How medicine discovered small talk

Some time ago my Twitter timeline had references to a little article on The Virtues of Irrelevance. I quite like the text, although more the sentiment behind it. And yet, I want to comment on it, because the authors really get all wrong. The issue is not irrelevance at all. I think.

The article, by Daniel Wolpaw and Dan Shapiro, is about what they call irrelevant opening comments; these brief moments when the doctor chats with the patient. And the authors argue, somewhat labouring the point, that these moments of irrelevance are important. And while perhaps the article is not presented as an important discovery, still, it must have been significant enough for the journal to publish it.

And here is the first point I want to make. About a hundred years after Bronislaw Malinowski, my fellow Kraków alumnus, medicine discovered small talk.  Because what the authors do not write about irrelevance, in fact, they write about something highly relevant. They write about phatic communion. They write about communication having only social functions, establishing and maintaining contact, creating and managing social bonds.

And so, while I agree with the authors’ (intended) message, I am somewhat surprised that communication which is just about essential in most human contact has to be argued for and is casted as irrelevance. There is really nothing irrelevant about small talk. I would go as far as saying that it might be just about the most human thing you will do during a consultation with your patient. Surely, that’s not irrelevant.

So yes, do small talk, doctor. And I urge the authors and other medics not to view small talk as irrelevance. In my earlier post on doctor-patient relationship, the doctor’s initial

When you saw my name, you might have thought I am Polish, but I am not. In fact, I am….

is precisely about the phatic communion, establishing contact and rapport. And there is nothing irrelevant about it. In fact, I was smitten and the consultation went very well. Incidentally, I was smitten, because it’s quite rare to sit in front of a fellow human being in the consultation room.

But there was something else in that. His little statement was so natural, unforced, yes, let me say it: human! I am stressing it, because in my mind’s eye, I can already see  ‘irrelevance exercises’ practiced at communication skills workshops.  The whole point of this ‘irrelevant talk’ is that it can’t be learnt. And words cannot express how much I would not like to hear this robot-like reciting of a phrase, ideally made with the pained expression so many doctors assume as I come into their surgery.

What’s also worth reminding ourselves is that most of us have no difficulty at all doing small talk. We might not initiate it, but we just go along with it. So, you really don’t need training here. And the only difficulty I can realistically see for you, doctor, is your ability to get down from your pedestal and mingle with us, puny humans. However, I would like to venture making a communication rule: speaking like a normal person will not diminish you as a doctor. If anything, it might actually make you a better one.

 

Alas, as much as I like the overall message of doing small talk in medicine, there is a discordant note in it, one that quite wrecked it for me. The authors offer four reasons why medics should engage in ‘irrelevant talk’. They write:

First, they convey that we see the patient as a unique individual. Given the speed of medical practice, it is not surprising that patients worry that their individual concerns will not be heard. Second, these questions reveal that we have had shared experiences, that despite our training and attire we are not so different from the patient.  Third, they communicate that we are observant and attending to details, which patients find comforting. And finally, they indicate that we are open to a conversation with the patient.

 

It turns out that the whole thing about ‘irrelevant talk’ is really not about relationships, empathy or whatever other fashionable thing in medicine, but it is about image management. The fragment focuses almost entirely on the doctor and the image they would like to project. Nothing they do is about me, how I feel, whether I am at ease or comfortable. Oh no, that’s not the point at all. The point is how I will perceive the medic.

When I read the fragment I had two reflections (I actually wanted to write about how patronising the fragment is, but I just can’t be bothered). First, that yes, there will be courses in irrelevant communication. After all, doctors must be trained in image management. My second reflection was that perhaps I was actually wrong. The article is not about phatic communion, about social bonds at all. It actually is about irrelevant talk which serves the construction of medics’ image. And if so, I would like, fairly respectfully, to thank you for your irrelevant talk. Please take it and….do what you like with it. I’m uninterested.

 

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