One of the quickest ways I can help get people out of pain is to perform an injection, and there are a variety: steroid, platelet-rich plasma, prolo. So, I spend a lot of my time distracting patients from joint, bursa, or tendon injections, as I perform them. It may not be everyone’s style, but I find the silence overwhelming if I don’t do it.
Somewhere between searching for my entry point and cleaning the skin where the needle will go, I bring out “Wheres,” “Whens,” and Whys,” directed at the patient. Because in my mind, more often than not, distracting people from the injection is just as important as delivering the medicine to the place it’s supposed to go. During an injection, the patient responses range from gritting their teeth just to get through it, to telling a complete beginning-middle-end story that’s tied up by the time I put their bandage on. Or very often, responses comprise of broken sentences punctuated by combinations of sighs, grunts, or winces. The latter category of response motivated a resident working with me to quip “Dr. Wilt, you’re like the host on 'Hot Ones' when you do injections.”
For those who may not know, Hot Ones is a popular talk show where the host interviews celebrities as they eat chicken wings or vegan wings sauced up with the help of hatefully spicy peppers. The premise juxtaposes a calm host opposite celebrities who suddenly find themselves trying to answer questions, like “What stands out as the most bizarre or memorable injury you have ever had while making a movie?” while they struggle to fight a culinary blitzkrieg that alights their mouth with searing pain, fills their eyes with tears, fills their tissues with snot, and often hobbles their voice to the point of only being able to register a hoarse whisper.
Some find this entertaining.
After watching an episode, I quickly understood why the resident made their comment. A big reason I adopted my current style for injections and other procedures is also motivated by trying to maximize entertainment value. The only audience I wish to entertain, however, is the patient. This notion of entertaining the patient is not new. A famous quote from Voltaire reads: “The art of medicine consists in amusing the patient while nature cures the disease.”
And honestly, I think it’s sacrosanct to not try connecting as deeply as possible with my patient as I guide a needle into them. Yes, they signed a consent form, but I also don’t want them to regret it once we hit the point of no return.
My go-to question is “Do you have any trips coming up?” It gives me glimpses of what matters most to a patient: connection with others, food, hobbies. And it is the most likely one to make them forget about the injection. As I start my "interview," some people say, “You’re just trying to distract me.” But they say that in the sweetest way: Like someone who understands the sleight of hand that a magician wants to use for an illusion, but who is at the same time thankful that there are still magicians in this world who believe it’s worthwhile to attempt sparking whimsy through tricks.
Additionally, over my years of treating patients with a variety of procedures, not just injections, another facet of humanity was elucidated: There is a certain authenticity others may express if they are uncomfortable or if they just went through something uncomfortable. Whether that authenticity is a response to getting an injection or chomping a ghost pepper on camera, most people don’t typically show it within the first 15 minutes of meeting someone new.
But I do get to experience that side of people, after having only met them just 15 minutes prior, on an almost daily basis. And after being a party to it so many times, I’ve come to realize that that expressed authenticity from patients should be paid reverence. This feels right and like the only choice I can make when it happens.
Paying reverence means listening and asking that one additional question, even though we as doctors must all deal with the crush of spiraling administrative burdens. And I’ve learned a lot about my patients through conversations over injections. Some confess that their partner may have passed away recently, that they have lived alone for the past several years, or just their favorite restaurant in the area. And I’ve learned about whole professions I never knew existed. A farrier puts horseshoes on horses. A luthier builds violins. I’ve also learned that ryegrass is a great thing to plant in area that doesn’t get much sunlight and if it’s during the fall. And there’s the story of man who I did a knee injection on who had terminal cancer. As I was about to leave the exam room, I told him to call the office if he wasn’t feeling better in a couple weeks or if there were problems. After dismissively waving his hand in response to my instruction, he told me about having had a good life. And he spoke of living in The Village in New York City, in the '70s, and I listened. He told me he was ready to go at anytime because of cancer and that he was grateful I tried to help him get out of pain.
Doing my “interviews” helps me know I did my best to entertain my patients when they are uncomfortable or nervous. It also means I paid an authentic version of a patient their due respect. And when a patient feels respected and that their doctor is taking a chance to briefly take their mind off of something scary, I believe it gives them a better chance to heal, whether or not that patient is getting a joint injection, chemotherapy, dialysis or the myriad other difficult, but also necessary scenarios that any doctor and patient partnership could find themselves having to navigate.
What are your go-to questions to coax authenticity out of a patient? Share in the comments.
Jason Wilt is board-certified in emergency medicine and primary care sports medicine. He writes medical satire on his Overbooked and Overlooked Substack. You can also find more of his work on McSweeney's Internet Tendency and KevinMD.
Illustration by April Brust
