We talk a lot about communication in medicine and try to teach the right skills to students, such as the importance of body language and simplifying medical terminology. But how often do we look at non-medical language and the effect it has?
Suzanne Gordon’s BMJ blog “Medicine’s F word—Fail” in early December reminded me to do better with our population of somataform/psychological/recurrent disorders (what is the correct term?) whilst also battling my fear of them. In paediatrics we don’t often talk of our patients “failing,” but we do have our own language problems. As a registrar, I’ve had multiple approaches to the recurrent patient “problem” explained and demonstrated, and perfectly nice people (myself included) find themselves ranting behind closed doors, only to then attempt their best “comms skills scenario” face in the clinic room. I can’t say I believe this is a successful tactic, and the only times I’ve seen it done well are by the small and select group who understand the impact their baseline attitudes have towards these encounters.
It strikes me we do ourselves, our colleagues, and our patients, a huge disservice in this. Firstly, what impression do we give to our junior colleagues about approaching patients? Of course in medicine, we have black humour, but this isn’t laughing at death, it’s instead a frustration—people wasting our services when they are not “sick.” We may laugh along, but we’re telling each other that these patients aren’t worth our time and are a burden on the NHS. But from now on I think, surely they are worth some attention? Aren’t they? For whatever reason they are missing school, being brought to the doctor a lot, worrying, and having tests done—by us, by doctors. And then, once we’ve satisfied ourselves, we tell them it’s “stress induced,” “the gut is very sensitive to change,” “it’s not serious,” and then follow it up with “so we would recommend some relaxation techniques, but can discharge you.” What are we really telling our patients?
To us there is not a serious life threatening cause of the pain looming over them, but this has taken over their lives, everything about it is serious to the patient and their family. Have we treated ourselves or the patient? Serious—what a word, what does it mean? To us? To them?
These patients are hard to treat, most of us aren’t experts or any good at it. Instead of embracing the challenge—who has time?—we hide behind our words. Can we not listen a little more closely, think a little more deeply, tread a little more carefully, and bring our best holistic selves into the room to give them the service we would want our teenage selves to have?
The problem is, I am due to start an A&E shift, where there is a high likelihood that in amongst the bronchs, wheezers, and kids in resus, I will see a child with a similar background. And I will somehow not give them the kindness, attention and care they deserve as their parents panic about why they are in so much pain if “there is nothing wrong with them.” The cycle begins again and I tell myself I will try harder the next time. I try to picture the mother from “Snakes and Ladders” by Hilary Cass and remember the tenth consultation for me is the one and only consultation for them. Perhaps I am hoping that writing this will be the catalyst I need for my new years resolution.
Lizzie Wortley is a paediatric registrar working in Northwest London who is interested in quality improvement, acute care, and particularly enjoys debating the psychology of doctors and patients.
Competing interests: None declared.