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March 27, 2007

Offering Reassurance

In today’s clinical skills session I saw a re-emergence of a problem that presented a few weeks ago whilst on another clinical skills session, the issue of offering reassurance to a distressed patient. Owing to our lack of knowledge and qualifications, I think some medical students feel powerless to address this situation.

A few weeks ago as a part of a cardiovascular examination I was measuring a patient’s pulse rate, a process which usually requires 15 seconds of concentration, and consequently, silence. Once I had measured their pulse, the patient asked if everything was OK, to which I replied ‘yes’. As a colleague later highlighted, this was the wrong thing to say because despite finding a pulse of 70 beats per minute there was no way of telling if this was healthy. Therefore I didn’t have the right to tell the patient that they were OK, simply because I’m not a doctor and have none of the skills required to diagnose or treat patients.

Sometimes when patients are concerned or distressed about their health it is important to be very cautious when offering them reassurance because, especially as a medical student, this may come at the cost of instilling false hope. What I should have said to the patient is that as a medical student I have no place to say whether or not they are healthy.

In today’s session I saw a stroke patient who was concerned about a persistent pain in her chest and right arm. She was very distressed and quite emotional, probably due to the symptoms of the stroke she had a few weeks earlier, and she was in tears when mentioning this pain in her chest. She asked if it could be a heart attack, to which I replied ‘there’s no way of knowing’. In hindsight this was probably the wrong thing to say as it may have worsened her anxiety by making her feel very uncertain about her symptoms. Again I think this was a case of blurting out the first thing that comes into your head in a rash attempt to allay the fears of the distressed patient in front of you.

In these situations I think it is safest to firstly take time to think and never rush to close silent moments, then mention that as a medical student you can’t offer medical advice. To ease the patient’s distress you can reiterate that there is a team of doctors and nurses caring for them. It may also be a good idea to call a doctor or nurse to chat with the patient.

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