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.