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Patient Communication Blunders


A physician looks back on some recent patient communication mishaps, sparking an internal debate on how they make her feel about her profession.

There's an episode of Parks and Rec in which the main character, Lesley Knope, encounters a recalcitrant voter during her political campaign for city council. The voter, a blue-collar man from her town, just doesn't like her, despite her crazy antics to win him over. I felt like that today.

One of my patients this morning was new to our clinic and came in with abdominal pain of rather sudden onset. I reviewed her chart before her visit. I took a careful history and updated her medication list. I did imaging and appropriate lab work. Once I had the diagnosis, I discussed it with her and prescribed medication, even discussing a couple of different treatment options. I left the visit feeling confident that we had a good visit and the patient felt well cared for.

Ten minutes later, the patient was at our clinic's front desk, reporting that I had misdiagnosed her. I offered to have her come back to the exam room to address the concerns or to see a colleague if she wanted a second opinion. Opening the electronic health record, I re-read my notes and double checked the imaging results. I took a mental inventory of the visit to make sure that I didn't miss anything. The patient ultimately decided to try the treatment I prescribed and "see what happens." Needless to say, I probably felt as uncomfortable as my patient.

Truthfully, these are the moments I hate being a doctor. There is a level of uncertainty in many of the patient cases I see. I have become comfortable with that over time, as I recognize that medicine is an inexact science. Patients are generally less comfortable with this, a point I very much sympathize with, especially when I am a patient myself. Enter the art of medicine – working with a patient in a way that you convey confidence amid uncertainty, being honest without causing undue concern. I believe that I usually do this well, but not always.

I had another patient today in which I was pretty sure of the diagnosis, but not 100percent sure. I recommended that we do a lab test that, while not diagnostic, would be additional information to help me make the diagnosis. I ended up confusing the patient who couldn't understand why I needed to do a lab test that could be normal even in the presence of disease.

I have found over time, as I become more experienced with medicine, that I spend an increasing amount of my time with patients carefully considering not just the diagnosis and treatment but how to explain it to the patient in a way that is neither paternalistic nor overly familiar, informative without being too complex, and decisive without inhibiting dialogue.

Sometimes I do a great job. Sometimes I don't. Sometimes I'm aware that I haven't done a good job, but I am not sure how to remedy it. Sometimes trying to remedy it makes the situation worse. And sometimes, I just have to accept that I am an imperfect provider of an imperfect science.

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