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To a non-native English learner like me, understanding of, and familiarizing with the wide scope of usages of idioms associated with basic verbs such as “do, get, go, let, make, and have” are always a great headache. For instance, there was the following sentence in New Yorker’s (July 11) article titled, “How to tell someone that she is dying”:

“This raises a fundamental question about the doctor-patient relationship: Is modern medical practice all about “patient knows best?” or do physicians still need, on occasion, to cajole their patient into doing the right thing? The encounter between Elizabeth and her oncologist got off to a rough start and only got worse.”

What does the patient and doctor’s encounter “got off” to a rough start mean? Doe it mean they went or diverted into a rough start? What is a single word (verb) to represent for “got off” used here? Why is it "get off to," not "get off from (a rough start, and got worse)"?

CED defines “get off” as an idiom to mean; 1. escape a punishment, be acquitted. 2. go to sleep. 3. (usu. get off with) have a special encounter. 4. (usu. get off on) be excited or aroused.

Collins Cobuild English Dictionary defines “get off” as an idiom meaning; 1. not punished, or given a very small punishment. 2. leave a place because it is time for you to leave. 3. tell someone “get off” when they are touching you don’t want them to.

Which of the definitions of CED and Cobuild does the “got off” of the above article come under?

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    Help wanted: This is irrelevant to the question. My PC was crashed 2days ago. So I'm using an old Window 98 OS PC, and unable to link to the familiar page of mine in EL&U site, nor access to chat to get an advice for remedy. Could somebody help for me to restore the accustomed page by say, e-mail to: [email protected]
    – Yoichi Oishi
    Commented Aug 27, 2014 at 3:13

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"Got of to a rough start" simply means things went badly at the beginning of some event or relationship. If you are leaving on a trip, and your taxi breaks down on the way to the airport, and when you get off the flight you ultimately caught, find out that your luggage is in a different city than you are, and you trip on an ice cube you didn't see in the entranceway of your hotel, you might say that your trip "got off to a rough start". In the case of the article you cite, the phrase means that for some reason the patient and the oncologist did not have a good working relationship at the beginning of their interaction.

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    I found after posting this question that a user asked about the meaning of “We got off wrong,” which unfortunately “closed” because of the phrase being too local, relevant to a small geographic area, and not at all standard English (according to FumbleFinger). tchrist said in his answer to this question that he thinks it’s a equivalent to “got off to the wrong start.” So it seems to me that “get off to a rough start” is more normal than “get off wrong,” which some answerers said never hard of it.
    – Yoichi Oishi
    Commented Aug 27, 2014 at 2:45
  • "Got off wrong" might be a shortened form of "got off on the wrong foot"; either way, got off to a rough start is more common.
    – anongoodnurse
    Commented Aug 27, 2014 at 6:25
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    It seems that "got off to a rough start” is the variation of “get off on the wrong foot,” meaning “Make a bad start to a project or relationship. – www phrases.” I found detailed explanation of its origin www.phrases. It says: This has the sound of an old expression - from Shakespeare, the Bible or similar. Shakespeare did use the notion of a 'better' foot (which implies a wrong foot) in King John, 1595: KING JOHN: Nay, but make haste; the better foot before. O, let me have no subject enemies, - - - and goes on.
    – Yoichi Oishi
    Commented Aug 27, 2014 at 22:28
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And he's off! This is something we say when someone starts a race. If he begins badly we might say, "He got off to a rough start." This does not mean he will lose the race, right? So in life, as in a race, many times we get off to a rough start, In relationships (such as your patient and doctor), in a job situation, or in trying a new way to fold clothes! I believe it is a metaphor from a race. In a horse race we might say the horse got off to a rough start, but then, he may finish first!

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"Get off" in this case means "depart from" the "off" here is in the sense used in "send off" which is roughly synonymous with "send away" but avoids some implications: to "send away" can imply the object is unwanted, using "get away" frequently implies an escape.

In the common phrase "Get off to a [description] start" the departure is from an implied starting position of nullity and to the described initial state. In the case described by the New Yorker, Elizabeth and the oncologist got off from not having a relationship to having a difficult relationship. A project that gets off to a great start is departing from the state of not having been undertaken to a state of making good progress.

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