How do I fix communication with my patients?


There is a basic communication gap between you and me. How could there not be? It’s not what you expect. I say you have cancer, or heart failure, or emphysema. Full stop. A conversation ensues. This is not what I’m talking about.

It’s more like when I report to you a series of normal lab results, and at the end flippantly mention a slight elevation of the white blood cell count. In my mind, it is a minor issue and likely due to that viral infection that you are recovering from. As the days pass, my words simmer and eventually come to a boil, consuming you. The elevation could be leukemia after all. You could be dying. You could be like your uncle Stew who went to the office for routine blood tests and was gone a week later. You search the Internet and are confused by what you see. You wait anxiously to repeat the blood tests four weeks later.

The white blood cell count comes back normal. You are relieved and tired. It has been a long and scary four weeks.

And I had no idea that you even suffered through this. I apologize. The problem with familiarity is that it is easy to forget perspective. I have spent the last few decades becoming intimately familiar with the ebb and flow of wayward lab results. And you have not. Frankly, I sometimes forget to look at my words, my utterances, through your eyes. The big stuff, sure. But it’s the minor and less tangible that escapes scrutiny.

God knows, there are also many other barriers. I am rushing off the phone to get back to the call from the emergency room. We are separated by an electronic elephant in the room that stubbornly inserts itself between us, and blocks my view. There are boxes and checks to be marked, and I am stuck trying to figure out whether you are a Pacific Islander, while you just want to talk about your chest pain.

Per usual, I don’t have adequate answers to this conundrum. Sometimes the gulf is overwhelmingly vast. Although I take full responsibility, I doubt that I will always be attuned to which of my words affect you so. Unfortunately, my experience will still color me blind from time to time.

But going forward there is one minor adjustment I will pledge to make. One way we can work together as a team.

At the end of every visit, every phone conversation, I will train myself to ask:

Tell me what questions you have? What haven’t I made clear?

Then, I will pause.

And you will answer.

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion. Watch his talk at dotMED 2013, Caring 2.0: Social Media and the Rise Of The Empathic Physician. He is the author of I Am Your Doctor: and This Is My Humble Opinion.

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