Finding Out The Hard Way

I mentioned in my last post how there a lot of subtle body language cues and voice inflections that go into dealing with patients.  I got to thinking about my rules in dealing with patients, my little pointers that I would pass on to someone going into medicine.  I wrote a couple of them down.  It will be interesting in a couple of years if my perspective changes on this.  I may look back years from now and say how stupid or naive I was in writing this, but I feel right now like these are pretty solid ones.

1. Sit down and speak eye level with a patient, never talk down to them if you can help it.

You'll notice that some people are immediately confrontational if you stand there talking while looking down at them.  It's much better if you find a chair or seat 2-3 feet from them at eye level.

2. Always explain; do it slowly and patiently (even if you don't feel that it needs done).

People often really appreciate it if you take 5 minutes out of your day to educate them on what is REALLY going on.  I break it down very simply and explain what is causing there problem (if I understand it myself ;P), sometimes understanding a problem is as relieving as the medicine.

3. Don't use big words, speaking to a patient isn't the place to show off your education.

I had the displeasure of working under a doctor who would push his ideas and treatments onto people by saying big words.  "Ohhhhh you've got Myotonic Dyskenesis...You should take my vitamin supplement."  (He was more of a snake oil salesman than a doc). I don't really know if Myotonic Dyskenesis is a real disease, it's medical Latin for "muscles that move wrong".  If you can help it never use medical words in conversation with a patient.  Use it for naming the disease, don't use them in anything else and if you do, explain what they mean. 

4. If you don't know, don't hide it, explain and tell them you'll find out.

Amazingly it's appreciated when you cop to your ignorance, it shows you know your limits, and patients trust you more for it.  Just do your best to find out and you'll be great in their eyes.  Plus it's much easier to me than trying to bury their question under a pile of BS and big words, which more Doctors do than you would imagine (not a ton, but more than their should be).

5. Fix your mask on tight even before entering the room.  You never know what they will say.

A good portion of "being" a doctor is acting.  Among your friends and family you are allowed to be yourself, but in a room with a patient, you must be non-judgmental, passive, and more mature than anyone you'd ever care to meet ;P  I had to put stitches into a kids leg last night (huge knee wound, almost to the bone), sweat was pouring from my face as I did it...it was nervousness, but I asked the nurse very nicely to blot my forehead and I finished without incident.  If that kid knew how nervous I was or if I had acted the least bit freaked out by his wound, none of what we did that night would have worked with him...the patient has to buy into you as the doctor or you can't help them (or at least not near as well).


6. Don't be afraid to show that you are human, just do it in a controlled and intentional manner.
 
If a patient tells me something horrible, I will empathize and acknowledge it, but it doesn't do the patient any good if you are overcome with emotion and can't do your job.  Some might debate me on this.

7. When you don't know what to say, sometimes silence is the best answer.

I remember this mother finding out she had inoperable cancer in her stomach.  I didn't have clue what to say. Something made me keep my mouth shut, but I sat with her and her husband as they cried, and when they were done, then we talked, but sometimes your silence and time is all there is to give.

I'm going to stop at 7, cause the others I can think of aren't that interesting (ie. how to sit when talking to a patient).  But if I think of anymore I'll add to this and change it as my experience dictates.  Thanks for listening guys.

Newbie Doc

No Hablo Espaniol

One thing that I wish I had done before going into medicine was learn Spanish.  I've heard several different doctors bat around the statement that by 2030 the US will be predominantly a Spanish speaking population.  That statement doesn't hit home anywhere else more than it does in clinic, where I would say I see about 1 English speaking patient for every 9 Spanish.  To talk to a Spanish speaker I have to use a phone interpreter, which is not only a huge pain in the @$$, but also really decreases the level of care they get (not to mention the added cost to the clinic in using an interpreter).  I can't hear the subtle inflections in a mother who is being abused, I can't tell when a dad is really worried about his kid and he's trying to hide it, and I can't relay my advice, my directions, and my health care nearly as good as I can with an English speaker.  There is a lot of subtle body language cues and language inflection codes when dealing with patients and I miss a lot of those cues because I was stubborn.  When I went through high school and college my thoughts on the subject were pretty one sided.

"They are the foreigners, they need to learn OUR language, not the other way around!"

Now that I'm seeing these patients every single day, to be honest, my thoughts on the subject hasn't changed much ;P.  I still feel like they should learn the national language if they want to live and work here, but my view has changed in that I now see that it's less their fault and more ours.  We (Government, Business, or whatever)  are enabling it.  I really can't blame them for wanting to come here, it's a better life.  I would do the same for my wife and child (which is exactly what our ancestors did before us).  I don't pretend to understand all the political under currents of what's caused this, but I can see the way the country is going and one thing I do comprehend is that I was an idiot for not learning Spanish ;P. 

Newbie Doc