Can we communicate better with our Doctors?
(and importantly, they with us!)
A from-the-shoulder report by Trish Holme, Vice-Chair of Sussex Lupus Group
Have you ever wondered about the difficulties in communication experienced between yourself and your doctor? Apart from feeling unwell and being anxious about a consultation what other factors come into play which can make the difference between a successful and helpful consultation, with both parties receiving each other well, or an unsuccessful and unhelpful consultation, with both or one of the parties feeling dissatisfied and aggrieved?
It is a huge question and yet a fundamental one. It is about communication. How else do we access the gateway to recovery, whichever path we take, unless we are able to communicate successfully what our needs are? For me it is dependent on there being the most open of channels from the moment I step inside the consulting room. Not always easy for either the patient or doctor.
Like most people who have had years of experience, I can sniff out a bored, disinterested, weary, arrogant practitioner very quickly. Equally, I can speedily determine the successful outcome of a consultation that is led by a practitioner who is interested, is listening and who is checking to see whether she/he has understood what I am communicating. A successful outcome for me is whether or not I feel I have been heard; that is to say, whether or not I leave the consultation with my integrity intact and not just necessarily because there has been an easy solution to whatever difficulty I have presented.
Why is this important? It is important because we need our integrity to be intact when we are faced with years of uncertainty, pain, loss of identity through losing our careers, frequent hospital admissions and treatment, disruption of family, social and spiritual life and an unwelcome entrance into the world of chronic ill health.
Our integrity is fundamental to who we are; decent, honest human-beings. If we leave a consultation feeling under attack, belittled, disbelieved, not heard, then we leave with who we are, the very core of our being, having been severely shaken. It only takes one such experience to shape how we enter future consultations. What is worse than this? Having our, as we thought, steadfast diagnosis regularly redefined by complete strangers, who communicate a medical scepticism that borders on complete hostility. Is it any wonder that the patient no longer feels in control, no longer knows how to address the illness, no longer feels safe in the diagnosis, no longer feels an equal partner in his/her health care, no longer feels that he/she is worthy of the time in the clinic and feels increasingly alienated from his/her own support and care network etc? Extreme? Perhaps. But I have met too many people who are just exactly in this position to think that this only happens to a few.
In addition, we need our health professionals to take the time, and perhaps the courage, to communicate to us a little humility as well as medical expertise. Each fresh meeting, particularly when we are at our most vulnerable, requires a high level of sensitive communication whether it be for an emergency admission, regular clinic appointment, new referral to a different department, or an appointment with our G.P. Add to this a willingness to be patient led, in the patients need not only to be heard but also a need to engage in a partnership of equal status then we may well begin to have a way of moving forward in this possibly most fraught of medical minefields.
Perhaps also include a basic courteous greeting; an indication that the doctor is interested in your well-being and less about making a political point; that he/she has read your notes and is ready to communicate to you that vital piece of information that you have waited months to hear; that they look at your face as well as at the computer screen or your file etc.
When there are no easy answers to a problem of diagnosis, how about affirming the patients suffering or difficulty and not, as so frequently happens, putting the burden of the lack of medical knowledge onto the patient. Do patients not have more respect for doctors who share the burden of uncertain diagnosis than for those who so arrogantly are dismissive of anything that the patient has to say in the apparent absence of pathological evidence?
As if all that were not enough there is yet another most unsatisfactory and unhelpful communication device used by some doctors whose sole aim, it appears, is to convey a level of disinterest and collusion rarely experienced outside the medical profession. It is the widespread use of euphemisms and mixed messages.
Consider the following: You have a very thick file. This means in doctor speak that, You are a neurotic, or a hypochondriac and that you have been seen by many other doctors, so I am not going to find anything either, even before I start my examination or dare to think of the extreme possibility that I with all my expertise might be able to find that missing link. (Heaven forbid.)
Oh, Dr Smith thinks that everyone has blah. Take this to mean that you dont have blah, but I cant tell YOU what you do have because I dont actually believe that you have anything wrong with you at all. In fact, I am going to write to your G.P. and suggest that one way forward is to say that you seem depressed and in that way I have done my job and, oh, I dont think I need to see you again.
How about this: There was once a patient who, during the course of one consultation, was told by a doctor new to him that he didnt have blah, had never had blah and what is more, didnt have blah blah either. However, the doctor said, there was something wrong with him and prescribed steroids for him to take, saying that he would be reviewed again in six months. Did the patient ask what exactly was wrong with him? No, by the end of that consultation, he was too confused. Incredible? Yes. True? Sadly, yes.
We deserve better. We need honesty, openness, integrity, humility, respect and a clear understanding of our needs to be heard. These are vital to a successful ongoing professional and working relationship between our doctors and ourselves.
We have much to gain from each other and much to learn. Patients have their part to play of course but surely there is an easier way. It is hard enough trying to understand the nature of our own beast without having to tame the occasional beast we may encounter within our medical advisers. There is no room for complacency, arrogance or political point-scoring at the patients expense. It is time for a radical reform and the patient is willing.
It goes without saying that there are some excellent communicators out there. This is written for all those who are not and for all those patients who are struggling.
How much of all this is true for you? How can we really change for the better the manners and attitudes of some medical professionals? Might you write to News & Views and tell us how.
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