Errors in Communication

Medicine has provided me with a myriad of challenges that have certainly changed the way I live my day-to-day life. At first it was subtle; the words I used, the hours I kept. Then it became more dramatic, changing the way I look at people.

Medicine is all about observation. From the second they come in the door to the start of the physical examination you want to learn how a disease process affects a person's behavior. Some doctors claim they can make diagnoses just by watching the way someone walks, or how they speak. Sometimes pathology will only present itself as understated hints that will only become evident to the keenest observer.

This skill, however, has diminished others, namely, the art of conversation. Most physicians will claim they posses superior interview skills - knowing the right questions to ask to arrive at the diagnosis. I think, though, that physicians only know how to question the pathology, and forget the person all together.

The supermarket is somewhat overwhelming as your learning about medicine. You see products and people and judge (yep, the j-word) what people buy based on their appearance. You think to yourself, that person probably has the metabolic syndrome, why are they buying all that soda? Or, how could that guy with the horrible cough buy a carton of cigarettes? I swear I've diagnosed my neighbor with chronic bronchitis (a cough productive of sputum for over three months' duration during two consecutive years and the presence of airflow obstruction) by listening to the perpetual dry hacking cough for the past three years.

There lies the problem. Bronchitis, diabetes, obesity, hypertension. Not, Jane the 30-year-old chef who works 12 hours a day to make the rent. Or bill the truck driver who has to grab his meals on the go so he can get across the country on time. I've been taught, slowly over the past three years, to ignore a person's character and instead label them with an illness.

I don't know who's to blame. Part of the excitement of being a doctor is seeing what others can't see and helping them get better. You can ask any doc about a case that made them feel like they actually "saved a life." Helping people, after all, is one of the big reasons people become a healthcare professional. But with my head in the books, I've been losing my people skills. I learn to identify the pathology and not to understand the person.

This is why primary care suffers in America. Sure we have a pill for diabetes, and I can lower your blood pressure, but without an understanding of the behavior that leads to the disease, I can never truly "cure" these chronic conditions.

I understand that a complete overhaul of how doctors think is an insurmountable task. But maybe, just maybe, we can change how we talk with patients. Maybe we can spend a little more time getting to know the person, and looking past the pathology.