Thursday, March 1, 2012

THE PATIENT TRIBE

I’ve mentioned here a few times that to understand how physicians think, it’s helpful to consider them a tribe, a group with a unique and exclusive perspective, language, and objectives. 

Patients are a tribe, too. 

Since each group honestly senses a different world, miscommunication, as exemplified by the following vignettes, is a deeper problem than we normally recognize.

Dr. N: “Ms. V asked me how serious it was. I told her to just let me worry about it.”                               Ms. V: “Fine if Dr. N wants to worry about it. Maybe he can turn it off, but I can’t.”

R.: “I told Dr. F I hurt, but all he recommended was an over-the-counter pill which didn’t touch the pain.”                   Dr. F: “R. just told me he hurt. If he’d told me his pain level was nine out of ten, I would’ve prescribed something stronger.”

Dr. B: “It was time to talk with Mr. L about hospice care, but I didn’t want to scare him.”                     Mr. L: “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.”

J.: “If only Dr. R had admitted he’d made a mistake, I’d have forgiven him. It’s his stonewalling that made me sue him.”                   Dr. R: “My lawyer told me not to talk about it.”

B.: “Dr. Y called me into his office to talk about test results. After he said the C word, I didn’t hear a thing. I’m sure my eyes glazed over. But he kept talking and talking…”                                   Dr. Y: “I sometimes wonder why I spend so much time educating patients. Half the time they’re not listening.”

D.: “Dr. O’s nurse informed me of my cancer with a message on my answering machine. On Friday afternoon, too. Didn’t make for a great weekend.”                       Dr. O: “I don’t like patients to stew over unknowns. I’d rather they get information right away.”

Dr. G: “Mr. H’s son told me to do everything for his dad, pull out all the stops. I thought if I told them that’d be futile, it’d destroy their hope. After he died, they seemed to look at me like I failed them.”                            Mr. H’s son: “Sure we wanted everthing done, but Dr. G never told us he thought that’d only stretch out dad’s suffering.”

N., a physician: “My surgeon, Dr. E, told me the night before my surgery that there was a five percent chance I’d die on the table. He could have told me there was a ninety-five percent chance things would go well. I hadn’t ever considered how two sentences could say the same thing but elicit such different reactions.”           Dr. E: “Semantics.”

Dr. N: “I like to think I’m concerned about my patients’ emotions, so I ask them if they feel stressed. If they say yes, I send them to a psychiatrist. If they say no, I leave them be. Ms. V told me she could handle it.”                 Ms. V: “I told Dr. N I thought I’d be able to handle it okay. I learned soon enough, though, that that was wishful thinking.”

Dr. F: “H. told me she wanted to try alternative treatments before she’d go to standard oncology. I told her that was playing with her life, and I stand by that. Most of the people I’ve seen go alternative are dead.”                                H.: “I wanted to try alternatives first because control is important to me. I wanted to be in the driver’s seat. When Dr. F told me many of his patients who’d done alternative treatments are dead, I said so are many of his chemo patients.”

Hospice nurse L: “I advised the family that when his hearbeat stops, do not call 911, call Hospice. Emergency techs are obligated to do CPR, and at best that would only prolong his suffering. When I asked them if they understood, they nodded. So I said, ‘Just so we’re clear about it, what will you do when his heartbeat stops?’ They said, in unison, ‘Call 911.’”


In each of these scenes, participants would have benefited from more extensive conversations. We have our work cut out for us. Docs and patients inhabit different realities, but since even men and women actually come together occasionally, so can they. 

1 comment:

  1. Yeah, I think we have all had these interactions. It's amazing how the correct words in a situation can make all the difference. I wish I could do it all the time, but I remember once when I was warned about a very "hostile" patient that I was about to see. When I "confronted" him I asked, "Are you all right, how can I help you?" We were able to really talk after that.

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