Don’t Tell Your Patient This. Or That.

Jo over at Head Nurse had an interesting question about a month ago. She was prepping for an interview for a Reader’s Digest article called “50 Things Your Nurse Won’t Tell”. It’s a common format for RD, I soon learned after checking their website, and features such articles as “50 Things Your Flight attendant Won’t Tell” and “50 Things Your Waiter Won’t Tell You”. In turn, the articles prompt answers along the lines of “Yes, the waiter will really spit into your soup, and how!” See the comments section in Jo’s post for the nursing version.

But the more I thought about it, the more I thought the question as posed by Reader’s Digest was curiously framed. Nurses are supposed to provide information to patients; withholding information seems like, well, unnecessary power-tripping. In fact, I will tell patients things I am not supposed to mention, like about the cosmic suckiness of hospital food (because it does) and how an ECG looks — but if I bring you in right away after doing it, you pretty well know it’s not good.

So there is very little, in the end, I won’t share. There are some things, however, that are beyond the pale. Here’s my short list of ten things I will never, ever tell you, my patient:

  • Anything that would violate confidentiality of anyone in the known universe. Not only because it’s unethical, unlawfully and probably fattening, but also because it’s none of your fracking business.
  • That your dire medical emergency is not, in fact, likely to be all that dire, though I do understand you may have been misled by the name “Emergency Department” into thinking that since you are here, it must be an emergency.
  • Anything that would tend undermine my physician or nurse colleagues. It’s nasty, and more importantly, I have to work with them.
  • You’re about to die. A situation where a patient is fully awake and aware and whose death is imminent is fortunately relatively rare. Even so, I’m not going go to pipe up and say cheerfully, “I think you’re about to cack, so get ready for the ride of your life.” That, as they say, is way above my pay grade.
  • What I really think of the peculiar family dynamics circling your bedside. Opening up that particular can of worms never ends well
  • About your dirty underwear. Yes, we do notice. No, I will never speak of it.
  • Similarly, your body odour will go unremarked. I will not tell you that you’re perfumed like the thing that rudely crawled under the front porch and expired. Even if you stink, you still have dignity and worth as a human being. But if I come in right after assessing you with a basin of hot water and rather a lot of soap and towels and wearing a bright yellow gown and mask, don’t be surprised and/or offended.
  • That I strongly question a pain scale of 10/10 if you’re drinking an extra large Tim’s double-double while telling me this at triage.
  • Along the same lines, claims of severe migraine will provoke some internal doubt, but nary even a raised eyebrow, if you’re also allergic to every analgesic and NSAID in the known universe except Demerol.
  • Your claims of alcohol consumption will be automatically tripled for accuracy.

I’m sure every nurse has his own list. At the same time, I wonder what patients really want to hear from us.

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  1. #1 by dm on Thursday 26 May 2011 - 0934

    I would NEVER tell a patient that I would not let the surgeon of their choice operate on my cat, let alone myself or anyone I care for. I always say, So and So is a fine surgeon and you are in good hands (even if I gag a bit)

  2. #2 by Jenn Jilks on Thursday 26 May 2011 - 1252

    You are right, the RD articles are so negative.
    Here is my take on What a patient wants from a nurse, as I rest from my 3 recent ER visits, cut-up thumb, and tenosynovitis!

  3. #3 by Decemberbaby on Thursday 26 May 2011 - 1624

    From you we want to hear that there was a bad car crash and you’ve got four patients in very dire circumstances, so the wait time will be five hours but hang tight, you’ll get us taken care of. We want to hear “The good news is that you’re not critically injured. The bad news is that means you’ll be seen after the people who are. The magazines don’t get changed very often around here, so if you’ve brought someone with you maybe they should go get you some reading material.”

  4. #4 by Ab Brody, RN on Friday 27 May 2011 - 0902

    I don’t think that bullet 4 is above your paygrade. I might consider HOW I say that someone is not doing well, but we can’t shirk the responsibility of talking to patients about their mortality. Doctors are just as bad (see article in the NY Times published yesterday: )

    • #5 by torontoemerg on Saturday 28 May 2011 - 1005

      Well, funny thing, I have no difficulty whatsoever telling family their 80-something father is on the cusp, or counselling palliative care patients about end-of-life and what to expect, but telling a patient on an ED stretcher I don’t expect them to live the hour is beyond me — I’m not even sure how I would broach the subject, if only to say, ‘You’re critically sick, and we are doing everything we can.”

  5. #6 by The Nerdy Nurse on Sunday 29 May 2011 - 1945

    I hate this mentality of withholding medical information.

    If a patient asks me their INR level, it’s absurd to withhold it until the doctor reveals it to them. Insane.
    The nurses who do this make the argument “I don’t want to be he held liable for it.”

    Really? It’s the patients INR, what’s there to be liable about.

    or “One time a told a patients something the doctor didn’t want them to know, and I got chewed out for it.”

    That’s the WORST. Seriously? The doctor didn’t want them to know? It’s a good thing you did tell them, or else that patient would never know.

    Now don’t go blurting out “The CT says it could be cancer” because frankly, as a nurse, you are licensed to interpret that sort of information.
    But if someone ask you “What was my last hemoglobin level?” – you’re being a huge douche-bag power-tripping healthcare provider if you refuse to tell them.

  6. #8 by Scottk on Monday 30 May 2011 - 1542

    The worst example of the bone headed Dr. was one who spent almost 15 minutes explaining to me why I as an RPN was not educated enough to relay lab results to the pt. The lab result in question? A glucometer reading!

  7. #9 by grass fed beef manitoba on Saturday 05 May 2012 - 1823

    It’s interesting health is something few people value. The reason why I say this is because people drink and smoke. People eat bad food and only when they have very bad health problems do they want to change. As a nurse or any health care provider you have to have a lot of compassion for people even if it’s their fault. Maybe these people never received good guidance on how to be healthy. Emotional health is the most overlooked aspect of someone’s health and your support as a medical care partitioner of any kind can make the hugest difference in that persons healing.

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