What Your Doctor’s Really Thinking (But Won’t Say to Your Face)



Nancy Kalish




Here’s what your doctors would tell you if they weren’t worried about time, lawsuits, or hurting your feelings.




Put away your phone!

“I hate when patients text during a visit. It tells me that they do not value my time. I feel disrespected. I have left patients talking on their phone in the examining room and moved on to see another patient.”

Oncologists hate pink

“Of course raising money is great. But during breast cancer–awareness month, in October, everyone comes in thinking she has advanced breast cancer. Our patients hate it because they can’t go anywhere without being reminded of their disease

Don’t ask me to lie

“I’ll get a call from a daughter who says, ‘Don’t tell my dad I called you, but you need to know he’s having chest pains again.’ Now I’m not supposed to know, but I do know, which is bad for everyone. I want to sit down and say, ‘John, your daughter says you’re having symptoms that you’re not telling me about.’ I don’t like those kinds of secrets.”

Don’t ask me to lie

“I’ll get a call from a daughter who says, ‘Don’t tell my dad I called you, but you need to know he’s having chest pains again.’ Now I’m not supposed to know, but I do know, which is bad for everyone. I want to sit down and say, ‘John, your daughter says you’re having symptoms that you’re not telling me about.’ I don’t like those kinds of secrets.”

Your missed appointments really worry me…

“I want to give my patients the best care, so I get frustrated when they turn it around and accuse me of trying to ‘pay for my new boat’ instead of taking responsibility for their disease. When patients delay treatment, something as simple as a filling can become involved and costly.”

…But late is better than never

“When a patient finally comes in, years late, I walk in with a smile and an outstretched hand. ‘Where have you been, stranger? So glad you are here! Tell me, what has happened since I last saw you? I know patients are busy. I know it is not in our nature to think about our health, even though we should. With good health, you can always make more money. With more money, you can’t always buy good health. So the fact you are here is a good thing.’”

I’m not scared of your Google search

“When patients come in with three inches of printouts, I know I’m going to have a good conversation. But they’ve also almost always terrified themselves beyond need. I wish they would e-mail or call me so I could put things in perspective. But in general, patients who have researched their condition tend to educate faster and take better control of their care

I could use sympathy too
“Many doctors have depression, so don’t take it personally if they seem distant. Our greatest desire is to help patients. That’s why we delayed starting our lives until our 30s. Many doctors give up their own family life to overextend themselves to you. And they’re kind of a mess after years of doing that. I’d like to see more patients have more empathy for doctors. It would be so great if a patient said, ‘You look kind of frazzled today. Can I give you a hug

Tell me your story, not your symptoms

“I like it when my patients in the ER tell me things like ‘I was running my usual five miles when at mile one, I started to have chest pains that stopped when I sat.’ That’s much more helpful than just saying ‘I had chest pains

I contradict you very carefully

“Even if a patient is wrong about her problem, it’s not helpful to tell her so. Finding the right answer is the best way to dispel the wrong answer. I never try to shake someone’s belief until we have enough facts to do it.” —Mark Liponis, MD, corporate medical director of Canyon Ranch in Lenox

I trust your gut


“Parents are so smart and so intuitive and know what’s normal for their child and what’s not. So I always work to take them seriously.”

Sometimes I don’t know what’s wrong

“Doctors are supposed to know everything, but we don’t. When I’m worried about whether a treatment will work, getting sued is always in the back of my mind. It’s scary

I welcome your e-mails—within reason


tell all my patients that we need to be on the same page for surgery. If that means you need to e-mail me 30 questions, then it’s totally fine. But don’t expect that I’ll e-mail you back. I’ll call instead

I may cave to your pressure

“If you really want a test that’s not covered by insurance and not really necessary, I’ll give in as long as it’s not ridiculously expensive or invasive. In primary care, our relationship is important. If you feel like I resisted your seemingly innocuous request, you’re not going to trust me. This way, I keep you as a patient so I can steer you toward appropriate tests

I run late for good reasons…

It’s hard to be a patient, but it’s also really hard to be a doctor and walk into a new room every 15 minutes with a new family and new challenges. One person shows up late, and it creates a domino effect. But when a teen comes in and admits feeling suicidal, I’m not going to kick her out. Sometimes I want to go into the next exam room and say to the irritated person who’s been waiting, ‘You are so lucky your child is healthy. If you’ve never had to double your doctor’s time, you’re just really lucky.’ ” —Wendy Sue Swanson, MD

But you’d better have a good excuse if you’re tardy

“When patients are very late, the good doctor in me feels that there must be a valid reason, and I want to accommodate them. The bad doctor wonders how they could be so inconsiderate. Why should my other patients have to wait because someone else could not be punctual? Typically, I will see a late patient as long as it does not inconvenience other patients.” —David Broyles, DO

Second opinions help me too

“They could confirm my diagnosis, which means the patient will have confidence in it, and that could reduce my liability. And if the other doctors don’t agree, I might learn something

I read your body language

“A patient’s gaze tells more than any exam. A patient who is modifying his history — because of anxiety or concern about what I might say — makes poor eye contact, squints, and looks slightly distracted. If he is trying to control me, he may stare without blinking, ignoring things I say, and tend to give short answers. You can spot pain from the distant, glazed nonfocus of a patient’s gaze.” —James C. Salwitz, MD

I relish your tough case
“Here’s how I react whenever a new patient tells me, ‘Every other doctor said that this was all in my head.’ On a bad day, I might think, This patient has a million complaints, and I am never going to figure out what’s really wrong. On a good one, I will see it as a therapeutic challenge. Most days are good days.” —Kenneth Lin, MD, MPH

I never get over losing patients\

old doctor friend used to say that a piece of you dies with each of these cases. When you’re taking care of people for 15 years, you really get to know them and their families. I know all the children and the best vacations and who fishes. I go to most of the funerals. After someone has passed away, you wake up at 3 a.m. thinking about him or her.” —