Day 3: Communication 101

Being a doctor is about communicating information that is nowhere near common knowledge in a way that makes sense to people who have never read a medical textbook.  It is tough.  It takes a lifetime to even consider being remotely competent in this skill.

I had the chance to go through the communication workshop last year which made this year slightly less nerve-wracking.  While I felt like there were areas I did better in, there is still so much that I can learn and work on.  The underlying theme though, in most cases, is "less is more".  Less in the sense that, there is only so much a person can process at any given time.  There is a way to provide difficult information so that people are given space to absorb and process.  If it takes us 7+ years of training to even be allowed to work as independent physicians, why should we expect our patients and their families to be able to hear, process, analyze, and decide on some of the most difficult decisions in their lives in less than an hour?  It's selfish and cruel.  I can't imagine many people go into medical school saying "this is all about me; forget the people I'm taking care of; they only matter if they do what I want them to".  And yet, that is almost what we do when trying to make people make life-altering decisions in a blink of an eye.  On top of that, we forget to give them the respect of getting to know them and what's important to them before dropping bombshells of information on them.

The challenge of this year will be disseminating the message that a palliative medicine consult isn't about "getting the DNR" or "making someone hospice".  It's making sure people are informed to the best of our ability and provided recommendations on further treatment based on their hopes and goals.  Emphasis on the Patients and their Families hopes and goals, not ours as the team.  Our agenda is second to what is best for the patient and family.  And especially if the patient isn't able to communicate and it falls on the family to speak for them, the family needs to be comfortable with each step.  If they're loved one dies based on the decisions they made for their loved one, they need the peace to know that any decision they made was in their loved ones best interest.  We move on to the next living patient, the family's world stops turning for some time as they cope with the loss of someone important to them.  Our hope is that we were able to guide them through the complicated decisions to a place where in their grief, they know that did everything their loved one would have wanted for their medical care.