Doctor-patient relationship

I saw a doctor the other day. It was quite an interesting encounter. This is because the moment I sat down, he started building a relationship with me. And that’s what I want to write about.

I was referred to see a specialist and after two months’ waiting (it is silly, isn’t it?), I finally went to see a doctor. As usual, the person who saw me was not the person on the form, but, hey, let’s not split hairs here. The doctor came to get me from the waiting room, waited with a smile as I was packing my tablet and the phone I was using to go on-line (has anyone thought of providing free Wi-Fi for patients for more than 15 minutes?). No pressure.

I went to his surgery, he invited me to sit down and then something strange happened. Before I managed to open my mouth, he said something like:

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

He didn’t realise, of course, that I didn’t have his name, and that I am linguist and so, no, I would not have taken his name to be Polish.

But, obviously, that was not the point!

The point was that he was trying to talk to me, make conversation. This simple statement put him right outside medical discourse. For a moment or two we just chatted, like two persons who had just met and were making small talk. It was only a minute. And then it was his smile, posture, voice. And no, it was not ‘empathy’, it was friendship, well, friendliness. I was smitten.

And then, with a smile, he invited me tell him what I came with, interrupting 10 seconds later, and apologising for it. He was genuinely embarrassed, I was genuinely taken by it. He was taking notes, surprisingly, with a pen on a piece of paper, so he was constantly turned towards me. He not only created a relationship with me, he also changed the medical interview into a conversation. Yes, a conversation, even though he was asking me medical questions.

But there was something else. I could see he suspected what the problem was. I asked him and he confirmed. But what was amazing about it was that he didn’t preach. He told me that his diagnosis explained A, B, and C, but didn’t explain D and E. Moreover, wait for it, he said he didn’t really know much about D & E. Bloody hell, can you please do something wrong?!

The visit was just about perfect – he created a relationship, we had a conversation, he acknowledged his limitations. It was all very natural, especially, as he was apologising. It sounded so sincere and, I bet, it actually was.  And it all got me thinking, which resulted in the following two points.

The first point is that after the introduction, he could have done just about anything. The shifting of the frame in which we interacted positioned him much more as a friendly person than a doctor. Masterful! The subsequent shift back to the medical footing did not and could not change the friendly atmosphere he created, well, he started and I played along.

The second point is somewhat more serious: How did he know what to do? You see, I am not entirely certain (for reasons I am not going to divulge) that the doctor had had any significant training in communication skills. And that raises a significant issue. The issue is: Why do I bother? Sorry to make it personal, but it kind of hurts!

You see, I tend to agree with the psychiatrist Giovanni Stanghellini, who argued that the medical interview is not just art, it is also technique, which can be understood and taught. But if this is the case, how come my ‘specialist doctor’ could communicate like this? If I am right and he was not trained in the art of medical communication, he should have sat down, looked at the computer, ignored ‘my narrative’, asked me ICE questions (also to be ignored) and then pronounced his diagnosis at which point I should have knelt and said:

Oh thank you, the wise one.

Yes, I exaggerate. A little.

So, what about medical communication? I have no idea. My experience suggests that there is much to be taught. But then I would, wouldn’t I? And so, humbled by my experience, I hope that we, linguists, can offer some insight into the intricacies of medical communication, be it only by explaining why it’s great. I hope, but I’ve had a bad day.


Oh, and I forgot to add one thing about my wonder of a doctor.

He was an EU immigrant.



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