pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Communication With Your Doctor – when things don’t seem to be going right

The earliest thing an infant learns to do, even before talking, is to: Communicate. It is something most of us struggle to perfect; and, are still learning as we close out our lives.

Research tells us that there may be as much Communication without words as with them. (Gestures, touch, body language, etc.)

Talking is one directional but Communication, which involves more people, is the process of understanding what is “really” said.

Most professions rely heavily on this “art” and the medical profession is no exception.  I am not sure that I know any physician who feels that they do it perfectly!

At least one impediment to Communication is: inaccurate perception – in many different forms.

In diagnosing a problem a physician first takes a history. He then tries to perceive how the patient or care giver perceives the problems. Unfortunately this may not be accurate, however, and he then must use his other senses for input in the examination.

Cases come to mind where children seen in the emergency room had only fever and continued vomiting noted by the parents but no other symptoms (including cough).  None-the-less physical examination revealed pneumonia and the child is admitted for therapy only to be found coughing copiously.

For whatever reason the parents had not perceived the cough.

Even during the examination the physician is not immune to the perception problems.

In medical school they taught us “you can’t find it if you don’ t think about it and look for it”.

So the very best way to perform a physical examination is to think about every potential problem as you exam each organ system.   — No simple task!

For example looking at the eyes you say to yourself, “Are the lids okay? Is there inflammation? Are the pupils responsive and the right size? Do the muscles work normally? Is the lens clear? Is the chamber clear? Are the vessels normal size and pulsing? Do the nerves look sharp and crisp?” etc. etc.

Obviously this is extremely time consuming and… (unfortunately) not always done. But, if you don’t even examine the area, you will never pick up things like hernias, genital infections or cervical cancer.

Occasionally a physician will need two or more examinations in order to delineate the problem, especially if it is of a changing nature or has an emotional component.

It is not unheard of that a physician to notices something on the second examination that he didn’t notice on the first. As we all know “things would be a lot easier to find if we just knew what we were looking for.”

Just because the diagnosis is made it does not mean that communication is assured. The diagnosis has to be explained in a way that it can be understood and the patient has to be prepared to hear what you are about to tell them.

Sometimes the doctor misunderstands what the patient desires and expects to be told.

The adolescent girl with a totally normal examination may not want to hear “You are perfectly healthy” and then receive instructions on how to combat the blemish problem; rather she may want to hear “You are not pregnant”.

Emotion does change perception and Communication.   A girls first pelvic examination can be greatly misunderstood (and I suppose a boys first prostate or hernia exam).

If a physician perceives that he has just told a patient some distressing news or information he is taught to wait for a moment before discussing anything else, as otherwise it may totally be forgotten.

For example, a person who has just been told of the possibility of cancer may deny ever hearing that the doctor said it was just a possibility and further tests should be done, despite other persons in the room hearing it very well.

An important thing to remember about communication is that it is two directional and it occurs over time.

If diagnoses are slow to come, questions are unanswered, expectations are not met, you feel confused upset or angry, chances are that communication process has not worked well.

The mature way to handle it would be to ponder what your questions or concerns were and then talk to the physician about it.

If medication or treatments do not seem to be progressing well, go back and talk to the physician about it.   Physicians are not immune to miscommunication either.   We may totally misunderstand what the patient has said.

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