Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Have you done this before?


Listen for a patient’s anxiety when they ask questions about treatment. Addressing all concerns builds a trusting relationship and helps them better tolerate procedures that may initially be painful. 

Early in my practice, I was treating an older patient with thumb arthritis. The pain was limiting her ability to crochet, her favorite hobby. She’d tried splinting and ibuprofen, but it still hurt too much to crochet. I told her that a joint injection might improve her pain and allow her to use her thumb with more comfort. “Have you done this before?” she replied with an anxious look. 


As a junior attending, I was often asked this by patients before doing a procedure or surgery. I had darker hair and a babyish face, so I tried not to receive it as anything more than a question about my clinical experience related to my age. But I still worried that it meant my patient didn’t trust me. I responded with a count of the times that I’d done the procedure or surgery previously and then went on to explain what I’d be doing, what it would likely feel like, and how long it might take for them to start feeling better. However, I soon discovered that their original question wasn’t about me at all. 


Most of the time, the patient was sharing their anxiety about letting me, a relative stranger, take a sharp object to them to hopefully feel better. As I explained the steps of the procedure, what parts might hurt either during or after, and how soon they could start using their hand in their everyday life, I could see their tension begin to ease. 


As a hand surgeon, patients rarely see me for conditions that threaten their life or limb.  They’re putting their trust in me to do procedures that will hurt in the short term but improve their comfort and function in the long term. Understanding their goals and values helps me guide them to the treatment option that best meets their needs. I remember this every time I discuss surgery with a patient; I may have done this procedure many times, but it’s often their first experience. I make sure that they understand what their experience with the surgery is likely to be and that our treatment plan feels like the best choice for them as we proceed with it. 






his piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.