Everything Is Negative

Patients often arrive with various ideas about their condition—drawn from personal worries, discussions with others, or online searches like Google. As a doctor, it may seem unnecessary to explicitly name conditions I know from the start are unlikely or absent. However, listing the specific things I ruled out can be valuable. It reassures patients that I took their concerns seriously, demonstrates that I thoroughly evaluated them, and builds trust and goodwill.

This approach is far better than the common shortcut of saying, “Everything was negative,” especially when we’re busy. To patients, vague phrases like this lack meaning:

• What exactly does “everything” refer to? We mean everything we tested, but that’s not specific—it’s concise but imprecise.

• What does “negative” imply? To us, it’s good news (no abnormality detected), but to a layperson, “negative” sounds inherently bad—the opposite of “positive.” If a doctor told you your tests were “negative,” how would you interpret that? Good or bad?

We often do a poor job of clearly communicating the tests performed and the conditions excluded. Simply stating “Everything is negative” tells the patient very little and can leave them feeling dismissed.

I had a patient who received an extensive workup for chest pain at one ER, only to present to another ER complaining, “They didn’t do anything for me.” When I reviewed the records, it’s clear they received an EKG, labs (including serial troponins), a D-dimer, a CT pulmonary embolism protocol, fluids, blankets, and even a breakfast sandwich. Clearly, all of that is not “nothing”.

Yet, depending on how the results were communicated, the patient may not have understood all the serious conditions that were systematically ruled out, or the scope of what the ER can reasonably accomplish. Taking a moment to name those ruled-out conditions can prevent misunderstanding and improve patient satisfaction.