The Doctor Is in the Details
Kendra Campell -- I’ve always tried to be a good communicator. I really enjoy conversing with other people, and I consider myself to be fairly cognizant of others’ reactions. I try to alter subtle details of the way I speak depending upon who I’m talking to, and what the circumstances are. I’m certainly not perfect at it, though. And the more deeply I delve into medicine, the more I realize how critical it is to be able to effectively communicate with patients. I can only hope that I’ll do a decent job when I actually start working on the wards.
I once observed a fellow student interview a patient who had a very long list of complaints. After the patient finished describing each complaint, the student said, “okay, and that’s it?” The student was obviously hoping that the patient had no more problems that they’d have to explore. It was quite apparent that the patient quickly caught on to the student’s annoyance, as she eventually gave less and less information about each complaint.
Another time, I heard a patient mention that they used “bush medicine” to help treat their headaches. This being a Caribbean country, many people treat various ailments using bush medicine. However, instead of asking more about the type of treatment that was used, the student condescendingly said, “okay, so you don’t take medication, and you still feel worse.” The expression on the student’s face was obviously one of disapproval. It’s nearly impossible to get a history from a patient if you quickly dismiss what they’re trying to explain to you.
We’ve probably all seen at least one med student get so wrapped up in taking a history or performing an exam that they walk into the examining room without introducing themselves or asking the patient’s name. This “lack” of communication with the patient certainly does communicate a lot!
There are so many intricacies involved in the doctor patient relationship that it’s impossible to master every detail. But as a future doctor, I want to attempt to do the very best job that I can with every patient. A simple smile or an understanding nod can ease a patient’s anxiety and allow them to open up to you. Communicating effectively with patients is not just about the questions you ask, but rather how you ask them. The tone of your voice and the reaction on your face can frequently communicate more to your patient than their lab results or their diagnosis.
Taking a good history and being a good doctor requires paying attention to even the most seemingly insignificant details. Many doctors might be very adept at scrutinizing their patients in every way, yet they forget to turn their astute powers of observation on themselves. I hope that in my future practice I can remember not to focus so much on my patient’s details that I forget my own.
I totally agree! I actually have a blog too and just posted about this not too long ago.
I was in ICM and a fellow classmate asked about past operations. Turned out she had two. He then asked if she had any complications with them and she replied no, that they went smoothly. When asked if she had any blood transfusions she replied that she had not. Kind of condescendingly, he responded "Well you just told me you had 2 previous surgeries so you MUST have had blood transfusions." Not only displaying a lack of knowledge but having this kind of attitude I found truly repulsive. This is not the only time I have seen this too. Granted we are new at this, but still seeing this just left me with such disappointment. Students can know every detail of a disease but this profession requires a certain personality, I feel at least, that I find alot of students lack.
Hopefully we will all continue to grow and become the kind of physician that patients will be at ease with and able to openly converse all of there thoughts and feelings, in order to build their trust and confidence in back their health care provider/system which has seemed to be missing now-a-days... That's what I hope for at least!
Posted by: | Jun 28, 2007 2:07:30 PM
hopefully he will become a radiologist or gravitate towards a research oriented career. when you take away the human/communication aspect of clinical medicine (even during residency), you're left with a 80 hour a week job that pretty much sucks.
Posted by: | Jul 4, 2007 7:58:24 AM
good points. to address this from the patient's perspective, My mom has had a long medical history, and when she goes in for checkups, evaluations and followups it is very difficult for her to get her doctors to pay specific attention to all the things she needs to have attended.. in her nervousness, she would just walk out the door without discussing any of them and then get home to a head full of worries... so she takes a checklist of concerns and issues to the doctor and won't leave until everything is checked off.
Posted by: joshypoo | Jul 4, 2007 2:05:02 PM
I think the check list things is really useful for both doctors and patients, when i have encountered a list it ensures the Pt addresses all their concerns and also helps the doctor because the Pt is focused and has already taken the time to think of all the things they want to address. I love the communication side of things and enjoy finding out about ppl, and if i have the time just having a chat. It worries me that when im a busy house officer i might not have time for these things which make the job worth doing.
Posted by: alison | Jul 4, 2007 2:47:08 PM
I agree to abve comments.I feel communication is as important as diagnosis and treatment.May be we should include this in medical curriculum as well.
Posted by: Anand.M.R | Jul 5, 2007 12:29:22 AM
kendra, It is true. The way some doctors attempt to communicate with their patients is appalling, esp. with the older population. My grandmother has to literally make-up symptoms that she is having just to get her doctors to listen to her concerns or just run a simple ECG. Not to mention the attitude a lot of doctors have towards anything that is not western medicine (i.e. bush medicine, naturopathic and the like). One of my grandmother's doctors actually said to her in a condescending tone, "you are an 80 year old woman and you think you should go to the chiropractor," after she went to him complaining of sciatica. Granted, I understood his reservations to some degree, but did he have to treat her like an idiot? NO. I hope as medicine progresses, physicians attitudes evolve and they will begin to treat their patients with more compassion and patience.
Posted by: Amy | Jul 5, 2007 1:08:51 PM
It is strange I should be reading this shortly after reading a similar article on patient-doctor communication in Malaysia on medicine.com.my/wp.
If only medical students AND doctors would realise that communication isn't actually a whole lot of fluff, and if anything, something the patients value more than all the knowledge in the world that you have on neuroanatomy, or whatever.
To quote a friend's MSN message: People don't care how much you know, until they know how much you care.
Posted by: Sheena | Jul 12, 2007 6:34:08 AM
Doctors I have seen have frequently treated me like an idiot over the years, though I am fairly healthy and do not see a doctor very often. The last visit to a doctor I hadnt seen before to clear up a small infection was the last straw. She came in the room stressed out completely, decided she did not like me instantly upon looking at me, and it went downhill from there. She did not inform me of it, but tested me for all kinds of std's and I am not sexually active. She then touched things all around the room and then did an examination with the same gloves in a private
Posted by: Chris | Jan 13, 2008 7:31:52 PM
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