There’s a new article from me up on Doc2Doc, this week we’re discussing to what extent you communicate with your patients.
Interesting post, Kal. Per usual, I will respond here because “Dammit, Kal, I’m an accountant, not a Doctor!”.
I think I’d rather have an EMT or Paramedic just get on with things, should I ever need them. Granted, folks there (and here, too, if you read some US ambo blogs) seem to often think of EMS as “Mobile GP Offices”, but really, if I’m ever so sick/injured that I’d need an ambulance, I’d really rather just let you guys get me safely to the hospital.
Once there, however, I will query the doctors and nurses incessantly “What is that? Why are you doing that? Is this necessary? What does that do?”
When I do go to my GP (every 3 months at least), I have a list of maladies and questions – and I make sure I understand what he tells me before I let him out of the little cubbyhole room. However – I take the pink pill, the green pill and the big white one in the foil-wrap at night, and the pink, green, little white, big white in foil and the time-release capsule in the morning.
I have a list of the names and dosages in my wallet. Don’t ask me to remember what they are or what they do. I’m just an accountant, Jim.
There are no answers.
I can tell you precisely what each tablet I take does, what strength it is and how often they are taken. I can also tell you both the medical name and the generic name, and I am not a medical professional.
I am a fairly intelligent (or so I like to think) adult male human (or so I like to think) who likes to call a spade a spade and who doesn’t like getting either patronised or treated like a small child; if it’s going to hurt, for example, then tell me it’s going to hurt in plain english – don’t couch it in euphanisms because if you do it will only annoy me. By the same token, if it’s serious then tell me the damn thing is serious – I can handle it.
I am big enough, intelligent enough (or so I like to think) and certainly ugly enough to be able to make informed choices and informed decisions. Treat me like an adult and we’ll get along fine.
– but –
on the other hand I fully understand that there are people out there who, and let’s be honest here, make your average garden table look intelligent; the sort of people who can watch someone get run over by a car then blithely say that hte problem is, naturally, that the person is allergic to peanuts (No, you tosser, they are allergic to getting hit by 2 tons of metal moving at 40 mph).
You could spend a week trying to explain to that person that their cruciate ligament has parted company with their femur 9or some such) and they are still not going to get it. Why waste your time trying, do you not have better things to do?
As much as I don’t want to repeat myself, there is no answer. I suspect that GPs have an advantage because they should, over time, get to know which patient they can talk to and which one would improve the gene pool by their removal. The likes of yourself are, essentially, on a hiding to nothing; only time and experience will mean that, usually, you can get it right and give the correct amount of information to the patient – there will be times whan you get it wrong but it’s not life threatening if you patronise someone (though the thump you recieve might be )
You’re not blinkered. As the paramedic, the decision of “left arm or right” is all the casualty needs to be able to make. That small decision will give them a feeling that they still have some control over the situation, even though it is strange and maybe scary.
You can tell it to them in plain english. They can say if they don’t get it, if they don’t want to get it, if they want more information. You know how to help them. That’s all that really matters.
On the other hand, as a 16 year old saint john volunteer, I sometimes have the problem that I’m really out of my depth. I can’t talk to the casualty about it: I don’t know what I’m doing. Normally I tread water until a paramedic appears. I’m terrified that one day they won’t.
I have only talked to my regular doc and “doc-in-a-box”* as a patient what I try to do is ask intelligent questions about what is being done to me. The doctors I like are the ones that meet me in the middle. I learn a little bit, but I am not required to have much beyond basic biology and chemistry. The good doctors will get technical, then back off when they lose me. It may take a bit of back and forth to find the middle, but we get there.
*no appt, no emergency, but need to see doc soonish. Usually located in strip malls. Good when you’re new to town, visiting, etc.
In the last couple of years, I’ve had a few friends diagnosed with cancers. They’ve all had early stage, treatable problems and have all been offered a range of treatemnts.
Each one has complained the same thing: too much choice. Yes, they like to be informed. Yes, they want to know what’s being done to them and why. But they don’t want to be the ones choosing their treatment. All have ended up saying to their specialists “well, which course do you recommend?” and have all been told “that’s your choice…”.
When faced with something as serious as a cancer diagnosis, many people don’t want choice. They want a proper, grown-up medical professional telling them that this specific treatment is going to give them their best chance.
[…] in January I wrote for the BMJ about the phrase “trust me” and this afternoon I found myself using it in an unfamiliar […]
Mail (will not be published) (required)
Powered by WordPress - Handcoded by Tommaso Baldovino