Wednesday, October 6, 2010


Associates and I are currently designing a conference in which we’ll convene doctors and patients in order to explore their cultural differences.

I’ve written here that I consider the two groups “tribes,” with all that connotes: distinct perspectives, languages, and behaviors. We hope that by educating each tribe about the other’s culture we’ll be promoting effective communication.

How do the worlds of patients and doctors differ? Why bother about this, anyway? Consider these interactions:

  • Marie says, “I asked Dr. N how serious my illness was. All he said was, “Let me worry about that.”

  • Dr. A says, “She’s such a frustrating patient. When she told me about her pain she played it down, and now she says I didn’t give her strong enough pain meds.”

  • Says Dr. B, “It was time to talk with Mr. T about hospice care, but I didn’t want to scare him.” Her patient, Mr. T, says, “I wanted to ask Dr. B about hospice care, but I didn’t want her to think she’d failed, so I didn’t mention it.”

  • Will leaves his exam angry that the doctor took his history with his back to him, typing on his laptop.

  • Josephine says, “If only Dr. C had simply admitted he’d made a mistake, I’d have forgiven him. It’s his stonewalling that made me sue him.”

  • Bennett says, “My doctor called me into his office to talk about some test results. After she used the C word, I didn’t hear anything…”

Those examples barely scratch the surface. You could probably conjure dozens of others. People aren’t being mean or dismissive; they’re behaving reasonably within their exclusive perspective.

Please help me out here. How would you educate each tribe about the other?


  1. Sounds like a great conference!

    I suppose we are culturally different “tribes”, although as a nurse I always thought of myself as aligned with the Big Tribe. Then I was diagnosed with MS and became a member of the Other Tribe. So I see things from both perspectives. And communication truly sucks.

    For the examples you cite, there were ways to improve the communication process. Marie, Dr. A and Dr. B. all could have asked questions to help clarify the situations. Marie could have said “But I want to understand more about what I have.” Dr. A could have asked the famous 1 to 10 scale and, since he apparently knows the patient downplays her pain, he could have asked her about it. “Mrs. Smith, sometimes I worry that you downplay your pain. I want to make sure the medicine I give you is enough to help you. Is your pain always a four or is it worse at some times of the day?”. Dr. B not only needed to get over her own discomfort but should have offered the patient an opportunity to ask questions.

    It can be hard to come back with a question or statement that might feel like a challenge. Patients need to be their own advocates, but physicians have to make it easier for them, not harder by being patronizing, intimidating or rushing out the door.

    I found your blog on the NYT site. I'm glad you posted it. :)

  2. Hi, Marie,

    Thanks for your note.

    As you say, every one of the "poor communication" examples I offered would have been remedied by further conversation. I'm constantly astounded that the solution is so simple, yet we continue allowing a healthcare atmosphere that insists on rushed sound bites to dominate us. Go figure.