I need to see a doctor. I’m slightly worried about something, but I’ve been putting the visit off for some time now. And as I hover between the feeling it’s really time and that it’s not so bad yet, I also wonder how many doctors reflect on this.
Before my professorial self takes over, I guess I need to explain why I’ve been putting the visit off. This is because over the last couple of years my experience with doctors has been less than good. Hearing that I am looking for an illness is hardly pleasant, as is laughter that my throat is still sore. I fear that my next consultation will consist of another battle. And I will need not to allow the medic to undermine me, I will need bang my head against the wall, as I will be told that things are fine and I just need to do even more watchful waiting. And I am too tired, too old, too disheartened to go to battle.
And all of you who have just read it, consider that I am highly educated, quite intelligent and gobby professor who really doesn’t suffer fools gladly. Consider all those without as much less symbolic capital than I have.
And here is the researcher bit. Almost daily my Twitter timeline shows statements about communication skills, empathy, shared decision-making and, I’m sure, other things medics are supposed to do when they communicate with their patients. And I cannot remember a single tweet or article (I’m not claiming there are none!) which wonders about what happens before you get the chance to lean forward when you talk me, as, I wrote some time ago, great communicators lean forward. This is because before you get to communicate with me, I must actually come along.
For me the issue is one of the channel of communication. Apart from all those skills that doctors are taught, communication must be physically possible. In other words, the communication channel refers to the physical medium (like a wire, for example) along which signals will be sent. Moreover, in order to establish the channel, one needs a sender and a receiver of the signal (that’s the very basic model of communication by Shannon and Weaver). And so, if you phone someone, the signal from your phone must be physically delivered to another device and then that device must be operated. If the network is down or nobody answers your phone, you can talk till you’re blue in the face, but you will still not be communicating.
And here’s my issue. What if the patient doesn’t want to communicate with you, doctor? But before you say that’s not a communication issue, it’s one of the myriad reasons why people do not seek help (for example, men tend to seek help less frequently than women), I disagree. I don’t want to talk to you. I don’t want to engage in the verbal battle, it takes too much energy and respect I still have for you. So, this is entirely a communication issue. In other words, clinical communication is not only about what happens when I sit down in front of you. Communication is also about whether I communicate with you in the first place.
I also reject the idea that a doctor with good ‘communication skills’ will not have problems like that. In fact, there is nothing more irritating for me than seeing a doctor use the skills they learnt on a communication skills course. I see too many of them, all are irritating. It’s also harder and harder not to comment on your comfortable armchair as you relax in it, thinking that just because I haven’t made a snide comment, I’m fine. Sometimes, I’m just beyond caring.
There is a joke about diplomats. A diplomat is a person who will tell you to go to hell in such a way that you will look forward to the journey. I wonder whether you could make a similar joke about doctors. Something like a doctor is someone whose pained expression makes you want to care for her/him. So, no, the empathic pained expression doesn’t do it for me, either.
And here is the fundamental issue I would like to pose for all those communication skills trainers and trainees. What do you do to make me feel that I want to communicate with you in the first place? What do you do to make me think that I want to open the channel of communication? Put differently, do you spare a thought or two, doctor, on that I (your generic patient) might not want to communicate with you. That I don’t open the channel of communication with you because I keep wondering whether communication with you will be more costly than beneficial to me.
And so, as I keep coming the same inevitable conclusion that you don’t wonder about it, I move on and wonder whether I can make any suggestions. On the one hand, I could say again that there are things that you should never say to me (I have written about them in this post). You know things like: “Why are you looking for an illness?”. But this is too tokenistic for me. On the other hand, I can also say things like “you must listen to me” or “you must not reject what I say”. But these are platitudes which are as irritating as they are nauseating. If I really need to tell you these things, I actually don’t want to talk to you in the first place.
And so, this is a blogpost which will end in hopelessness. I don’t think there is advice I can give you. The only thing I can suggest that you might want to have a conversation (I described one such conversation here) with me. It’s refreshing when doctors don’t preach, don’t judge, don’t undermine, don’t speak with certainty they can’t afford, don’t behave like gods, don’t patronise. But I do know, it’s extremely difficult. After all, you have so many more things to worry about, being a human being might be a step too far.
So, I think I’ll wait some more. But when I decide to go, I might tell you why I waited so long. That will surely go down like a dream.