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How to talk to your doctors

Posted in Health

doctorWhen the young Chinese doctor entered the room where I was, perched on an examination table, enveloped in a pink cotton gown, he seemed more nervous than me. I had recently been diagnosed with breast cancer and was seeking a consult with the surgeon who ended up excising the tumour.

As it happens with most doctors and surgeons of experience and renown, they are surrounded by fellows – apprentices really – training to become surgeons or specialists themselves. I had been told by the nurse who first examined me that the Chinese doctor would see me before the surgeon. Now he was standing there, somewhat unable to meet my gaze, and asking me inane questions such as “What worries you?” Are you fucking kidding me?? He examined me with heavy hands, nearly hurting me. But I didn’t say anything. He vanished, my surgeon stepped in and I was charmed by her wonderful ways and straightforward but kind manners. Years of practice, no doubt, but also a matter of her personality.

I never said anything to her about her fellow. I was too busy managing my disease. But I should have. If the object of the exercise was for the doctor to review my case and learn, I suppose he should have also learnt how to deal with the patient herself.
Nor did I say anything the time I went to see a periodontist, who came highly recommended, and who tried to gouge me for a set of X-rays I knew full well my dentist had already provided him with. I simply stood up and left.

For too long, people have revered doctors and their knowledge, hardly ever questioning their decisions, recommendations or bedside manners. But doctors are flawed humans just like the rest of us and their biggest challenge is often being able to involve a patient in the decision-making process or emotionally deal with him.

Delivering difficult news or complex information in a clear, concise manner while imbuing it with empathy is not easy. Some are better than others. And it’s an art that is hard to teach. Add to that the need to create a layer of distance for a physician to be able to function, day in and day out, without falling prey to depression or getting too involved (the medical profession has one of the highest incidence of suicide) and some doctors can come across as positively cold-hearted.

In their defense, the business of keeping people healthy can be an emotional minefield. I have witnessed first hand the expression of dismay, sadness and exhaustion right after a patient died, when I walked into the hospital’s cath lab on an errand, right when the team of doctors were discarding their gowns, silent, unable to even talk to each other. It doesn’t even come close to a bad day at the office, with a cranky boss.

Still, I have also witnessed a young doctor delivering the news of the death of a wife, mother, sister to her large family, while gingerly sitting on a desk, outside a bank of elevators, in plain earshot of anyone else, i.e. me, waiting for an elevator. I shouldn’t have been able to listen in; the child who threw herself on the floor, wailing, didn’t need my averting gaze. When I returned, a few minutes later, a priest and a grief counsellor had the situation under control but I kept on thinking the doctor should have thought of corralling the family to a more private setting.

But how on earth are they going to learn if we, the patients, don’t take the time to let them know about an interaction that did or did not work? Since my whole cancer ordeal, I now make a point of letting doctors (and nurses) know what they did well, what I appreciated or could have been done or said differently. I try to be clear in conveying my expectations, to let them know in advance what kind of patient I am going to be.

The relationship between a patient and a physician should be one of the most honest, devoid of silly pleasantries, fears or timidity. Too much is at stake for both.

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10 Comments

  1. Good advice. I’ll try to put it into practice in the future.

    August 25, 2016
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    • camparigirl
      camparigirl

      🙂

      August 26, 2016
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  2. When it comes to control over medical care it’s more often than not avoidance of perceived unpleasantness or worry about the what if’s. It’s hard to know what to ask when you in fact, don’t know what you don’t know. Yet it takes courage and some self-assuredness to call healthcare professionals out. I recently changed insurance and thus, personal doctor and after two encounters intend to change to someone different. This one just doesn’t get me like my last one but your post has given me new mettle to make to better support and advocate for my needs. Thank you for that!

    August 23, 2016
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    • camparigirl
      camparigirl

      Nothing worse than having to face a doctor you don’t feel completely at ease with. Keep looking. I failed to mention in the post I changed my primary physician after two appointments – it’s not that I challenged her knowledge but she was incredibly inefficient. I always observe the front desk when I walk into a doctor’s office: are the people behind the desk efficient, warm, welcoming? Do they look happy? To me they are a doctor’s business card. I probably sound like the patient from hell!

      August 24, 2016
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  3. silvia
    silvia

    So many things to think about. I totally agree with you. When one becomes a patient he/she should be completely involved in every step of his/her medical path. It is true that some patient still today prefer to rely upon the physician advice. And a doctor should immediately understand what kind of person he is treating. Not easy but not impossible. Now that I know what I know I’d do a couple of things in a different way, the first one being choosing a female surgeon for breast surgery. I also think that other holistic therapeutic approaches helped a lot people in gaining a much more critical and self-conscious attitude towards science and, needless to say, sharing info and data played a major role nowadays.

    August 23, 2016
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    • camparigirl
      camparigirl

      Doctors are not mind readers and I think we should help them along. I agree with you that looking into alternative therapies has made a lot of patients, at least, ask more questions. And questions are always good. I don’t have to know as much as a doctor, which is why I need to feel trust, but I can ask questions.

      August 24, 2016
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  4. Winston Moreton
    Winston Moreton

    So many responses come to mind. Thought provoking stuff even here on the beach at Lido dei Pini. Even a book maybe?

    August 23, 2016
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    • camparigirl
      camparigirl

      Lido dei Pini! May I suggest un bel fritto misto di pesce for tonight’s dinner? Yes, a book. Maybe. I have been asked to compile the cancer posts in some fashion but I don’t quite know how yet.

      August 24, 2016
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  5. Much food for thought here. You are so right – how will they know if we don’t tell them? Especially the younger doctors who are still learning how to treat people.

    There are some older exceptions that I’m willing to accept, though. My doctor in South Africa was a wonderful man, so kind, gentle and attentive. He sent me to a surgeon some years back to have a cyst removed, but he warned me that the man had NO bedside manner whatsoever; he was sending me to him because he was the best surgeon for my type of surgery. My doctor had sent his own wife to this man when she had breast cancer, and I knew that there was no higher recommendation from him than that, but I was glad he had forewarned me. My surgery wasn’t serious, but the surgeon gave me every detail that I never would have dreamed of asking, and I was grateful for that. He did a really neat job too – no scaring or loss of nerves.

    August 22, 2016
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    • camparigirl
      camparigirl

      You hit on something very raw here. Which is our willingness to put up with someone’s horrid bedside manner for the sake of their brilliant skills. I suppose if it was a matter of life or death, I would consider going to the doctor who is labelled “the best” but I have forgone doctors at the top of the heap because I did not feel comfortable or fully respected. Somehow, I need to trust and I find it hard to trust someone who can’t be assed to develop some empathy. On the other hand, I would truly appreciate a surgeon who gives me as many details as possible.

      August 24, 2016
      |Reply

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