By Merrie Spaeth
Dallas, TX – You've heard about the problems in health care: financing, lack of insurance, concern over patients' rights and privacy - and the list goes on. I'm concerned about the communication crisis in health care, particularly the communication between doctor and patient. It begins with how we address each other. I call my doctor "Doctor," and the doctor usually calls me "Merrie." There's an immediate status difference.
When do we see the doctor? Most of us think of the doctor as someone who 'cures' us when we're sick. The system trains specialists - narrowly trains them - to cure illness and pays them on that basis. Add to all that increased physicians' patient loads and the attendant paperwork and hassles. Don't forget the complexity of medicine today. And it's no wonder we have a communication crisis.
Here are a few of the common problems I observe - and some solutions. Doctors tend to rattle through facts very quickly (because they're rushed): "Take three of these and four of these and watch for nausea." Then they say, "Any questions?" and we say, "No." It doesn't mean we don't have any questions; it means we can't think fast enough and don't feel comfortable challenging the doctor.
Solution: Ask up front. Ask the nurse, if not the doctor, if you could have a chance to reflect on what the doctor says and then ask questions.
Next: Statistics mean something different to us than to the physician. I've watched a doctor try to explain why an untested process a patient found on the internet is highly unlikely to help. The doctor says, "Only a tiny minority of patients benefit." He thinks that's persuasive because he's looking at a big picture. The patient thought, "Maybe I'll be the one."
A common complaint I hear is that doctors 'don't listen.' Some of this is that they are rushed. Some are bad habits. The doctor writes while we talk or appears to focus on something else. Some answers are easy. The doctor should say, "I'm listening carefully. I'm writing down your comments." How do we know that's what he's doing if he doesn't tell us?
Patients can do a much better job keeping track of and describing what's wrong. If we are going to be partners in health care, then we need to be clear and concise. Write down what happened, when.
Doctors are not mind readers - although the really good ones come close. Here's an example: an overweight very young teenager was in the emergency room four times in a week with very vague symptoms of not feeling 'good.' The nurses thought she was just a chronic complainer. Finally, the examining physician had a hunch and gently questioned her about whether she had a boyfriend. He elicited the news that she had had sex with an older boy; she had gotten gonorrhea; and she had a horrible infection. She could have died. Her parents, as you can imagine, were shocked in more ways than one.
You can't believe the fuzzy, mixed-up patients I've heard. If you're the family member and your child or elderly parent is the patient, you need to help translate.
This topic is important to me, and I have a much longer list of mistakes and suggestions. But perhaps if both doctor and patient pay attention to the communication aspects of health care, we'll help each other - and in the process, help ourselves.
Merrie Spaeth is a communications consultant in Dallas.