Wednesday, December 17, 2008

All Those Little Words Can Mean A Lot To A Patient - Dr . Yoel Abells, National Post

The power of language is profound. The words we say and the way we say them can have a significant impact upon the person to whom these are directed. A minor alteration in the way something is phrased can mean the difference between offering hope or despair, between providing one with a sense of success or failure. Nowhere is this more apparent than in physician-patient interactions.

I can recall a number of years ago having a patient who was in labour. She was fully dilated and had been pushing for quite some time. It had become apparent that she would not deliver vaginally and would require a Caesarean section. I was mortified when I heard the resident explain to her that the reason for the operation was that she was unable to bring the baby down the birth canal. Not surprisingly, upon hearing this, the patient was distraught. She felt that the necessity for surgery was her fault. Greater sensitivity in wording would have prevented her from feeling this way. What should have been said was that the baby would not move down, thereby reassuring the mother that her effort was not the problem.

At around that time, the importance of language in the patient-doctor relationship was highlighted by Dr. Robert Buckman in his seminal work How to Break Bad News: A Guide for Health Care Professionals. Published in 1992, the book's goal was to provide health care providers

It was clear that little or no time was being spent teaching medical students how to communicate (physicians in particular) practical guidelines for imparting information to patients, especially when the news was bad. It was clear that little or no time was being spent teaching medical students how to communicate, and there were no textbooks available to provide direction. This book was intended to fill the gap. In many ways it did. Moreover, medical schools started to place greater focus on helping students learn the nuances of communication. As a result, further positive changes have occurred.

Unfortunately, over the past few years, I have begun to see a return to old, bad habits. Perhaps because of heavier workloads, or due to the science of medicine having become so overwhelmingly complex, cavalier use of language has reappeared. This must not be allowed to happen because--much as was the case with my patient in labour -- patient care suffers. Dr. Jerome Groopman addresses this issue in his most recent book How Doctors Think: "Most of what doctors do is talk and the communication piece is not separable from doing quality medicine. You need information to get at the diagnosis and the best way to get information is by establishing rapport with the patient. Competency is not separable from communication skills. It's not a trade-off."

The art of medicine is no less important than the science. It is rooted in clear and compassionate interactions between physicians and their patients. Today's doctors need to be reminded of this. Moreover, our institutions of medical training must reinvest time into teaching tomorrow's physicians how to effectively connect with patients using the sublime power of words. 

http://www.nationalpost.com/related/topics/story.html?id=1083903