Wednesday, June 20, 2012


Facilitating a cancer caregivers' support group yesterday, I was struck by a particular theme. Every female participant lamented that her husband wasn’t skillful at expressing emotion. "I've been trying to draw his feelings out of him for thirty-five years now," said one.

This rang a bell for me, as my wife could've said that at some point. I am, after all, a guy, and guys are, shall we say, challenged in this field. It's not that we don't have emotions, just that we follow unwritten cultural prohibitions against expressing them.

I remember the moment I learned this, during my first week in junior high school. Following a classmate down a corridor, I noticed, in capital letters, that HE WALKED LIKE A MAN, his hips tight and his shoulders raised and swinging, as though he'd just moved fifty bales of hay. Compared to his gait, mine was sissified. I figured that if I didn't want to be considered a wimp--or worse, a homo, as we said then--I'd better adopt masculine behaviors across the board, such as stolidity and impressive cool.

I succeeded all too well. Pretend imperturbability for a few decades, and it becomes you…and there you are finally, an example to the next generation of boys. Your emotions are as present as anyone’s, but failing expression, they roil about amorphously, without nuance, beyond your understanding and control. No wonder so many men confuse sex with violence. But even short of that, unawareness of our anger or sadness or stress aims us toward hypertension, heart disease, and a host of other sorrows, and when we finally get sick, we unduly burden our caregivers.

The women in our group yesterday called their task frustrating, infuriating, and depressing. “He won’t tell me when he’s hurting. He just clams up.” “He refuses to speak to me or the kids, and we don’t know why.” “All the work I do, and no appreciation from him.” The problem in these households is less cancer than an astonishingly common kind of inadequate communication.

Over the years, I’ve learned to be more expressive, mainly because my wife convinced me it’d make my life easier. She was right: imprisoning feelings takes a lot of energy, and besides, once you’re at long last comfortable with your sexuality, there’s nothing at all to be gained from it. But many caregivers either decline to intervene for a variety of reasons, or have utterly given up. I’d like to encourage them anyway, since while emotional withholding isn't violent, overtly harsh, or malevolent, it breeds enough frustration to make for unnecessarily miserable lives.

Wednesday, June 13, 2012


A friend went to his doctor for a bone marrow biopsy. Since this means punching a small hole through the pelvic bone, he was anxious. The doctor, preparing his equipment and probably meaning to lighten the atmosphere, said, “Don’t worry, I’ve done one or two of these before.”

My friend told me, “Sure, I knew he’d done plenty before. But this was my first, and his joking only added to my anxiety. And when I left, he said, ‘I don’t think you’re going to die anytime soon.’ I hadn’t asked him that, so why did he bring it up? Don’t doctors think before they speak?”

I hear this sort of complaint from patients weekly. As I’ve written before here, we’re impressively advanced in technology but the lowest-tech aspect of our craft, communication, is often lacking. I encourage patients to give their doctors feedback—to point out where they could improve and also praise them for communicating well. Most do that, usually by snail-mail letter. If they don’t provide feedback, there’s no mechanism within medical practice that informs docs about their behavior with patients.

You'll no doubt be surprised to learn that even I have received critical letters and irate phone calls. Believe me, I’ve paid them attention since they indicated a shocking discrepancy between the saintliness I assume about myself and the way others sometimes see me. So I know feedback works, but I ask myself how we can insert some preventive medicine here—improve doctors’ communication before the train wreck.

It’s a difficult business, though, for a couple of reasons. First, when no one’s told us otherwise, we naturally believe we’re doing well, so we don’t need, say, a communication workshop. And second, doctors absorb their profession into their self-image more than most others do. Medical training isn’t limited to learning medicine; it simultaneously imparts an implicit course, How To Be A Doctor (which, by the way, doesn’t include communication skills). In training and practice, doctors learn a special outlook and language, what to say and how to say it, pertinent gestures, what to wear, what to avoid. They tend to stick together socially, and to value views of fellow members over those of outsiders. So criticism of any part of a doc’s performance is ego-threatening. I’m not saying improvement in medical communication is therefore impossible, only that to be effective it must be done with finesse and compassion.

If you accept that this is the case, how would you educate practicing docs?