Why physicians should repeat themselves

I hate repeating myself.  It’s an impatient quality, but I wish everyone could just hear me the first time.  With a surgical personality, I prefer to convey things in the most efficient way possible, i.e., “Blade!” or “Kelly, please.”  So when folks ask me to repeat myself repeatedly, I feel my inner voice protesting, “This is so inefficient, ahh!”

If someone repeats something they have already told me, and catches me in an impatient mood, I might retort, “I heard you the first time.” But lately, I’ve changed my tack, and have tried to come up with a different response each time I’m told the same thing.  It’s possible the individual repeating himself or herself is trying to tell me something, and I am not quite getting the message. I figured this trick out while speaking to a family friend with Alzheimer’s disease. Now I find it useful in daily conversations.

I thought it over and considered the possibility there could be benefits to repeating oneself. So in a quest to do everything better, I have adopted repeating myself as a rule.  Here are some reasons why.

With my husband, if I assume I will need to repeat my message to be heard correctly, then that will be my baseline expectation. If I get feedback that I was heard right away, that’s a bonus. If I have to repeat myself, after all, that’s just what I expected going into the interaction. He’s got other stuff going on, after all.  Repeating myself is the price I pay to get an idea from my brain to his.

My little boy is 14 months old, so repeating myself to him, with as much variability as I can, is a good way to teach him our language. I repeat words and phrases, even some American Sign Language gestures.  Sometimes, being repetitive serves to comfort him. I sing the same lullabies when he’s struggling to settle down for a nap, or fighting a diaper change. I sing Czech folk songs in the hopes he’ll learn some words and be comforted by a part of his heritage.

As a doctor, repeating oneself can be a useful tool.  Patients and families need plenty of explanation regarding what we are proposing to do, and how we are going to do it. They need to know the risks and benefits of a given procedure or course of treatment. Before the patient arrives to our department, they are already being inundated with information, often while they are acutely ill.  Therefore, they’re not in the position to grasp all of the information conveyed to them. This is why having family or friends at the bedside is so helpful. It allows for the benefit of repeating yourself without having to, because the family can do it for you.

Every time I repeat an element of a discussion in a slightly different way, I’m working on my communication skills.  I am trying to get a new concept across to someone who may not understand it yet.

In medicine, there is an element of social anesthesia provided by using more words.  It may depend on the patient, but I find most patients want to hear more from me, not less. They want the space between us filled with words, whether neutral, explanatory, or encouraging, to keep their nervous thoughts from cycling. I believe in social anesthesia, and it can begin with building trust through reiterating, clarifying, and soothing the patient through the consent process.

Fleshing an explanation out with as many simple words, phrases, or descriptors as possible will help to depict the journey a device will take from the groin to the belly.  Showing a deployed vena cava filter within an acrylic model, or drawing a diagram of the arteries below the knee goes a long way in bridging the gap between what a physician knows and what the patient understands.

I recall listening in on attending level consents as a trainee, and marveling at the masterful use of words to envelop the pathophysiology, mechanics, and solution to a particular problem, sometimes with the attending perched at the foot of the patient’s bed.  If one is going to venture into another’s heart or lymphatics, it seems an appropriate gesture to get eye to eye in such a manner.

Sometimes, we physicians are over-caffeinated or filled with adrenaline, and we can’t possibly slow down to the speed of those around us. There are patients to take care of!  But learning to repeat myself is making me a better person to work with — a more patient practitioner. At home, a better partner. So, at the risk of repeating myself … give it a try!

Barbara Hamilton is an interventional radiologist and blogs at Tired Superheroine. She can be reached on Twitter @TSuperheroine.

Image credit: Shutterstock.com

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