What your Doctor Thinks About You In The First 10 Seconds

What your Doctor Thinks About You In The First 10 Seconds

What your Doctor Thinks About You In The First 10 Seconds

First Impressions

I have seen THOUSANDS of patients, and with each of them there was always a first impression. Right off the bat, I can tell a lot about a new patient. Most importantly is sick vs not sick. “Sick” has a very specific meaning in this context.

Subtle clues can often be what make or break your decision to get a full workup on a patient verse reassure that their problem is harmless. These decisions are sometimes made in seconds when seeing a patient and are based off many different aspects of the patient’s appearance.

Sick Or Not Sick

When an ER doctor says a person is “Sick”, this means they are actively experiencing a severe medical problem which could cause them to die if they don’t get immediate treatment. This could be a heart attack, appendicitis, bad pneumonia and many others. SICK MEANS BADNESS. Determining degree of illness is a skill that takes many years to refine.

Sometimes doctors who are unfamiliar with very sick patients may not pick up on the subtle signs that someone is critically ill.

Not-sick patients may have a small pneumonia, a mild flu-like illness, simple UTI etc. This is your regular patient with a real problem who isn’t dying but needs treatment.


This triangle is taught to all doctors who take PALS (pediatric advanced life support). PALS is basically CPR for babies and children. Note the triangle is the FIRST THING YOU DO when assessing a sick child. This shows you the importance of first impressions.

We can also see many individual signs.

Here is a rough list to give you an idea.

  1. Cachexia which is when a patient looks thin, gaunt and sometimes almost skeleton-like can be a sign of malnutrition, cancer, HIV or many other long term illnesses.
  2. Yellow skin can be a sign of liver disease.
  3. RESPIRATORY STATUS is very important and respiratory distress can be a sign of a patient about to die from a lung issue.
  4. Mental status- is the person awake? This is tied to respiratory status and is of CRITICAL importance.
  5. Are they anxious? This can be a sign of an underlying medical condition like a heart attack causing anxiety or the patient may simply be anxious.
  6. Overall health – this is broad but gives you an overall feel of the patient. Important for this are things like: does the patient have severe tooth decay, are they obese, do they have skin lesions, are there scars anywhere, is the patient paralyzed, do they have a foley catheter suggesting urinary issues and many more.
  7. Is the patient SWEATING? A mentor of mine once told me “Kapper, respect the sweat”. Simply put, sweat is often a sign of critical illness.
  8. And finally age of the patient which is of obvious importance.

Check out my podcast Medical Cases Podcast to hear more great stories about being an ER DOC!