Be Nicer, Stupid!

Sometimes I feel like I have a parade with me when I go into a patient’s room.  I go in, the medical student comes with, as well as my scribe and a nurse and a tech as well.  Sometimes, to lighten the mood, I tell the patient it’s time for his rectal exams.  Then all five of us put on gloves, you know, joking with patients keep up satisfaction scores, right?

Here’s the problem with satisfaction scores for physicians, especially in the ER.


I reprimand patients making poor decisions (drunk driving, no seat belts or helmets)

Right: “You put yourself and others in serious danger with these behaviors.”

Wrong: This is you (running around the cot with an inflated glove on my head) “Der-duh Der-duh Der-duh Duh!”


I tell people to quit their vices (smoking/drugs).

Right: Stop smoking! stop smoking!  It causes cancer and heart disease.

Wrong: “What’s the result from smoking too much? Coffin! hahahaha! No but seriously you have emphysema.”


I inform patients their loved ones are dead or have cancer.

Right: “I’m so sorry, but I have terrible news.”

Wrong: “You know how you used to hate doing your hair in the morning, good news”


I infuriate those wanting narcotics for a cold, sniffles, or minor injury by saying no.

Right: “Narcotics are not medically indicated. Let me recommend some OTC meds.”

Wrong: “You want Norco?  How about norcNO.  Get it? hah? Get the hell out of here!”


I do this as gently as possible, but criticism often creates anger.

Then patients judge me, which plummets my scores as a physician and my reimbursement.

So, if I know I’m being judged, I can understand the temptation to take the easy way out.

What is the easy way?

Give all patients narcotics, never explain how terrible diets and smoking/drinking ruins lives.  Ignore hypertension and obesity.  Tell people everything is fine and they are doing a great job regardless of the truth.  It wouldn’t hurt me, actually, it would only help me any my scores.

Screw that.

Now, personally, I try to go out of my way to be nice, since my policy is “no one comes to the ER on the best day of their life.”


Being nice is sometimes the meanest thing you can do to a patient.  Staying silent about addiction helps no one.

Say it with a kind heart.  Educate your patients.

For example:

“I know you were hoping to slim down when you quit smoking, but pregnancy doesn’t work that way.”

Explain the reasons for your education.  Explain how narcotic addiction is often the pathway to harder drugs. Explain how smoking/drinking kills.  But still have the conversation.  It might be the talk that tips the scale in a life. Obesity is difficult, but ignoring it does not help.

For example

“Sir, you can get back to your high school weight with a simple, short, fifty-mile walk each morning.”

This is why, if you see an overweight person running, or at the gym, it should be celebrated.  Making fun of hypernourished people doesn’t help.  We should celebrate any effort for improvement.


Every time I hear someone in the ER say “I haven’t smoked for XXX years,” I profusely congratulate people.  Let’s rejoice in the small victories. And also, gimme my 5 starts for telling you to do so 😀

While you’re at it, gimme my 5 starts for telling you to do so 😀






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