Things I Didn't Say
Doctors are taught, as part of their consulting skills, to "gather before you give". In other words, before you start your long and detailed explanation of the patient's condition, it's a good idea to find out what the patient knows already. Otherwise your explanation could well be at best irrelevant and at worst thoroughly offensive.
Another way of putting it is "Explore before you explain".
The keen young dentist whom I saw recently hadn't taken this on board at all.
"I'm going to teach you how to brush your teeth!" she said brightly, suddenly dumping a model of a mouth in front of me and waving a toothbrush at me with wild swoops.
If she'd been a bit more clever she could at least have wrapped it up in a tactful way along the lines of how she knows I have been brushing my teeth for over half a century but some new and exciting teeth-brushing methods had been discovered in the last couple of years and would I be interested in hearing about them?
But no - - it was just a standard demonstration of how to brush your teeth, as given to any five-year-old in the land, and it taught me nothing I didn't know, and since I do brush my teeth, regularly, and since they hadn't found anything particularly wrong with them - - well, as a matter of fact, I was thoroughly annoyed about the whole thing, and would have loved to have given her some instant feedback on her communication skills.
But I don't have much - if anything - of a setting in between Calm Compliance and Furious Sarcasm, so I just said nothing and waited for it all to be over.
Then there's that thing they do in the pharmacist's.
In the olden days you just went in and asked for whatever you wanted - - two hundred paracetamol or whatever - - and they sold them to you and off you went.
But now they have to check up on you. Is this for your own use? Have you had it before? Have you any medical conditions?
And yes, yes, I know it's all for my own good. But I was at school with the local pharmacist, for goodness' sake, and he knew the Communist (who was also a pharmacist) and the Communist looked after his shop when his children were born - - and they know that I'm diabetic and they know that I know a lot about it and that I look after myself well because I don't want to go blind and have my legs amputated when I'm older.
Yesterday there was a new assistant. I was collecting a prescription and decided to stock up on some Lemsip, which is a comforting cold remedy with paracetamol and decongestant and yes, it's got sugar in.
"Is this for your own use?"
She made it sound as though I'd asked for half a pound of heroin.
"Yes, it is," I said, immediately aware that I should have lied.
"I'll have to check with the pharmacist."
She disappeared into the back for about a hundred years (things are never fast in that shop) and finally came back with an Accusing Look.
"Do you know that this has sugar in? And you're a Type 2 diabetic, aren't you?"
What I wanted to say was: "I know a lot about diabetes. I am very careful with what I eat. Since the beginning of May the sweet things that I have eaten are, in total, four biscuits and one portion of bread-and-butter pudding. IN TOTAL. Since the BEGINNING OF MAY. Yes, I have a sweet tooth and every day I say "no thank you" to offers of cake, chocolate, sweets and biscuits when I'd much rather say "yes please". I don't drink, I don't smoke and I do a lot of exercise. And - - drum roll - - if I get a cold, and I want a Lemsip, I am jolly well going to have one."
But I didn't. I just muttered something about keeping some in for the rest of the family, then, and scuttled off. One of these days, though, I will snap and say what I think. And THEN there'll be trouble.
Another way of putting it is "Explore before you explain".
The keen young dentist whom I saw recently hadn't taken this on board at all.
"I'm going to teach you how to brush your teeth!" she said brightly, suddenly dumping a model of a mouth in front of me and waving a toothbrush at me with wild swoops.
If she'd been a bit more clever she could at least have wrapped it up in a tactful way along the lines of how she knows I have been brushing my teeth for over half a century but some new and exciting teeth-brushing methods had been discovered in the last couple of years and would I be interested in hearing about them?
But no - - it was just a standard demonstration of how to brush your teeth, as given to any five-year-old in the land, and it taught me nothing I didn't know, and since I do brush my teeth, regularly, and since they hadn't found anything particularly wrong with them - - well, as a matter of fact, I was thoroughly annoyed about the whole thing, and would have loved to have given her some instant feedback on her communication skills.
But I don't have much - if anything - of a setting in between Calm Compliance and Furious Sarcasm, so I just said nothing and waited for it all to be over.
Then there's that thing they do in the pharmacist's.
In the olden days you just went in and asked for whatever you wanted - - two hundred paracetamol or whatever - - and they sold them to you and off you went.
But now they have to check up on you. Is this for your own use? Have you had it before? Have you any medical conditions?
And yes, yes, I know it's all for my own good. But I was at school with the local pharmacist, for goodness' sake, and he knew the Communist (who was also a pharmacist) and the Communist looked after his shop when his children were born - - and they know that I'm diabetic and they know that I know a lot about it and that I look after myself well because I don't want to go blind and have my legs amputated when I'm older.
Yesterday there was a new assistant. I was collecting a prescription and decided to stock up on some Lemsip, which is a comforting cold remedy with paracetamol and decongestant and yes, it's got sugar in.
"Is this for your own use?"
She made it sound as though I'd asked for half a pound of heroin.
"Yes, it is," I said, immediately aware that I should have lied.
"I'll have to check with the pharmacist."
She disappeared into the back for about a hundred years (things are never fast in that shop) and finally came back with an Accusing Look.
"Do you know that this has sugar in? And you're a Type 2 diabetic, aren't you?"
What I wanted to say was: "I know a lot about diabetes. I am very careful with what I eat. Since the beginning of May the sweet things that I have eaten are, in total, four biscuits and one portion of bread-and-butter pudding. IN TOTAL. Since the BEGINNING OF MAY. Yes, I have a sweet tooth and every day I say "no thank you" to offers of cake, chocolate, sweets and biscuits when I'd much rather say "yes please". I don't drink, I don't smoke and I do a lot of exercise. And - - drum roll - - if I get a cold, and I want a Lemsip, I am jolly well going to have one."
But I didn't. I just muttered something about keeping some in for the rest of the family, then, and scuttled off. One of these days, though, I will snap and say what I think. And THEN there'll be trouble.
posted by Daphne at 11:17 pm
5 Comments:
The thing I hate is the 16 limit on paracetamol. If I wanted to top myself, that's not the way I'd choose, but even if it were, I'm more than able of visiting more than one shop. Sheesh!
My mum used to have bottles of 200 paracetamol. Luckily I survived, in spite of myself.
Yes, that day the BBC will report the devastation caused in Yorkshire by Hurricane Daphne!
Daphne, my friend Ken, who reads your blog anonymously, sent me this to forward to you: http://elizabethaquino.blogspot.com/2012/06/diagnosis.html
It's not only relevant to your post today, but maybe to your training work as well. Ken and I have to deal with the same podiatrists and wish you had been involved in training them to deal with patients.
Many thanks for your comments. Jan and Ken, thank you so much for this link - it's about the sort of appallingly bad practice that I spend much of my time fighting against and I will keep it to show to medical students - thank you!
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