When I think collectively about the doctor's visits I've ever had, I'd say 10 percent of the time I've spent in exam rooms involved some sort of physical doctoring--examinations, vaccinations or procedures--while the other 90 percent of those interactions were purely verbal.
In fact, ironic as it sounds, the art of old-fashioned conversation is at the heart of the telemedicine movement. "Tactile interaction" is often unnecessary to delivering good care, according to an article from FierceMobileHealthcare. While their patients are selected carefully, mobile doctors provide pretty much 100 percent dialogue-based care.
The purpose of pointing out these ratios is not to say that one aspect of medicine is any more important than the other, but to highlight the staggering dissonance between the time spent teaching physicians certain skill sets versus the amount of time they spend using them. If doctors spend the majority of their office time talking to patients, albeit about mostly clinical issues, how is it possible that traditional training incorporates almost no education about communication?
Fortunately, times are changing. With heightened attention to the role physician empathy plays in patient satisfaction and outcomes, healthcare providers today have greater access to communication training. But so far, giving clinicians lessons in communication hasn't necessarily led to better results. Physicians and nurse practitioners who took a course in discussing end-of-life issues with patients were no better at discussing the topic than their untrained counterparts, according to a study published in the Journal of the American Medical Association. What's more, researchers discovered that patients of providers who received such training were more likely to be depressed.
Timothy Gillian, M.D., and Mikkael Sekeres, M.D., both of the Cleveland Clinic, examined a handful of possible causes for these results--such as too much time spent talking about doom and gloom--in a New York Times blog post. Here's a passage that resonated with me:
It is also possible that, as we devote more time to teaching students and doctors effective communication techniques, we risk muting their authentic human voices, and instead of learning to connect, they apply rote tools and scripts.
The problem with scripts is that they generally only work when both parties have one. Medicine, like life, is mostly improv--relying heavily on the principle of "'yes' and 'and.'"
If you're not familiar with this idea, bear with me and consider this explanation from Tina Fey's book, "Bossypants":
The first rule of improvisation is AGREE. Always agree and SAY YES. When you're improvising, this means you are required to agree with whatever your partner has created. So if we're improvising and I say, "Freeze, I have a gun," and you say, "That's not a gun. It's your finger. You're pointing your finger at me," our improvised scene has ground to a halt. But if I say, "Freeze, I have a gun!" and you say, "The gun I gave you for Christmas! You bastard!" then we have started a scene because we have AGREED that my finger is in fact a Christmas gun.
Now, obviously in real life you're not always going to agree with everything everyone says. But the Rule of Agreement reminds you to "respect what your partner has created" and to at least start from an open-minded place. Start with a YES and see where that takes you.
Now think about how this principal applies to patient interactions. Do physicians respect what their patients say?
Failure to do so, in my opinion, is at the root of many items included in a recent list from Physicians Practice of things physicians say that might get them sued. It's not that there's anything wrong with the words, "calm down" or "don't worry about that." The problem is that saying them at the wrong time shuts down the give and take. It's telling patients their concerns or ideas are invalid--or, using the analogy above--calling their gun a finger.
But with some small adjustments, think about how this dynamic could change. What if a doctor was relatively sure a patient had a simple virus causing a sore throat but the patient brought to the office reams of Internet printouts listing symptoms of esophageal cancer? A doctor's reflex might be to strike such extreme diagnoses from the discussion immediately and tell the patient to simply go home and get some rest. Reasonable? Sure. But it couldn't it be far more satisfying on both ends if doctors could eliminate the tension?
By using the principle of "'yes' and 'and,'" the doctor acknowledges the patient's contribution before moving on. It could go something like, "YES, I see your concern that some of your symptoms could overlap with something more serious--AND you can trust that we'll look into that further if you don't feel better within the time I predicted."
Medical practice is not improvisational theater, and doctors have precious little time to play games. But when it comes to communication, keep an open mind. Just be aware. Ask what's working and what isn't. Not getting results? Change the approach. And as always, let me know how it goes. - Deb (@PracticeMgt)
