by Diane Glass
In the last five years, I have presented to Des Moines University medical students on the topic of doctor/patient communication. They have enrolled in an elective course called “Death and Dying” to learn how to communicate with individuals facing serious, sometimes life-threatening illness.
Although still in school, they are not unlike the doctors I have encountered over the years. In interviewing patients, doctors choose to stick to the script, asking questions about symptoms, offering possible diagnoses, and recommending tests and treatment options. Computerized medical forms encourage this approach; insurance companies need the information doctors collect to authorize payment.
What doctors often don’t often ask are the simplest of questions: “What is this like for you?” “How is this affecting your life?” “What do YOU think would make a difference?”
When I suggest these questions to students, they express reservations. “There’s not time for this kind of conversation.” “I won’t know what to say if they start talking about their lives; I’m not a therapist.” “Patients just expect answers from me.” Their reluctance underscores a basic misconception about the purpose of this communication. It is not simply to produce a medical outcome (a test, a diagnosis, a prescription), but also to create the kind of relationship between doctor and patient that will lead to quality care over time.
This relationship provides care and comfort to patients with terminal diagnoses. At this stage, patients seek not only treatment that will ease suffering, but also the opportunity to talk about life joys, disappointments, and desires. A caring relationship in which patients feel free to share their feelings and experiences also serves individuals with complex chronic illness and pain. In these situations, doctors find simple solutions illusory. Patients face needed lifestyle changes. The illness impacts all areas of patients’ lives. When I hear a doctor say to me, “There’s nothing more I can do,” I know that he or she underestimates the power of caring and commitment. There is always more that can be done.
So to the medical students I talk with, I offer this kind of advice in response to their reservations about open-ended conversations with patients:
Reservation: There’s not time for this kind of conversation.
Response: Take charge of your schedule. Without your initiative, you will be scheduled every 20 minutes (or so) for a new patient. You can change that. Reserve multiple blocks of time, especially in meeting with new patients. Arrange regular appointments with patients with more complex issues; don’t wait for them to request appointments. Yes, fill out the forms, but make that a secondary and separate part of the conversation.
Reservation: I won’t know what to say if they start talking about their lives; I’m not a therapist.
Response: Your job is to listen with care, not to provide answers. You are not expected to be a therapist or psychologist. Listen for underlying themes that may explain your patients’ symptoms. Often stories provide metaphors for what the body is experiencing. Notice gestures and postures. Be comfortable with silence. Your patient may be about ready to share something important when you speak too quickly. Say, “Tell me more” and repeat key phrases and words so your patient will know you are listening.
Objection: Patients expect answers from me.
Response: It’s true: many patients place the bulk of the responsibility on the doctor for their own health. Communicate (and believe) that you and your patient are partners with shared responsibilities. Build that partnership by involving the patient in every aspect of identifying problems and working out treatment plans. Focus your resources on those patients who are interested in this approach.
Patients tend to keep their stories under wraps, fearing their doctors will consider them irrelevant or distracting. Yet in open-ended conversation, they may discover factors affecting their health they had not thought about.
Most aspiring doctors get into their fields because they want to help people. Listening with respect, compassion and sensitivity equals medical knowledge as a tool for doing that.
Editor’s note: This is Diane’s fifth blog post in fulfillment of her Transformational Language Certificate.
Diane Glass teaches classes in storytelling as a tool for spiritual growth. She offers workshops in the spiritual dimensions of chronic illness and pain and in the body as home to the soul. Her memoir, “This Need to Dance” (Amazon), relates her own experience growing up with spina bifida, being diagnosed with breast cancer, and finding meaning in her pursuit of health