A medical student blogs about thinking as a physician


Category : General, Medical Rants

A Medical Mind (the link takes you to his entries – I am commenting on his Dec. 25th post).

The point is, I am sure that a barrier must be crossed to ‘know’ about patients and medicine and science, I am just a little unsure about when that will happen. I know that I have never really understood the science behind what my physician was saying to me, so I could never fully understand the complexities of each decision that he makes. However, when will that time come for me? I know everyone else thinks that time has already come – I can explain many things that they ask. However, when will I cross the barrier of knowledge?

As Anthony matures as a physician, he will face a major challenge. How do you as a physician explain diagnostic tests, treatments and diagnoses in terms that patients understand?

As physicians, we have an obligation to “break it down” into understandable terminology. I spend much time on rounds developing analogies of disease so that patients will understand what we mean.

A good exercise for medical students is to explain medical concepts to those who do not really know medicine. Practice on your friends (when they ask questions – nothing duller than a medical student talking about medicine when not asked). If you can explain things to them, then you will have an idea of how to explain things to patients.

Now for a quick practice session. Explain these 3 concepts in “laymen’s” terms.

Coronary artery stenting
Beta blockade
Osteoporosis and its treatments

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Comments (6)

Part of the problem in physician-patient communication is the lack of understanding by the physician of what the patient “knows” or “wants to know”. This requires initiating the conversation and taking the time for the patient to explain. Once this is completed, further communication in education of the patient regarding medical facts and issues is facilitated. Physicians should start with the request “Tell me what you know about…” and then “Tell me what you would like to know about…”. This will show what understanding represent valid facts and what understandings need further education. Finally, the physician will learn what the patient’s personal concerns are about the facts or issues. Unfortunately, there are physicians who don’t take the time or are aware of the need for such conversation. They will proceed with a standardized disclosure, hopefully meeting the informed consent criteria. But without the initial conversation described above, one should not be surprised that patients don’t understand nor remember the facts. ..Maurice.

I’m curious, do doctors have problems with their own PMD talking down to them as if they were laymen? I would guess it has to happen occasionally, with a new doctor who doesn’t know what you are, and I know it happens to nurses, since I’ve talked to them about it. I find it very frustrating, since they go on explaining things and I want them to just cut to the chase.

I don’t think there is any problem with doctors talking to their doctor-patient as if the patient was any patient without an M.D. The same questions I posted previously should be asked the doctor-patient. The real problem when a physician does NOT communicate to the doctor-patient as a layperson patient is that there will be increased chance of invalid assumptions made by both parties. These assumptions may lead to defective treament and care. Critical questions and issues involving emotions,sex,drug and alcohol abuse may not be obtained or discussed. Explanations by the physician to the patient become cursory and incomplete. “That doctor-patient should already know about this!”

When I have been a patient, I look forward to the doctor who will ignore my M.D. That is my best chance to get properly treated. ..Maurice.

Thank you maurice.

Many people go into an MD already quite informed about an issue, especially if it a long standing condition. They may have ideas of how they would like to be treated that the MD may not agree with or possibly is unfamiliar with. By simply asking them what they know it might give the MD a more valid understanding when discussing future treatment options. It becomes a discussion as opposed to a dismissal.

Have you guys considered putting dryerase boards in your exam rooms? I find lots simple drawings is a good start in chemistry, biochemistry. or anatomy. You may find that some patients are visual rather than verbal learners. Retention of the information you give them will be better if they see pictures-handouts, drawings. They will quickly forget things they are told. Just a thought.

I agree with Tina, using pictures of one sort or another would go a long way to explaining things. And giving patients a handout or brochure to read will help them retain information a lot longer.

And, as much as possible, don’t use the Latin name for a body part. You can say femur or you can say thighbone. With one of these, you are sure to make yourself understood. The more medical terms you use, the more confused (or intimidated) a patient is likely to be, and the less likely they are to volunteer information that you may need to know to treat them properly.

On the other hand, if someone has had a condition for a long time, they may be familiar with the relevant medical terms, so you could ahead and use them.

These comments are almost comical. Come out of your ivory towers and remember the time before you were a physician. When you speak to your patient, it is a no brainer to use “laymen” terms (short for talking to them like real people…like you spoke yourself before going to medical school), as well as using pictures and illustrated handouts. Just remember to have someone who is an expert in general and health literacy review your handouts for appropriate litercy levels first.
I like the recommendation to place grease boards in the exam rooms; also having your hospital place them in the patient rooms is extremely helpful.
Patient education is not the difficult to achieve, sometimes we make things harder then they have to be.

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