You might remember a children’s game from long ago called “Telephone:” Someone thought of a message and whispered it to the person next to them, who whispered it to the person next to them and so on. The last person would repeat what they heard out loud and it was always met with giggles and shouts because it rarely bore any resemblance to the initial message.
In effect any time we share information, there are two things in play: not just what we say, but also how the listener hears/interprets it. In theory it’s the responsibility of both parties to make sure that “communication,” a shared understanding, has occurred, but in the case of giving our medical history there are some very real barriers to that happening.
What gets in the way?
- It takes time to get to know each other.
The average medical encounter is about 15 minutes; a new appointment maybe 45 minutes. This is slightly more than a speed-dating encounter but it can still feel like one; perhaps enough time to form an impression, but not enough time to be assured there’s a connection.
While there’s a lot of debate about the value of annual physical, there’s no question that a brief encounter with a doctor adds stress to the communication conundrum. Having an ongoing relationship with a doctor at least means less of a speed dating encounter and potentially some context when a patient shows up with a problem.
- Our bodies and their inner workings are mysteries to most of us.
The fact that doctors understand how bodies work conveys an unspoken intimacy that a doctor knows more about how our bodies might be working (or not working) than we do. We assume doctors just get what we’re telling them.
Doctors aren’t mystics or mind readers. We have to challenge our own belief that a doctor can magically intuit what’s going on with us without our thoughtful input.
- The power dynamic between patients and doctors doesn’t always lend itself to patients questioning their doctors.
Let’s face it, many doctors make the assumption that patients are mind readers, too.
I’ve seen a small number of doctors ask a patient to repeat in their own words what has just been explained to them. This is the gold standard of assuring that communication efforts were achieved. But if we’re not invited, many patients are uncomfortable challenging that authority, taking the time in what is already a pressed interaction, or admitting they didn’t understand.
As patients, asking if we can repeat back what we think we heard challenges the assumption that patients magically understand what their doctors tell them. It takes guts but it can make a difference.
- There’s a language barrier.
Many doctors and healthcare practitioners work hard to speak plain English with us, but here’s the reality: Medical-ese is their every day language. It’s interesting, though, that when someone can speak “medical” with their doctor often the entire communication dynamic changes. It seems easier for the doctor to tell the patient what they’re thinking and questions are asked and answered more easily.
But this isn’t true for most of us. Just as non-native English speakers have to work extra hard to find the right words when they’re speaking English, the same kind of internal translation is necessary for doctors when they’re speaking with us. Slipping in a medical term here or there might go unnoticed by them, but I’ve seen it upend a patient’s understanding of what a doctor is trying to tell them.
And then there’s that issue of not confirming that we understood what was just so carefully explained.
- The medical record is the source document (the originating document) of the “facts” of our situation. And sometimes it’s wrong.
With patient portals readily available now, many times when a patient reads their doctor’s notes after a visit they’re surprised to see information recorded that wasn’t at all what they believed they said to their doctor.
It’s that “telephone” game thing. But if our medical record is the basis for members of our medical team to interact with us, there are many circumstances where it’s vitally important to make sure that it’s an accurate accounting of our situation.
What do you do if there’s an inaccuracy in your medical record? How is it corrected? How might these kinds of errors be prevented? Watch for our next issue for Part 2 of this series.