When you are the physician in the room, you fill the space, but as a husband, you are simply half of a patient.
—ANESTHESIOLOGY RESIDENT DESCRIBING GOING TO OB APPOINTMENTS WITH HIS WIFE
It is difficult for those who have worked so hard at perfecting their medical knowledge to reflect on the fact that they are not perfect at something—people who may be the only one in their families to become a doctor, who are following in their parent's footsteps, who spent 16 years training for the moment when they are ultimately responsible for a patient. Acknowledging that they may not be great at something goes against their grain. And if we look to history, at times, keeping patients alive required our full attention, and communication skills probably mattered less to the patient than not dying. Yet today, patients expect both. They expect competent, high-quality medical care, and they expect a level of service that clinicians may or may not be used to providing.
We want to acknowledge the thousands of caregivers who opened themselves to this training and who taught us many of the lessons and insights we've shared. They opened themselves to a process that they were skeptical about at times and that perhaps went against their grain, but they did it anyway. We'd like to spend time on some of the recurring themes they taught us (Table 12.1).
Table Graphic Jump Location TABLE 12.1Communication Dos and Don'ts ||Download (.pdf) TABLE 12.1 Communication Dos and Don'ts
|Keep ||Stop |
|Matching the gravitas of the emotion ||Saying I understand before you actually understand |
|Expressing your intention of care and doing the right thing ||Telling people not to worry |
|Being empathically curious ||Missing emotional cues |
|Perceiving emotional cues ||Using reassurance or data to allay fear |
|Saying you don't know when you don't ||"Winging it" when it comes to challenging conversations |
Major Recurring Communication Themes
Matching the gravitas of the emotion
DOCTOR: Hi, Mr. Smith, I'm Dr. Brown. I understand you are here for a biopsy. How are you?
PATIENT: I'm a little nervous. My friend bled and died from this procedure.
DOCTOR: You're at the best place. Our complication rate is less than one percent.
DOCTOR: I see you are from Indiana.
This conversation elicits several observations: one is that we really like to respond to emotion with data. We suspect this comes from being uncomfortable and not knowing what to say, and then subsequently defaulting to what makes us more comfortable, which is medical knowledge and data. This is another good example of responding to emotion with not just information, but reassurance. And in most cases, the reassurance is premature. Patients need hope, and we ...