Tuesday, January 02, 2007

What I Say won't be What They Hear

I went to see my family doctor this week. After watching several people get their annual physical as part of my training, it kindof sunk in that I haven't seen a doctor for a routine check-up in years, so I scheduled one for myself.

My doctor's secretary told me that my doctor wasn't booking physicals until June, so I felt special when I got a call back saying my doc was willing to squeeze me in over Christmas. I told another doctor about him not booking physicals until months in advance. He told me that isn't exactly a proper policy.

I didn't feel odd at the time, but looking back on it, it was my first time in an exam room as a patient in a long time. The nurse came in and took my blood pressure. I was hoping she'd ask what I was doing, and after I answered, what I was studying. She did. Seven months after finding out about my acceptance it still feels nice telling people.

My family doctor is great, and he's really friendly. He moves quickly, but he always makes me feel like I've got his full attention. As I was hoping, he was genuinely interested in the fact that I was in medical school, and didn't treat me like a regular patient. "Make sure you try to stay active, though I'm not sure how you do that while you're a med student." He related what I was doing to my education. "I do this a bit differently than you'll learn, but it works," and, "This is how I do my review of systems..."

Later, he asked me what I wanted ordered in my blood tests. "You know, it'll be kindof neat for you if we get all these levels; you'll be sitting in lecture and hearing about triglycerides, HDL, and LDL levels, and it's kindof fun knowing where you stand." Sure enough, I got a phone call a couple days later saying that I could come in and pick up my lab results. One piece of advice I can pass on: don't let an abnormal urine dipstick test worry you too much until their results are confirmed by lab work. They can be over sensitive.

That's all beside the point. The story that I sat down to tell is this one. While I was at the doctor I started to think of a conversation I had with a friend.

Earlier this semester, I was telling him how we're being taught how to interview patients, and how we have to be careful the way we phrase things, because our patients might hear it differently depending on their context; how they view a certain condition, whatever circumstances are going on in their lives, their past experience with the health care profession (they have a term for this last one, 'transference'; the opposite, where a health care provider brings their past experiences into a relationship, also has a term; 'counter-transference').

In other words, what you say might not necessarily be what they hear. Anybody married could tell you that, but it doesn't hurt to have it re-emphasized. To put it a different way, I once heard: "If you tell a patient they have cancer, and then go on to tell them what type of cancer it is and what happens next and how to manage it, nine times out of ten your patient won't hear any of that. They won't hear a word you say beyond 'cancer.'"
After I told my friend about all this, he replied, "Now that you mention that, it makes me think of when I went to the doctor the other day.

"I was having a bit of an off day, just feeling down a little bit. During my checkup, my doc took a quick glance at my back. She said, 'Oh, let me get that blackhead for you on your back. Not like anybody else is going to catch it.'

"I missed what she said next, because I was hung up for a second on that comment. It's funny how when you're depressed, your mind can jump to conclusions. 'Nobody else is going to ever see that? What, she thinks I don't have a girlfriend? How does she know that I'm single? Why is she assuming that?'

"It wasn't a big deal at all, and I shook out of it pretty quickly, but I guess when you told me that right now I recalled that moment, and realized that for a moment, I was kindof pissed off at my doctor, for no good reason at all. She was just trying to be friendly and make conversation and I took what she said the wrong away and got all worked up about it."

Obviously, my friend overreacted. He even said that. And I don't even think anybody could say the doctor was wrong in making that comment; I'll probably never be told in class that comments like that are risky, because I'm sure that 99% of the time, they're not. But it reminded me that if I want to come across to my patients as a respectful physician, a habit of paying attention to how they're feeling and choosing my words extremely carefully will be one more tool I can put in my skill set.

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