“Better” is another one of the difficult words I have to deal with on a daily basis.

“Doc, I’m better” can mean a lot of things and can lead to both misdiagnosis and poor treatment.  Does “I’m better” mean you are well?  If not, are you really better or is it just wishful thinking?  How much better are you?

On a busy, stressful day, even the most skilled physician can fall for, “Doc, I’m better.”

“I’m glad you are better, Mrs. J.  Please stay on the same medications and see me in a month.”  This typical exchange sounds perfectly fine, doesn’t it?

Mrs. J was very depressed when she was seen 2 weeks ago.  While she was not suicidal, she had started to disengage from her family and friends.  She was feeling somewhat hopeless and could not envision ever being happy again.  I often ask patients to assign a numeric value to their problem, 10 being the best day they ever had and 1 being the worst.  Mrs. J would have been a 2 of 10 when first seen.

On her return visit, Mrs. J was “better.”  Had the doc asked her to define better, she would have been a 3-4 of 10.  While better, she was far from well and still in jeopardy.  Hopelessness is a very bad thing and Mrs. J still felt hopeless.  “Mrs. J, please stay on the same medication and see me in a month,” sends the wrong message.  The message Mrs. J hears is that she is going to feel like this for another month or this is the best the doc can do.  These are not messages that inspire hope.

Accepting “better” leads to a mediocre outcome at best.  Had Mrs. J said, “Doc, I feel a little better,” or had the doc asked, “How much better do you feel?” the scenario would have played out differently.

“Mrs. J, I’m glad you are feeling a little better.  That’s a good sign that we are on the right track.  Let’s increase your dose of medication and see me in 2 weeks.  Hopefully, you will feel a lot better.”  In this scenario, Mrs. J has can have hopes of feeling better and one day being well.

If “better” means well, say so.  If better means a little better, acknowledge that, as well.  Set your sights on being well and work towards that goal.  While a 10 of 10 may be an unrealistic goal, 8 of 10 should be obtainable.  Become a great communicator and help your doc do the same.

Stewart Segal is a family physician who blogs at Livewellthy.org.

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