Speaking with patients

Patient satisfaction is entirely irrational and reasonably so: it is subject to a host of cognitive biases. Ultimately, satisfaction depends on whether the patient feels cared for, heard and understood. Patients are in no position to judge the technical or cognitive skills of the doctors who attend them and so they rely on their assessments of their clinicians’ social skills as proxy for everything else. I am reminded of Beckwith’s anecdote in which the lawyer stated that she had never had a client who said that she really, really liked her doctor, but that she felt, absolutely, that she had to sue him.

 

Speaking with patients needs time – time without distraction and time without a pressing deadline. And then there’s the real world. It also needs a history: people are subject to idiosyncratic shames, guilts and other prejudices that lead to omissions, ambiguities, diversions, misrepresentations and lies. No-one is immune: a colleague presented with a history of abdominal pain radiating to his groin when the truth was that he had an acutely painful and swollen testicle. Repeated interaction creates and improves trust which leads to more open and less ambiguous communication.

 

Communication is inherently and usefully ambiguous. In high pressure situations, the usefulness is inversely proportional to the ambiguity. We all need clarity when the stakes are high and ambiguity is most useful (ego-protective)in those circumstances.

 

Speaking with patients also needs simple language because stress slows down processing and big words and long sentences don’t make for easy repetition. Simple language is, unfortunately, very difficult and when I am tired almost entirely beyond me. It needs first that one know what is most important medically and to the patient. These may be two different things entirely. It needs also, an assessment of the patient’s receptiveness and the willingness and ability to recall the information given. To hear, to understand, to remember and to recall are all different things.

 

Information is provided with some end in mind, some action that must be taken or not or some burden that must be accepted. As always, one should begin with the end in mind.