I have a theory, entirely untroubled by scientific testing, that the quality of Doctor-Patient communication is best assessed in the surgery car park.
As doctors, getting our message across is a complex thing. Like Russia, It is a “riddle, wrapped in a mystery, inside an enigma”. It is a game of Chinese whispers.
First, we have to figure out what question we are being asked. It is not always clear, and even when it seems clear. “Should I have this mole cut out” may mean “Should I have the mole cut out?”, or it might mean “I saw Max Walker died from a melanoma, and the lady at the shop’s sister has breast cancer, and all my friends seem to be getting some sort of cancer, and it really freaks me out because my father got a sort of cancer when he was only 48 and ....” And so on.
Even if we get the question sorted, we then have to sort out an answer. The answer might be 100% true. It might be based on Level 1 evidence, peer-reviewed articles and a fortunate read of that very topic in How to Treat on the previous evening.
Or, it might fall into the “ maybe we should biopsy it just to be sure because it could possibly be a superficial SCC, or maybe psoriasis, or, on the other hand, it does have some resemblance to a rash I think I saw in a journal I may have kept somewhere last year ..”
Then we have to communicate our view, our level of confidence, the alternatives and the risks of treatment. We have to do this in a way that is a therapy for the patient, not the doctor. The blunt advice to the overweight, smoking diabetic to “stop smoking and lose weight or you’ll be in the box at our next meeting” may be true but it falls more into the category of therapy for the doctor (“I told him what he had to do....what more can I do”?) but does not quite meet the criterion as therapy for the patient.
Finally, we have to assume that more than half of what we say will not register at all. Why? Because that’s life. How much of what the accountant, or lawyer, or the lady at the shop tells us do we remember?
So, the patient leaves the room, pays a bill, makes a further appointment, chats to a neighbour in the waiting room, and then goes to the car where his partner is waiting. The mole was, of course, one of four matters on “the list”.
“What did the doctor say,” asks the partner.
In the answer to that question lies the standard of the communication that occurred.
This article was first published by Australian Doctor Group and has been published with the permission of the author Dr Jon Fogarty.
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