Speak to a patient as though you were speaking to your grandparents

It’s hard to believe that nearly 1.5 years ago have elapsed since my first-year orientation to medical school. Much of it seemed protocol with session after session on rules and regulations, but I vividly remember the few hours spent outlining standardized patient encounters and how my assessments over the next four years would be based on my interactions with a complete stranger. As alien as that idea sounded to me, I felt more surprised upon hearing one patient’s advice, “I can’t tell you how many times I have individuals come in here and use words like ‘exacerbate.’ Speak to a patient as though you were speaking to your grandparents.”

I wondered how anybody could speak in such a cold manner, especially since I had come to learn the intricacies of communication over the last seven years as a youth group coordinator for the local chapter of BAPS, an NGO in consultative status with the UN committed to empowering youth through spirituality and service. Each Sunday, our group of high school and college students convene to discuss topics centric to character and Hindu culture, like vegetarianism and introspection.

Obviously such topics don’t naturally stimulate this age group, so I realized the need to parallel these topics with their interests. Introspection intrigued them when we looked at a documentary explaining Batman’s ability to match his foe’s ferocity but only if it did not violate justice, like leaving a villain for law enforcement over dishing justice himself.

Empathic communication requires we imbue a message in an audience’s language, in line with the patient’s advice, but two years of medical school have demonstrated how all that can unravel.

Learning physiology, immunology, biochemistry, and other topics compared to the force of a fire hydrant opened as the torrent of knowledge forced down our throats. I remember struggling to use words like posterior and superior in presenting our dissections during anatomy lab, so my professor encouraged me in that it would get easier with immersing myself in the material.

With time away from the lab spent in study, it did not take long for me to master these words, even conquer them. Flaunting these words as the spoils of another exam justified the toll it took on our emotional energy, and we found ourselves the most vulnerable to the short-term satisfaction of ego. Empathy requires energy, and with none to spare, we rescind into using words like exacerbate as early as our standardized patient encounters.

By no means should we abandon medical jargon, but we need to bridge patients from their world into medicine. I remember shadowing a family medicine physician with a female patient in her mid-40’s come in for a follow-up visit after being diagnosed with pancreatic cancer. Non-alcoholic, non-smoker, no family history — I could sense her helplessness given that she did not fit the risk. The doctor took his time explaining the pancreas as a “bag of chemicals that help process food” and answering her other questions. Never once did the woman feel unable to understand, even when she was one of the last patients for the day.

Exhausted, the doctor could have easily construed a sound byte filled with scientific terms, but he would’ve traded empathy for ego. Moments like these helped me realize that while empathy may require effort, it renews us with the purpose needed to passionately serve our patients. Communication is but one outlet.

Rushil Patel is a medical student. 

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  • http://dr-souz.blogspot.com/ Dr Souz

    Umm, I use the word exacerbate with my close friends (no, not medical students), and it doesn’t come off as cold. Many of my colleagues, students, acquaintances would be insulted if I spoke to them like children (or grandparents as you put it…)

    Speak to patients like people. Avoid jargon. Don’t belittle. Make sure they’ve understood by having them repeat back the important bits. For the love of God, don’t talk down to anyone.

  • http://twitter.com/rvpmd Rushil Patel

    Thanks for responding – title is misleading. Just as you said, we should avoid jargon and belittling others, and the patient facilitator’s advice provided me with that insight.

  • Gold_Foundation

    While the title may be somewhat misleading, the sentiment that you express of bridging the patient’s world and the world of medicine is vital.  Speaking to patients in terms that they can understand paired with making eye contact, speaking in a compassionate tone of voice and giving them the uninterrupted opportunity to express their concerns is part of the art of healing.  Coupled with the science of medicine, it provides the best that a doctor has to offer.  The Arnold P. Gold Foundation works to ensure that healthcare is as compassionate as it is cutting edge, and we applaud your humanisitic approach to providing medical care.

    • http://twitter.com/rvpmd Rushil Patel

      Thank you for your kind words; though I am still a medical student, I hope to preserve this attitude moving forward.

  • http://twitter.com/KarenSibertMD Karen Sibert MD

    I would add to this:  Speak to your patients with respect, and don’t use the first name of a patient unless he/she specifically gives you permission.  Use Mr., Mrs., or Ms. as appropriate, at the same time you introduce yourself as Dr. _____.  This establishes respect and a degree of formality that older patients especially appreciate.  Your patient doesn’t want a buddy; he wants a doctor.  Many older male patients were in the military and will appreciate being addressed as “sir”.  Women can be a bit trickier–in the south, they’ll be fine with being called “ma’am”, though in the north or west they may feel that title should be reserved for extremely old ladies.  Med students and residents–for the love of God don’t go to your patient’s bedside wearing a backpack.  It makes you look as though you’re on your way to a youth hostel, and older patients will think you look quite silly if they’re not already annoyed. Don’t chew gum either.  Chances are that many of your patients grew up in an era where gum-chewing was considered extremely discourteous and low-class, and would get you thrown out of a class at school.  I could go on…But the writer’s advice is excellent–simple, clear explanations, and the courtesy you’d give to your grandparents.

    • http://twitter.com/rvpmd Rushil Patel

      I appreciate the advice though I imagine it must be cumbersome to approach a patient wearing a backpack!

    • EmilyAnon

      How thoughtful that a doctor would consider such niceties as important in patient care.  I hope your patients have reciprocated in kind.

  • http://www.facebook.com/nancynfoster Nancy Foster

    I have a college degree and the capability to research and learn new terminology when necessary. I would never return to a physician who ”
    explained the pancreas as a “bag of chemicals that help process food”.  Nor do I wish to spoken to as though I were your grandparent. That is demeaning and demoralizing to the patient who may already be feeling the exacerbation of being marginalized by the health care system. I am a teacher by original background, but I have also been a volunteer EMT and AHA spokesperson.  I read the NEJM and am a frequent user of PubMed.  You won’t necessarily know that about me…so please do not water down your message to me. As your patient I deserve not only your best care but your best presentation of my condition, my prognosis and your treatment plan.