The reassurance gap

By Jeffrey Millstein, MD, Penn Medicine

A patient and I were reviewing her recent echocardiogram that was done as part of a cardiology evaluation for dyspnea. The study was entirely normal except for slight dilation of the aorta. A portal message from her cardiologist said that this aortic abnormality wasn’t severe and required only yearly monitoring. The patient also mentioned that, during her recent follow up visit, her cardiologist said it was “nothing to worry about.” Still, she seemed unsettled.

When I asked her what she was most worried might happen, she handed me what turned out to be the key to reassuring her. “I’m afraid my aorta will explode and I’ll die suddenly like Lyndsay Graham or John Ritter.”

I explained that her aorta was nowhere near dilated enough to tear, and that her aorta “will not explode.” The tense lines in her face softened, her posture relaxed, and she released a long, decompressing exhale.

The lesson for me in this encounter was that reassurance needs to be delivered in a way that makes sense to the patient. General platitudes like “It’s not serious, You’ll be fine, It’s nothing to worry about,” may not counter the specific catastrophic fate patients have imagined for themselves.

When providing reassurance for patients, consider these five suggestions:

1. Ask what, in their own words, patients are most worried could happen to them.

2. Avoid general reassurances like “It’s nothing to worry about.”

3. Use the same words or images the patient uses in your reassuring statements.

4. Look closely for verbal and body language to see how your statement lands. If the patient still seems worried, reframe and try again.

5. In some instances, it may help to call out the discomfort directly. You could say something like, “You still seem worried—how can I best help you feel reassured about these findings?”