I am usually a humble person. Possibly because, as a smartass friend once told me, I have so much to be humble about. Yet I feel compelled to boast about one of my few impressive attributes, which is that I have always been an expert at coming up with good come-backs to unexpected responses from patients.

The only problem is that I usually don't think up these clever retorts until about two hours later. For example, I always found it effective to explain exam procedures to a patient as I performed them. Thus I once told a college professor patient during keratometry testing, "This instrument measures the curvature of the cornea of your eye and is accurate within 1/200,000 of an inch." 

"Obviously, that much accuracy is not necessary," replied the professor, clearly convinced that I was giving him a "snow" job. But I came up with the perfect answer:

"Perhaps. But I'd rather err on the side of too much accuracy rather than too little." Again, though, it was two hours later that this answer came to me, long after the professor had departed my office — forever.

Think before speaking

During my years in practice, I discovered that there were also many other ways of miscommunicating with patients. One of them was caused by my dreadful tendency to let my mouth get in gear before my brain does.

"I'm really tired," my first morning appointment, a very comely young lady, told me one day. "I had to work the night shift last night and I'm going home to bed as soon as you finish my examination."

I had had a rough week, and the thought of being able to just forget the rest of the day's appointments and to also go home to bed sounded mighty appealing. So, again, putting mouth in gear ahead of brain, I unfortunately replied:

"Gee, I sure wish I could join you!"

My stuttering attempts at explanation, after I realized what I had said, did not seem to make much headway, and I'm afraid she was certain a dirty old man was examining her.   

Bird brained

Another type of miscommunication is failing to make your message sufficiently clear. For example:

The metal strips the federal government uses to band birds are inscribed: "Notify Fish and Wild Life Service, Wash., D.C." They used to read, "Washington Biological Survey," now abbreviated to "Wash. Biol. Surv."

This was changed, the story goes, after a farmer shot a crow and disgustedly wrote the government: "Dear Sirs, I shot one of your pet crows the other day and followed the instructions attached to it. I washed it, biled it and surved it. It was turrible! You should stop trying to fool people with things like this."

Which ones?

Lastly, in addition to patients at times misunderstanding you, there's also the problem of making sure you understand them.

"One of my patients presented for her annual exam," Dr. Sheldon Kreda of Lauderhill, Fla., explained to me via e-mail. "She had just had cataract surgery at a relatively young age, and her figure was extremely well endowed. A short while into the exam she flung open her arms and said, 'How are my implants?'

"It took me a moment to realize she was speaking of her IOLs rather than her chest," Dr. Kreda writes. "I told her they looked fine."

JACK RUNNINGER, OUR CONSULTING EDITOR, LIVES IN ROME, GA. HE'S ALSO A PAST EDITOR OF OM. CONTACT HIM VIA E-MAIL AT RUNNINGERJ@COMCAST.NET