Patient Speak

        At least for a country doctor, it is best to use patient speak, as opposed to doctor speak, when you talk to your patients.  I found this out early in medical school on daily rounds.

        Sometimes the attending would come in the patient’s room with a big entourage, and speak “at” the patient, instead of with them.

         “Mr. Charles has an ejection fraction of twenty-five, but minimal peripheral edema, and no jugular venous distention.  His current respiratory compromise is more likely on the basis of his obstructive pulmonary disease.  I would pursue bronchodilators but not at the expense of diuresis.”  This would go on for a few minutes, and then the attending would wheel around and  walk out the room, his entourage right on his white coat-tails.

        As the lowly med student we were left behind to get our history for the day.  I sat down to listen.

        “Hey, Doc,” said the patient.  (I was just a med student, but even at that stage, I had come to cherish the title and respect the obligation that went with it.)  “What wuz he talking about?”  He handed me a can of Planters.  “Care for some nuts?”    

        “You better leave these with me, man.  That salt’s gonna swell you up.  Makes the water build up in your lungs.”  I sifted through the can for the cashews.

        “Really?” 

        “Yeah, no kidding.”  I handed them back.  “I ain’t gonna take ‘em all, but you better go light.  They can go against you.”  You’ve got the head of your bed up, you having much trouble sleeping?”

        “Yup, I can’t lay flat Doc, sure enough.” 

        I checked his chart.  “Looks like you didn’t pee much last night.”

        “Shoot fire, I told that nurse I needed that water pill, they didn’t give me one.  It was right at shift change.  I think she had boyfriend troubles.”

        “Tell you what, let me call the intern and see if I can make sure you get it today.”

        We got him the missed diuretic, and the breathing treatment recommended by the professor on morning rounds.  By that afternoon, the patient was better.  The attending was pleased, and everyone complimented him on his brilliance.  (Rule number one in med school- always make the attending look good if you want to graduate.)

        All this talk about patient speak reminds me of an old story that came out of out of Hawthorne Gray School of Medicine.  It is apocryphal, but makes the point.

       An old country preacher had prostate cancer, and wanted to get his treatment at the medical center.  The attending saw him, and recommended surgery.  “Reverend, in the morning we are going to proceed with an orchiectomy.”

       “Doctor, whatever you say is fine with me. You doctors at Hawthorne Gray are the best doctors in the world.  I trust you, and will do what you  recommend.”

        “Excellent.”  The Professor handed the patient a consent form, and the preacher signed it.

        The resident was not so certain the Preacher got it.  “Preacher, I want to be sure you understand.  In the morning, they are going to remove your testicles.”

         “Whatever you doctors say is fine with me.  You doctors at Hawthorne Gray are the best doctors in the world.  I trust you.”  The preacher handed the signed consent form back to the resident.  “I am ready.”

        The doctors left.  The med student was worried. He was not at all sure the preacher got the message, and decided to speak to him one last time.  He pulled up a chair.

        “Parson, (the med student was a bluegrass boy) I want to be sure you heard them right.  In the morning, they’s gonna cut your balls off.”

         “The Hell they are!”

        In my line, as country doc, I gotta go with patient speak over doctor speak.  I sure don’t want to be misunderstood, especially over such an important issue. 

Dr. B

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8 Comments on “Patient Speak”

  1. amberfireinus Says:

    Dr. B,

    That is so true! I can’t tell you how many times that patients get compltely confused as to what the doctors are saying. I literally find myself translating as though it were another language for my mother and brother or whoever to tell them what my or their situation is.

    I saw a very interesting article that you might find of use. A heart surgeon found that the tone of voice that he used with the patient produced healing results! He gave them the news in an upbeat way. Told them how great they were doing. He believes him and they get better.

    I also have to say that I have had my share of battles of knowledge with doctors who didn’t know what the hell they were doing. What they don’t get is that I have been studying MY disease for 10 years. There is not a journal or article regarding the subject that I personally have not read. So when I have been faced with doctors who give me the God routine, but really don’t know what they are talking about, I have to admit that I am forced to teach them….. in more ways than one. They try to give me the doctor’s speak, and are shocked when I can give it back to them! Then I start to go through the history in depth, my latest test results etc. Did I mention I HATE being patted on the head?

    I think that approaching a patient is really so important to how well they fare in their journey. A doctor can either be healing in his manner, or distructive… just with his words and actions to you.

    Patient speak and remembering your own humanity is the only way….

