One of my longtime patients, a man in his 70s with diabetes and hypertension, looked very worried when I stepped into the exam room to see him. He was recently treated at a local urgent care clinic for an abrasion on the bottom of his foot.
“What did the doctor tell you?” I asked.
“He said it’s nothing to worry about. Just a small clean wound that should clear up in a few days with some topical ointment,” he recounted.
“But I can see you’re still worried,” I replied. “Let’s talk about it.”
You’ve probably been told “It’s nothing to worry about” many times in one context or another, perhaps even at your own doctor’s office. When using this phrase, doctors are seeking to provide reassurance that a problem is not especially serious. And it can be exactly what some patients want to hear. So why does this consolation sometimes have exactly the opposite effect for others?
You may have seen comic depictions of ineffective doctor-patient conversations with thought bubbles containing things that are thought but not said. The doctor’s bubble contains his unvoiced diagnostic reasoning, and the patient’s is filled with unspoken worries.
My patient did not tell the urgent-care doctor how concerned he was about infection; he knew that people with diabetes are at high risk for serious foot infections that can progress to threaten limb loss if not properly recognized and treated. Why was there nothing to worry about? Had the doctor said, “I don’t think this will become seriously infected because there is no redness or drainage, but here’s what to look for…” my patient’s stress level would have diminished significantly.
In fact, having learned from his urgent-care story, this is just what I said to him, and his distressed look dissolved.
If a doctor tells you, “It’s nothing to worry about” and you do not feel reassured, it’s OK to share your specific concern, even if it did not come up during your initial conversation. It may feel uncomfortable to share additional worries, but your doctor will most likely welcome them. You can also ask for more detail about how the diagnosis was reached and treatment selected. This will help you get the information and reassurance that you truly need.
Jeffrey Millstein is a primary care physician and regional medical director for Penn Primary Care.