of one examination may require several other examinations.

   Example: Patient with weight loss, nigh sweats and hemoptysis:
   X-ray -> CT scan -> bronchoscopy -> biopsy -> pathology /microbiology results.

   The patient should be prepared that this workup can take a week prior to this workup, he will not be surprised.

5. Don’t hesitate to say: “I do not know.”

   Many doctors feel that at any point of time they must have an answer to any question. No reasonable person will expect this from his doctor, so don’t pretend like you know everything. There are plenty of things we do not have an answer to.

   Admitting that you don’t know everything or have to read up on something will strengthen your patient’s trust in you.
   Example: Patient with myocardial infarction: “Will I survive?”

   “You can be sure that we all will do our best and that you’ll receive the appropriate treatment, but the truth is that this is a life-threatening status and at this point of time I cannot tell you, if you’ll survive this.
   Any other answer would be a lie and the patient knows that a heart attack is possibly a cause of death. Telling him, that everything is gonna be just fine doesn’t help him.

What’s the question you fear the most? Leave a comment below!