You're going to be OK

A student-doctor reassures an SP.
[Hope in a Prison of Despair via wikimedia]

When a learner attempts to reassure me during an encounter by saying, "You're going to be OK," I smile on the inside even though I still look worried on the outside. Because I know the urge to comfort a concerned patient is almost overwhelming, and I can't fault them for the impulse.

But it's impossible to guarantee a patient will be OK. If I believe it and it turns out to be wrong, I am going to feel betrayed by and mistrustful of the person who said it. During feedback with learners, most wished they could take back that statement as soon as they said it. But they didn't know what to say instead. So here's the structure I recommend:

• Validate the emotion: sincerely acknowledging an emotion almost always de-escalates it. It makes me feel heard and like the student-doctor is attentive to my non-verbal communication.

• Next steps: of course, defusing the emotion is only the first step. Without further steps, the de-escalation will act as a pause button, but then my anxiety will continue to rise until I know what the student-doctor plans to do about it. The plans don't have to be in great detail, but anything student-doctors are able to do to manage my expectations will cause me to feel more confident in their abilities and less distressed.

• Reassurance: this is generally what "You're going to be OK" is meant to do, but it's hard for it to seem sincere on its own, which is why the other elements help to support it. An expression that indicates care and responsiveness is all that's needed here.

Here's an example of how this could work even in a first-year encounter:

SP: Am I having a heart attack?! 

Student-doctor: I can see why you'd be concerned about that. I'm going to do a heart exam and then check in with my supervisor so we can take care of you as quickly as possible.

Discussion question:
What other reassuring statements could the student-doctor make using this format?