October 6, 2026
You're on the List
By Noah Marco, MD, CMD
One of my responsibilities as chief medical officer of Los Angeles Jewish Health is to participate in meetings with our residents and family members when there are concerns. Many of these meetings center on communication misunderstandings, and they often remind me that communication challenges are rarely the result of bad intentions.
Recently, I participated in a meeting that included a resident of one of our skilled nursing facilities, her primary care physician (PCP), our director of social services, and the administrator of the resident’s building. The resident’s daughter was on the phone, and the rest of us met in a conference room. The daughter was angry. Prior to the meeting, she told staff that she wanted an apology from the PCP for something he said to her. Early in the meeting, the PCP did apologize, but the daughter remained angry. As the discussion unfolded, it became clear that several earlier communication breakdowns had left the daughter frustrated and diminished her confidence that her concerns were being heard.
The story of one of the earlier incidents really triggered me. The resident told our staff that her toenails had gotten too long, were making it difficult for her to wear shoes, and had begun to discolor. The nurse explained that a referral had been made and that she was on the list to see the podiatrist. As the resident continued to ask about the appointment, she repeatedly heard only that "you’re on the list."
The reason for the delay was that the resident was enrolled in a Part C Medicare plan and, therefore, only a contracted and authorized specialist could provide services. As time passed (without the resident being told the reason for the delay), her daughter became involved. Insurance authorization was eventually obtained, and the resident's toenails trimmed.
Looking back, we should have explained the process more clearly. Staff was actively working through the authorization process, but we did not keep the resident and her daughter sufficiently informed about the reasons for the delay. As a result, it appeared to them that nothing was happening. The care process worked as intended, but our communication about the process did not.
Events like this are all too common, but I was emotionally triggered for a deeper reason. My parents and my wife’s parents were Holocaust survivors. My wife is a Holocaust educator. My organization and I have provided care to hundreds of Holocaust survivors, and we currently care for 26. The phrase, “you’re on the list,” may not be so innocent to a Holocaust survivor, especially one with cognitive loss.
Steven Spielberg’s movie Schindler’s List told the story of over 1,100 Jews who were not murdered because they were on a list (that they were essential factory workers) and could not be taken to concentration camps. In fact, the man on that list who inspired the writer of the novel (that was the basis for the film) was my parents’ friend Leopold Page. I remember him well. In Mr. Page’s situation, being on that specific list was the difference between life and death. He lived to 87, the same age as the resident we met with.
Unfortunately, for many more of the Jews in Nazi-occupied Europe, being on a list was the opposite. The list was names of those ordered to be immediately taken from their homes, family, and friends to a so-called “work camp,” a euphemism for a slave labor facility and a death camp. I am alive, as are my children, and grandchildren, because neither my parents’ names, nor my wife’s parents’ names, appeared on a list for immediate death. My father’s parents, his first wife, all his siblings, my maternal grandmother, and several maternal aunts were on such lists and killed in gas chambers. Similarly, so were my wife’s grandmothers, grandfathers, aunts, and uncles.
That is why hearing “you’re on the list” triggered me the way it did. However, just like there was more to the emotional reaction of our resident’s daughter than what the PCP said to her, there is another aspect of my concerns when we use that phrase today.
Holocaust survivors are not the only people who may associate certain words or phrases with painful memories. Each person’s background and circumstances shape how they experience communication. This can be especially true for those who have experienced trauma, displacement, immigration challenges, language barriers, or other significant life circumstances.
A phrase intended to reassure one person, such as “you’re on the list,” may carry a very different meaning for another.
Every day, health-care professionals choose words intended to inform and reassure, yet those same words may occasionally be received in ways we never intended. The lesson is not that we should avoid every potentially sensitive word or phrase. That would be impossible. Rather, we should remember that clear explanations, genuine curiosity, and attention to how our words are received are just as important as the words themselves. In person, pay attention to body language. On the phone, listen for a change in tone or a long pause. Then ask whether something you said caused concern. If the answer is yes, apologize and clarify.
One of my favorite quotes, attributed to George Bernard Shaw, summarizes this point better than I can. “The single biggest problem in communication is the illusion that it has taken place.”
Noah Marco is the chief medical officer of Los Angeles Jewish Health, president of the California Association of Long Term Care Medicine (CALTCM), and chair of PALTmed’s State Advocacy Network.