BMJ  2004;328:E283 (13 March), doi:10.1136/bmj.328.7440.E283

BMJ USA: Filler

"Do it!"

The literature abounds with work detailing how little of what doctors say or explain to patients is retained by them.^1,2 What interests me is why, in the face of that truth, sometimes what we say has a significant impact—an impact we, as physicians, are unaware of at the time of the encounter.

Recently, at a gathering, an attractive woman introduced herself to me as a former patient. I recognized her, but remembered nothing of her history. She said to me, "You saved my life."

Wow, I thought, I should remember that. She then told me that she came to see me 25 years ago because she had experienced several weeks of unexplained fatigue, insomnia, and anorexia.

Apparently, I asked her the usual questions and then added, "What do you do for fun?" According to her, she answered that there was little in her life that was fun. I then pursued this line of thought and said, "If you had all the time and money in the world, what would you want to do?" Without hesitation she answered, "Teach." "Do it!" were my less than brilliant or insightful words. She told me that she went home that day and immediately wrote away for teacher college catalogs. She has taught for the last twenty years and with a smile that suffused her whole body she told me, "I find my work satisfying and fulfilling and am joyful because of what you said that day 25 years ago."

Why did those two short words, do it, make such a difference in this woman's life, and why is there so much else that I have said that my patients never even heard? I can only guess that words are like seeds. Seeds, in order to sprout, require that the dirt has been plowed and is moist and ready to receive them. It may be that when words make an impact they fall on fertile conditions in the human mind, take root, and flourish. My patient, having thought a long time about teaching, perhaps needed only the impetus of two short words to start, and it was chance that those lifesaving words fell onto prepared soil.

The unpredictable power of words surprised me again when I talked to John, an alcohol addicted teenager. The parents of this seventeen year old and I had addressed the need to control his addiction innumerable times. We were unsuccessful and he continued to drink. One morning early, after a night of drinking, I once again pleaded with him to enter a recovery facility. I was astounded when he said yes. I grabbed the phone and immediately made arrangements for admission. He has not touched alcohol for many years, graduated from college, and has a good job. Why did he say yes that morning when he had said no all the other times? As far as I was aware I used the same words and the same tone of voice I had used on previous occasions. What made him hear me that morning, react to me differently? What had prepared the soil so the seed could grow?

I do not know the answer to my question: why, when I talk to patients all day, one or two words or a particular sentence may become powerful and influence the person I am addressing, while the rest of what I say goes unnoticed.

Fort Collins, CO rjustin{at}greyrock.org

References

1. Snell LM, Wilson RP, Oeffinger KC, Sargent C, Chen O, Corey KM. Patient and physician explanatory models for acute bronchitis. J Fam Pract. 2002;51: 1035-1040.[Medline]
2. Waitzkin H. Doctor-patient communication. Clinical implications of social scientific research. JAMA. 1984;252: 2441-2446.[Abstract]

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