Exam Room Miscommunication

In school were you ever challenged to explain to someone how to make a peanut butter and jelly sandwich using words only? It’s harder than it sounds. Similarly it’s sometimes difficult to explain to a patient what I want them to do, at times to humorous effect. If you see yourself in any of the examples below, don’t take offense. I’m laughing with you, not at you!

As I bring an exam light up to check patient’s eyes, they often open their mouth, thinking I want to check their throat.

When checking guys for hernias I tell them to turn their head and cough. Men often turn their head to the left when I check their right side, then turn to the right when I check the left. The only purpose of having them turn their head is to not cough on me! Before doing this part of the exam I tell them to drop their drawers so I can check them for a hernia. I like to then slide forward the 2-3 feet on my stool, that has rollers, but guys often take a step towards me first, then I have to make sure I don’t butt heads when they naturally bend to drop their underwear. I also like to go to their right side so I don’t have to bend my wrist back, but in an attempt to be helpful, they often turn to the right to face me, so I have to slide farther to the side, thus doing a hernia check dance.

When I have people sit up on the exam table, they often start to lay down. I just want them to sit first since I like to examine their neck and listen to their lungs first. If not doing a full physical, I usually just pull up the shirt to listen to their lungs from the back side. When I then have them lay down, patients usually reflexively pull their shirt back down, but then I have to lift it back up to listen to their heart.

When patients have pain, such as in their abdomen, I’ll ask them to tell me if it hurts as I press in various areas. In an attempt to be helpful, patients off start pushing on their stomach themselves to try to find the tender areas, and sometimes will spend a fair amount of time doing so. I usually joke that they can examine themselves on their own time, but now it’s my turn.

Author: Daniel Ginsberg, MD, FACP

I'm an internal medicine physician and have avidly applied computers to medicine since 1986, when I wrote my first medically oriented computer programs. So yes, that means I'm at least 35-years-old!

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