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Implicit Messages

February 29, 2020
by Mark David Siegel

Hi everyone,

With everything we say and do, we send implicit messages. When I ask Heide how her day went, I’m not just asking for details; I’m saying I love her. When I drive to New Jersey to take my Mom out to dinner, I’m also signaling I care about her, and that she’s worth a 200-mile round trip.

The same is true with patients. When we ask them questions to diagnose their problems, we’re also telling them we care about their needs. And when we examine patients, we’re also telling them they’re worthy of being touched.

It’s the same with you. When a resident teaches an intern to read an EKG, she’s not just imparting a skill, she’s showing she cares about his learning. When attendings tells residents it’s unnecessary to call about all new admissions, they’re setting expectations but also signaling trust.

But beware- implicit messages are also prone to misinterpretation. What do patients think when you draw extra blood? That you’re being thorough, or that you’re worried about something scary but haven’t mentioned? When a resident leaves an intern alone on the floor, is he expressing confidence in her abilities, or that he’s above helping out? When an attending tells a resident not to call, is he conveying trust, or is he sending a covert message not to wake him up, even for emergencies?

We couldn’t possibly express all our implicit messages, even if we wanted to. When I bring muffins to rounds, I hope you know I’m just being nice and not implying that you look malnourished.

But let’s be careful to avoid misinterpretation. For example, when you ask patients what you should do if their heart stops, make sure you don’t make them worry they’re about to die. Or when you enter orders for interns, make sure they know you’re just helping out, not that you don’t trust them. Sometimes it’s better to make the implicit explicit.

With that, I’ll close with a question. I’ve been writing Program Director’s Notes every Sunday morning for several years now, without fail.* Why do I do this? What do you think?

Enjoy your Sunday, everyone. Heide says we should go to John Davenport’s for brunch. I wonder why...


*Check it out:


PS We’ll have much to say soon on Covid-19. For now, some resources:


Submitted by Mark David Siegel on March 01, 2020