Friday, February 22, 2013

Doctors and Communication



Yesterday afternoon, I met a former neighbor at a downtown bus stop.  We took the same bus, so we talked until the bus arrived, and sat together on the bus.  Last year had been a challenging time for me and my health, and we began comparing notes on recent medical experiences. I’m interested in hearing how other people deal with being a patient in our current (American) medical system.  No surprise – people love to talk about their experiences, especially their bad ones.

If you were to ask me what I think the most important skill a doctor needs for treating patients, I’d say communication.  They need to earn a patient’s trust and that’s done through communication and behavior that reveals the quality of him or her as a human being.  They have guidelines for ethics beginning with the Hippocratic Oath: “First, do no harm.”  Communication consists not only of talking, but also listening; and not simply hearing, but active listening.  My friend told me that she looked for a doctor who treated her with respect, listened to her and really heard her, didn’t rush her or her time with him, and who could explain things to her so she could understand them, i.e. everything she needed to know.


One painful experience for her occurred after a recent colonoscopy.  For this procedure, she had gone to a doctor she’d not gone to before.  I don’t know if he’d been recommended to her by a friend or her regular doctor.  I also don’t know if he was a gastroenterologist or a surgeon or neither.  She had been pleased with the actual procedure: the doctor had talked with her during it, answered her questions, and had been thorough.  Her procedure had included treatment for flat, precancerous cells in the lining of the colon, not polyps.  She wasn’t sure what the treatment had been, but it was different than for polyps, which are usually removed.  So, all went well.

After she arrived home, she developed severe abdominal pain.  Not an uncommon occurrence, unfortunately, after this procedure.  She called the doctor, and he instructed her to go to the ER, which she did.  The pain was so severe, she was doubled over and could barely walk.  The ER doctor gave her a pain reliever, and talked with her about the colonoscopy.  He suspected the pain was related to the treatment for the precancerous cells, and when she told him she had indeed had it, he explained that that treatment often caused severe pain afterward.  This was something the colonoscopy doctor had not warned her about.  She’d gone home with all the usual warnings following a colonoscopy, and instructions for after care.  She was upset that she’d not been warned about the aftereffects of the treatment.

An oversight by the doctor?  Perhaps.  It’s difficult for patients to know what to ask often because they don’t know procedures and their aftereffects.  But my friend had also had another experience with a different doctor whom she’d left as a result of his treatment of her.  This was another incidence of abdominal pain, located in the lower right side, radiating up and out.  She went to the doctor and he’d dismissed the pain as nothing.  So, she’d suffered with that pain, which steadily worsened, for days, calling the doctor to talk with him about it, but getting the same response from him – it was nothing.  Finally, her husband took her in to the doctor’s office, but he wouldn’t see her.  He told them to go to the ER.  So they did.  She had appendicitis and it had partially burst.  She had emergency surgery and a long hospital stay as a result.

Doctors are fallible human beings.  They make mistakes.  They are as guilty of preconceived notions as the next guy.  Abdominal pain and gastrointestinal distress are usually looked upon with skepticism because they are easy to fake in order to get pain killers or attention.  Severe abdominal pain can be a serious warning, however, signaling intestinal blockage or perforation, and appendicitis or pancreatitis, among other things.  If a doctor knows how to listen, he can hear the pain in a patient’s voice if that pain is genuine.  He can see it in the patient’s demeanor.  After that, he should be on red alert, asking the patient questions to assess her condition, listening intently to her answers. 

In both of these experiences, my friend had communicated her distress fairly precisely.  The first doctor listened, and instructed her to go to the ER.  Her complaint with him is that he had not warned her which, after the fact, could be considered moot.  The second doctor, however, really did not listen and take her seriously.  With all they must learn about the human body and diseases, I wonder if there’s any time for medical students to take a course in how to communicate effectively.  Remember, communication is not only talking…. 

Do you have experiences with doctors and communication that you'd be willing to share?  Please leave them in the comments section below.  Thanks!

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