Laziness? or the best medical student ever?

"In a recent study, Johns Hopkins researchers followed two groups of medical interns for a month and found they sat down at the bedside only 9 percent of the time.

Sitting down, which would seem like one of the simplest things to do, is the least practiced of five communication skills for doctors that Lenore would have endorsed and that research has shown can make a big difference in patient satisfaction."

I smiled when I read this. One: it harkens back to the thesis I wrote in undergrad about how important body language can be in patient-doctor communication. Two: I am the laziest person I know.

I will sit on anything. I have, on occasion, left a patient's room to grab a chair so I could sit down while talking to them. Standing? I don't have time for that. If I get five minutes off my feet, I am going to take those five minutes.

A lot of the times I feel like I get lucky a lot when I'm interacting with patients. I've had very few bad patient encounters, and a lot of times I get patients personally thanking me for being so kind. I wonder how much of this has to do with me being "lazy", not trying to be overly professional.

Anyway, you can read the rest of the article "5 Simple Habits Can Help Doctors Connect with Patients" at http://www.capradio.org/news/npr/story?storyid=261398048

A Slave to One's Emotions

On a recent episode of The Daily Show with Jon Stewart, the guest was Michael Fassbender and he talked about his experience on the set of "12 Years a Slave." It's apparently an intensely emotional and raw movie adaptation to an actual book written by an actual person in the 1800s. Fassbender, who is hella white, plays a supporting role as the incredibly cruel plantation and slave owner. Of this experience, and how he dealt with having to pretend to be a terrible person for most of his days, he said this:

"I mean especially when you're dealing with such heavy material it's nice and necessary sometimes to have light moments in between so it doesn't become all the time heavy and you get [blinded]....
so the moments you can find relief and respite you do, and other times that require it, you stay in the moment as it were."

I think this quote describes how I deal with working in hospitals. You're surrounded by so much of what is disgusting with humanity: pain, deception, corruption, death; so much unabated suffering. On the one hand, I'd like to live in the moment and experience the pain my patients suffer with them. But on the other hand, if I did that with everyone in the hospital, I'd be so drained every day that I don't know if I could function. Both of my parents are hilarious--albeit in different ways (one's abstract, surreal humor; the other's just dark and sarcastic)--maybe that's the only way they survived medicine for the decades they sacrificed to it. 

But on the other hand, I'd like to feel with my patients so that I never stop working for them. When I turn patient's into little anecdotes, I stop caring for them. When I just stare at their assessment statement and their labs, I forget that they are people who may lighten if I go talk to them, who may benefit when I hold their hand. 

How Doctors Think

In anticipation for orientation, I've been reading How Doctors Think by Jerome Groopman, MD. It was interesting, and I was immediately compelled to finish the 200+ page book after he references and quotes Judith Hall and Debra Roter in the introduction. Hall and Roter are two researchers who have looked extensively at doctor-patient interaction and communication styles, and I referenced them a lot in my Rhetoric thesis that examined communication in health care. The book was eye opening in that it did a great job of informing the reader about which types of cognitive errors bias the way doctors treat their patients. Absolutely fascinating. I've always found that understanding logical fallacies allows you to deal with people and to make sense of complicated situations. To know that there are several logical fallacies that even well intentioned doctors make frequently is reason enough to write an entire book.


I have two concerns with Dr. Groopman, however. First, he seems to be praising all the doctors he talks about (with a few exceptions). I wonder if it would be more useful for people to know how bad doctors think more so than to understand how competent doctors deal with diagnoses, because sometimes you aren't given the liberty, although you should have it, to choose your clinician for yourself.

My second concern is more insidious and/or uppity. Paternalism. It's clear that Dr. Groopman is against it. He is quick to praise a few doctors who unbiasedly talk to their patients in order to make sure that their patients choose their treatment for themselves and aren't subjected to being helpless to control their own medical destiny. But Dr. Groopman has a severe pronoun problem. Even though he talks about two or three excellent female physicians, he always refers to doctors as hes. And I guess that wouldn't be unforgivable, because grammatically he can be used as a gender neutral pronoun, even though it no longer carries that meaning for most readers. No, what makes it unforgivable is that he often refers to hypothetical patients as shes. He even ends his book talking about this hypothetical patient, and how she is adding vigor to the clearly sexist clinic by being an expert communicator and able to understand her male physician's every thought.

Gross. When the movement began to minimize paternalism in the clinic beginning in the 1970s, paternalism was symbolized by the interactions women had with men in that time. Women don't make decisions. They let their husbands decide for them. Because men and doctors generally have an elevated standing in society compared to women and patients respectively, this visualization makes sense and should strengthen a progressive individual's will to end clinical paternalism at all costs.

Though the insight that Groopman has into clinical practice makes it easy to forgive him. Also, the fact that he's in his sixties or seventies and trained during a much more... sexist time, makes it a burden, but an acceptable one, to not get overly upset and just take value where there is some and ignore the rest.

Debra Roter and Judith Hall are two excellent female researchers. They have looked into the differences in communication styles between male and female physicians and are aware of the challenges facing women in health care. I wonder if they, after reading Groopman's book, noticed this slight rhetorical misdeed, or just conceded that there are some minor injustices you just have to accept.