Doctors Are From Mars; Patients Are From Venus

I used to teach Behavioral Medicine at a Medical College of Wisconsin family practice residency. That’s a fancy way of saying my job was to teach doctors how to talk to their patents. And how to listen. Each clinic exam room had a camera. Every quarter, I’d tape each resident doctor. After sorting through the tapes looking for the good the bad and the ugly, we’d meet to discuss their performance.

The sessions for viewing tapes were, at times, tense. These high performing doctors grew wary when entering this unknown territory, far from the black and white certainty of lab results and x-rays. After all, where do you find more variables than in face-to-face communication? Some learned a few things and others were just glad that this “not real medicine” thing was over with.

The tenor of medical school training seems to be fear. Will I find the right answer? Will I make the grade with my attending? Will I make a mistake and look dumb? Always going for the cure has its downside. But these are the things that drive their lives and prepare them for the real world. Empathic communication barely makes the list.

The first thing to realize in this communication conundrum. is that medical schools recruit scientists. Left brain, analytical thinkers. The crème de la crème of college graduates. After four years of rigorous medical school training, they choose a specialty and enter residencies of varying length. Then they can take their boards and are ready for private practice. Family medicine is the only specialty that actually teaches behavioral medicine. So, surgeons, oncologists, pediatricians and all the others pick up their communication skills on the run.

I began to think it’s a dirty trick to address effective communication when a doctor is so far along in their training. But that doesn’t diminish the importance of this issue. And we’ve all heard of the age old problem of poor communication between doctors and their patients.

Personally, I think bed side manner is highly over rated. All you have to do is go through one life-altering or life-threatening medical experience and it’s easy. A doctor who knows his medicine is the one you want in the room with you. Not someone who tells a good joke or is able to relate to your problems with thirteen year old Billy.

Whether the metaphor depicts different cultures or far away planets, the distance between doctors and patients is formidable. So what can be done? I think people who want their health care needs met need to understand who they’re talking to and learn to communicate effectively with them.

Some patients may think it’s unfair that they have to do most of the work. But if you think you can, by all mean, begin a grass roots effort to change medical schools. And let me know how that’s working out for you. In the meantime, next week you have a doctor’s appointment.

Here’s my advice. Don’t sit passively. Bring information. Ask questions. It’s okay to disagree. If you don’t understand, say so. Ask for an explanation in more common or non-technical language. What about a second opinion? Don’t be intimidated by the presence of a computer. That’s the future. Actually, that’s the present. Since January, 2014 it’s a federal mandate that medical records be electronic. Don’t be put off by poor eye contact. That might just be the doctor’s personality.

Through this experience, I probably learned more than the residents did. I’m not sure empathy can be taught but I gave it my best with mixed results. And I did get some thank you’s. I do know that doctors are human and want to do a good job. I have little patience with people’s complaints that their relationship with their doctor is poor. I say get involved. You’re ultimately responsible for our own health care.

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