II. (Mis) Communication - Them vs Us

I don't like what you're telling me, Doctor!

Physicians, early in their training, are taught the importance of eliciting a patient's history prior to doing a physical examination.

Some time later, perhaps during post-graduate years, they may undergo training in communication skills, in order that they be able to convey to patients their ideas about treatment plans and options. There may even be an effort to teach new doctors how to do this so the patient-recipient feels good about getting the information.

During a medical encounter, one person generally has the upper hand, and it's rarely if ever the patient. Into this uneven contest can be injected all sorts of advice, commentary and suggestion, not always by means of words. Sometimes rolled up eyes or dismissive hand gestures will speak far more eloquently. For a patient on a quest for information as well as advice, this is a major put-down.

Here are some others:

The Good Father. This may (and should) be a relic, but the influence of this attitude is wide ranging in healthcare. Examples: Every time a doctor on TV (or in real life) says, "Were going to do this, OKAY?" Or, "There, there, you just let me handle that, don't you worry your pretty little head about it."

The Well Educated Snob. "Listen, I spent four long years in Med School, five years in residency and two years in a fellowship, for gosh sake! Don't you think I know what's best for you?"

The Laughing Hyena. "You mean to tell me you've been hornswoggled by that charlatan on the Internet? And you bought that ----p? How much did you pay for that swill? Awww haw haw haw!"

The Mumbler. "The thing is, bzsz sweppft sometimes but kktltuip dzissycous other times, and worst of all, mmthuifgh towilliwok!" (Some of our foreign imports with wonderful training fall, unfortunately, into this category.)

My Way Or The Highway. "That's it! No questions. Start therapy now or tomorrow you die!"

Old Slice And Dice. "That nasty uterus has to come out of there now, and I mean N.O.W.! Go home and get your affairs in order and meet me at the hospital in twenty minutes. No, better make that ten minutes. I'll be scrubbing my hands."

And last, our favorite, the physician who tells parents, "We did all we could, but he'll never walk again." When the child mounts the podium at the Olympic Games fifteen years later, the physician is not one of those he thanks.

Patients are turned away by attitudes, judgments made too quickly (and seemingly by rote), errors in diagnosis, and improper treatments. Or, they can as easily be turned away simply by perceptions that diagnoses and / or treatments are improper, even when those functions may be entirely appropriate.

We have to realize that physicians are granted the right (by education and licensing boards) to use medical as well as surgical tools that are very sharp. Used improperly, they can cut deeply in the wrong direction, and may at times do so lethally. It is also unfortunately true that some of our tools, even when used properly, can have bad outcomes. Most patients are as aware of this as their providers should be. Some patients use this fact to reject much of what we within the medical community regard as good, solid medical practice.

The question remains: If patients who consider themselves to be knowledgeable and "in control" reject orthodoxy, why do they so often go off in the direction of wild, unproven, and worthless remedies?

That's the topic for the next chapter.