How to avoid inappropriate conversations with patients

What do you do when a patient wants to talk politics, religion or some other inappropriate subject? Here are my three ways to handle it: redirection, humor or outright refusal!

I usually go with a combination of humor and redirection at first. If I have a patient who’s insisting that Obama is a socialist bent on destroying Western civilization, I’ll try (try!) to make a joke of it (“Well, he hasn’t done too well with reality TV so far, has he?”) and then introduce a new subject (“Speaking of reality TV, did you hear about that new show called Kardashians and Krocodiles? It sounds fascinating.”) Likewise, if I have a person who tells me repeatedly that Rick Perry is a fascist pig, I point out gently that he takes too much time with his hair to have any sort of plans for world domination.

Sometimes humor won’t work and you have to go straight for redirection. This works best with patients who are either too zonked on drugs or too demented to catch jokes easily.

Instead of engaging with them, I keep my voice calm and boring and low, and say things like, “That’s good, Mr. Smith. Please swing your legs to the edge of the bed so I can sit you up and listen to your chest.” What I’m saying is there’s never a bad time for a complex physical assessment, and you can always ask your patient not to talk for a bit as you auscultate her chest or mess with his abdominal binder.

When all else in the “redirection” department fails, I keep an oral thermometer handy. No, I am not joking.

As for outright refusal…there have been times when I’ve told patients bluntly that I will not, under any circumstances, talk politics or religion with them. There have been other times when I’ve told patients that their (racist, anti-Semitic, homophobic, etc.) comments are inappropriate and will not fly with me. Each time, I felt like I was walking the edge of something that might turn into a real confrontation. So far it hasn’t, I think because I’ve been calm and cool about it and have stated, just as if I’m stating a scientific fact, that calling my coworker X or telling Y joke or trying to convert me to Z is not allowable.

Just because we minister to their bodily needs does not mean we have to be an audience to whatever somebody says. Standing up for yourself this way is rarely easy, but it makes for a much more pleasant working environment.