I had a mother tell me yesterday, "Dr. Rob, I remember so clearly when you walked in to my hospital room when my daughter was born 10 years ago. You said 'I just want you to know that your daughter looks perfect.' I was just so happy that everything was OK, but you said that she was perfect!"

While I don't remember that specific situation, I have always chosen my words carefully when I talk to patients/parents. This comes from when Mrs. Dr. Rob commented to me after she took our first child to a visit to the pediatrician. "He told me that J was really cute!" she had told me. "He sees lots of children, but I think he really felt he was really cute." I saw how much those words meant to my wife, so I decided to regularly use words like that.

And so I have persisted in the use of words like perfect, beautiful, wonderful, and cute. I even have a little gadget on our EMR that prints out a "Certificate of Perfection" that I can hand to our patients that says that I was a "licensed professional" in determining perfection. It generally has the desired effect.

Perfect

When you are in the position of assessing a person or their child, it is very important to understand the way people cling to what you say. On every well-check I try to say how cute the child is (which is usually fairly easy, because I love little babies). If the child has a lot of earwax and the parents ask why that is, I say that it is associated with high intelligence (with a smirk). They laugh, but I don't doubt it has some impact. If the head size is a high percentile I generally say: "you have to expect she'd get a big head being as cute as she is."

I also try to say how healthy I think a child is when I do a well-check on a child that was premature or was significantly ill in the past. There are people who are convinced that their child is "weak" and "unhealthy." They interpret every minor bad thing through this filter, while they may have totally ignored the same symptom in a "healthy" child. My job in this case is to tip the balance toward optimism.

I also think that certain adult patients identify themselves with their illnesses. They always have complaints and never come in "doing fine." They seem to believe that the only way that they can assure attention is by having something wrong with them. This is an especially acute need when they are in the doctor's office. I make a point when I walk into the room of a person like this to say something positive - either about what they are wearing, their hair, or even just "you look better today." If I can pay attention to them because of things going well, then the reflex to complain may not be quite as strong.

If I have a day when everyone is saying to me "you look tired," then I end up feeling the way that people tell me I look - even if I started the day feeling fine. I think doctors sit in a position where their opinion carries a whole lot of weight. While it is important for us to treat illness and sympathize with the suffering, we can do a lot for people simply by paying some attention to the half-fullness of the glass.

When we do, sometimes it is remembered for many years.

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