Tuesday, February 22, 2011


I’m still taken aback, that after 38 years in practice as a health professional, that what a patient tells me is not what they report to their family. It is not because they have two faces or a peculiar cognitive condition. It may be that the patient has become the interpreter of medical events to their outside world. Isn’t that worth pondering?

The trajectory of medical and health services begins with the point of view that the person (the “patient”) seeking those services has also given them high priority. The healthcare professional proceeds on the following:

• Once in a patient-clinician conversation we think that the person believes we know more than they do.

• And, because we are knowledgeable we believe our corrective procedures will solve the problem.

• The problem solved?

If in the conversation of treatment the patient balks, changes subject, or dismisses the topic what is our response? Become more emphatic, offer mild threats or do we check to see if we are in the ball park?

Imagine what they are telling their family, friends, and neighbors. That the solution was a one-week stay in a place that neither speaks their language or serves their food and comes with a 2-hour surgical procedure that it will takes weeks to heal from. Or, that they will need to secure transportation, have family take a loss of half-day’s pay, travel to an unfamiliar place and repeat 3 times a week for months. Everyone shakes their head and then offers their suggestions.

Arthur Kleinman, psychiatrist and medical anthropologist lays out eight questions to prevent us from continuing to miss the boat. Many other sages remind us that we need to change our ways and not measure compliance but the degree to which we can have a meaningful conversation and where that will lead us in clinical practice.

The patient as interpreter, the patient as conversationalist, the patient as source of wisdom is not a frightening prospect. Even with significant cultural, language, historic differences the patient almost always wants you to succeed.

No comments:

Post a Comment