  2. drtombibey Says:

    Ms. Amber,

    Every once in while the thing does work in reverse. For example, one time I told a patient I wanted to get a heart tracing on her, and she said it would be O.K. to do an electrocardiogram.

    She was an I.C.U. nurse!

    It was something I shoulda known but I dropped the ball on that one!

    And I think you are right. Much of medical knowledge has not unfolded yet. Many of the answers are still unknown. While all that is going on, the least we can do is treat people with respect and dignity.

    Dr. B

  3. Ted Lehmann Says:

    While you’re at it, why not string up all the people who write forms (consent, insurance, tax, or any other you choose) by the same appendage your Parson patient was going to lose? How can any of us, even the most educated, expect to understand that stuff? No wonder we live in a service dominated country. The largest service industry is Consultant. And what do consultants do? They read forms and tell us what they mean and then charge us to fill them out for us. What a world! – Ted

  4. drtombibey Says:

    Amen Brother Ted.

    On my last day as a Doc, I am going to do a Cub Scout physical on some kid, fill out forms in triplicate, have four people on staff to process it all and explain to the insurance company why it was necessary to do one two days early, document it perfectly, right down to whether or not he will use the politically correct softballs at camp, charge $4000 for what I used to do on my porch for nothing on Sunday night ’cause the parents forgot to bring the paperwork to the office, and then go home, ’cause I won’t really be doing anything anymore.

    Dr. B

  5. Fran Rizer Says:

    Dr. B,

    Today’s column should have hit a familiar chord with everyone who’s ever been to a doctor. Fortunately, the physicians I’ve seen have been willing to explain when I say,
    “Run that by me again,” in that strange, doubtful tone we sometimes use.

    Wanting to do the $4,000 exam on your last day before retirement reminds me of what I always wanted to do. As a teacher, we were never allowed to leave the building during the school day, even for lunch on inservice days, without permission from the office. I always felt that as a professional, working alone in her room, on that day, it would be nice to be treated like an adult.

    On the last day I worked, two days after the students finished for the year, after all my check-offs had been completed (had room inspected and turned in a hundred or so forms along with the classroom keys), I walked out the front door, got into my car, drove two miles away, picked up coffee, and returned to the school for the remaining three hours of my teaching career, which I spent visiting with other teachers and sipping coffee. The world didn’t end. I felt totally wicked and loved every minute of it.

    The day my sons’ pediatrician retired after about forty years’ practice, I went by just before the doors would be locked for the final time. The doc was sad and wanted to talk. I had a seat in his private office and we chatted until one minute after closing time. When the minute hand moved on the clock, he reached into the bottom of his desk drawer and pulled out two plastic cups and a bottle of high-dollar bourbon. We toasted the many years he’d taken care of the children.

    As I said the first time I commented, I love your blog. The more I read it, the more eager I am for you to write that book you’re planning, so that I can read it. You asked for more info on mine. The title is Hey Diddle Diddle, the Corpse & the Fiddle by Fran Rizer. ISBN 978-0425220917, published by Berkley Prime Crime division of Penguin, USA. It’s available through Amazon.com and all major bookstores. If your local B&N. Books a Million, Borders, Waldens, or independent bookstore doesn’t have it, they will order it for you The price is reasonable – $6.99 for a paperback.

    I love hearing from readers. The first chapter is posted on my website – http://www.franrizer.com, and I’ll be posting some of my older bluegrass photos on the site in about two weeks. There’s a place to e-mail me directly on the webpage.

    Thanks!
    Fran Rizer

    I had a great time writing this book because it brought back so many memories from bluegrass venues

  6. drtombibey Says:

    Hey Ms. Fran,

    I love your retirement stories. I am am semi-retired at this point and gonna hold on for now, but these are great vignettes on the frustrations of work nowadays. We sure have made it difficult to do any good in this modern world.

    Thanks so much. Y’all, Ms. Fran is a real writer- I have seen her work in Bluegrass Unlimited.

    Tis an honor to have your comments. One of these days, I’m gonna get with you and get an autographed copy of your book.

    Dr. B

  7. mrschili Says:

    When we get right down to it, our whole lives are about communication, aren’t they? Either we do it right or not – how happy and well we are depends on the percentage of the former.

  8. drtombibey Says:

    mrschili,

    Communication is certainly the ticket as a Doc, and I’m sure it is for a teacher also. I suspect it is so for most other professions, too.

    Dr. B


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