Editor's Note
Working with Words
“Would you get that?” I ask my wife as our home phone rings. It’s 6 p.m., and I’m home and not on call. There are some days when one more phone call, even if it involves telling a solicitor “No thanks,” is one too many. I realize I’ve been communicating for the past 10 hours—talking to patients in the hospital, in the office, and on the phone; talking to my office staff and partners; responding to faxes and emails—and communication fatigue has set in. I feel like Hal Holbrook finishing his one-man Mark Twain show.
Yet I feel guilty. All that conversation is important, part of the job, what I signed up for. And the topics I’ve covered are important. I’ve explained the rationale for statin therapy to a man with high cholesterol. I’ve discussed a move to assisted living with a patient and her family, trying to “spin” the idea by explaining that her family and I know the decision is the right one. After gathering information about biopsies and scans for a patient with colon cancer, I’ve tried to provide him with some perspective about the recommendations he’s heard from the surgeon and the oncologist. And I’ve discussed with a patient why there isn’t really a good reason to do CT scans of her entire body to look for cancer. During a 10-hour day, I have gone from playing educator to mediator to translator to debater—a tiring assignment for any actor.
And for doctors, communication isn’t just talking anymore. We can email patients with advice and reports. We can text our colleagues about patient handoffs and requests. We can tap social media to reach out to patients and other professionals. For the practicing physician, a day can become a flurry of words sent by more media than Morse or Marconi could have imagined. Given how important communication is for physicians, it is surprising how little time is devoted to teaching it during medical training. Traditionally, medical schools have chosen students by the cut-and-dried calculus of their MCAT score, GPA, and aptitude for science. Speaking or writing skills are rarely considered. As a result, medical students and medical school graduates sometimes have difficulty writing declarative sentences much less a paragraph with logic that flows. Writing clearly doesn’t necessarily predict the ability to explain clearly, but it helps. Although some may demean such skills as mere fluff for doctors, they are indispensable tools of medical practice. Communication, not anatomy, physiology, pathology, or pharmacology, is the basic science of medicine.
Unfortunately, it is a science that is hard to teach, although our medical institutions are trying. Using videotaped student-patient encounters and instruction on mindfulness, many medical schools are attempting to train future doctors to not just absorb facts but to listen to people, whether they’re patients, partners, or colleagues. They realize that what a doctor misses could mean the difference between life and death. Communication is two-way for physicians no matter what role they are playing.
It all does seem so basic, listening. Open up the ears and the brain and try to understand what the other person is saying or writing or even what they’re not saying, which is sometimes more important. All so basic, and all so tiring.
Charles R. Meyer, M.D., editor in chief, can be reached at cmeyer1@fairview.org