Ideas, Concerns and Expectations
These days, student doctors are being taught to make their consultations more "patient-centred". This should mean that, unlike the Olden Days where many of them simply ploughed through a checklist of symptoms - or, in some cases, didn't - they actually listen to what the patient has to say.
The trouble is, if you ask "what's brought you to the doctor today?" - type questions, you run the risk of the patient actually telling you what's bothering them. And it may not be something that's easy to talk about, such as a sprained ankle. It may be embarrassing or - even scarier for some doctors - it may be emotional.
We all tend to run away when we're scared and doctors - by their own admission, if some I was talking to earlier in the week are a representative sample - tend to run away to the Land of Jargon. They speak in a strange language that only fellow doctors can understand. They feel safe there.
"Do you suffer from hypertension? Is there any familial incidence of this disorder? Have you had any previous MIs?"
Sometimes they don't do the jargon: they do Doctorspeak. This has language such as "I think there is a low probability that this bruising could have been caused by a disruptive sibling". It's English, but not as we know it.
The more emotionally demanding that a consultation gets, the more likely they are to retreat into jargon or Doctorspeak.
Not all of them, of course, oh no. Some doctors - and some student doctors too - have superb empathy and are able to cope with just about anything.
They are taught to seek out the patient's ideas, concerns and expectations. The more able ones do this subtly, so that, to the patient, it just seems like a friendly chat.
The weaker ones - if they are keen to learn - can be taught some techniques to show empathy, even if they're never going to be brilliant at it.
"I know just how you feel" is never going to be any use, but "That must have been terrible for you" often can be.
I play the roles of patients to help in the training. When I'm playing a patient with any kind of illness or situation that might involve strong emotions, I feel very strongly that I'm fighting the corner of real patients, past or present, with similar problems.
Today, somewhere in the UK, I was playing a woman who had been brought into hospital with a suspected heart attack (the myocardial infarction or MI mentioned above), and was having some tests to see if it had, in fact, been one. She had had a previous heart attack, five years ago.
Unfortunately, the student doctor I was talking to was finding this frightened patient rather difficult to deal with.
"So, have you any ideas about the reason you're here?"
"I'm really worried that it might be another heart attack."
"And do you have any concerns about that?"
It was a bit like talking to the Speaking Clock, but I persisted.
"Well, I'm very scared that I might d- - "
"Did you say that you're already on medicine for your hypercholesterolaemia?"
But then the next student was brilliant: caring and compassionate and understanding. The difference in abilities between students of the same age, and the same level of training, can be stunning.
The trouble is, if you ask "what's brought you to the doctor today?" - type questions, you run the risk of the patient actually telling you what's bothering them. And it may not be something that's easy to talk about, such as a sprained ankle. It may be embarrassing or - even scarier for some doctors - it may be emotional.
We all tend to run away when we're scared and doctors - by their own admission, if some I was talking to earlier in the week are a representative sample - tend to run away to the Land of Jargon. They speak in a strange language that only fellow doctors can understand. They feel safe there.
"Do you suffer from hypertension? Is there any familial incidence of this disorder? Have you had any previous MIs?"
Sometimes they don't do the jargon: they do Doctorspeak. This has language such as "I think there is a low probability that this bruising could have been caused by a disruptive sibling". It's English, but not as we know it.
The more emotionally demanding that a consultation gets, the more likely they are to retreat into jargon or Doctorspeak.
Not all of them, of course, oh no. Some doctors - and some student doctors too - have superb empathy and are able to cope with just about anything.
They are taught to seek out the patient's ideas, concerns and expectations. The more able ones do this subtly, so that, to the patient, it just seems like a friendly chat.
The weaker ones - if they are keen to learn - can be taught some techniques to show empathy, even if they're never going to be brilliant at it.
"I know just how you feel" is never going to be any use, but "That must have been terrible for you" often can be.
I play the roles of patients to help in the training. When I'm playing a patient with any kind of illness or situation that might involve strong emotions, I feel very strongly that I'm fighting the corner of real patients, past or present, with similar problems.
Today, somewhere in the UK, I was playing a woman who had been brought into hospital with a suspected heart attack (the myocardial infarction or MI mentioned above), and was having some tests to see if it had, in fact, been one. She had had a previous heart attack, five years ago.
Unfortunately, the student doctor I was talking to was finding this frightened patient rather difficult to deal with.
"So, have you any ideas about the reason you're here?"
"I'm really worried that it might be another heart attack."
"And do you have any concerns about that?"
It was a bit like talking to the Speaking Clock, but I persisted.
"Well, I'm very scared that I might d- - "
"Did you say that you're already on medicine for your hypercholesterolaemia?"
But then the next student was brilliant: caring and compassionate and understanding. The difference in abilities between students of the same age, and the same level of training, can be stunning.
posted by Daphne at 7:23 pm
6 Comments:
Frightening that some doctors seem to lack even the most rudimentary ability to empathise. Your job is very important indeed, I think! My own GP isn't great, but I've *touch wood* never been in for anything serious.
My dentist, on the other hand, who is my age and very nice, I'm very fond of...
Yes it's important for doctors like GPs etc to have communication skills and to have empathy. But medicine also needs doctors who are more technical, analytical and just plain geeky. I'd rather have a surgeon who can sew and saw better than one who is all chat. Once shared a flat with one such guy - completely obnoxious and monosyllabillic [sic?] but went on to be a devoted and very accomplished orthopaedic surgeon.
I think all medical students should do some counselling training. Difficult, I know, when they have so much else to learn.
Thank you all for your comments. The idea that surgeons don't have to be as good at communicating as GPs is partly true - but they STILL have to talk to patients and still need a reasonable level of communication skills - otherwise you get the "Your mother's had her operation, and it went well at first, but she's dead now," explanation. Or - as happened recently with my cousin - the surgeon did the operation but forgot to give him the result of it, which is that he has terminal cancer.
I work as a GP who teaches doctors to become GPs. We also work with actors playing patients, and I am always amazed that people who do this ever go to their doctor again! Your work is much appreciated.
Michael touches on an important point. The two components aren't really separate. Good communication actually improves people's health. If you can exp-lain an operation well, and reduce anxiety, you need less analgesia afterwards and so have fewer side effects. In general practice good communication results in better diabetes control, fewer headaches, shorter duration of viral illnesses. Obviously, you do need to know the medicine and the treatments, but they work better if you can talk with people. (And don't forget, many people seeing GPs don't fall into these neat medical categories.)
Jennyta, rest assured, all medical students (and most doctors doing higher training) do get communication skills training.
Tim, thank you so much - you have summarised my views on it all perfectly.
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