Talking to patients

TAUREEF MOHAMMED

TALKING TO patients is part of being a doctor. Some doctors – like GPs, paediatricians, geriatricians, palliative care physicians, psychiatrists – are required to talk more than others. The conversations are usually pleasant. But I’d be lying if I said they were always so.

Sometimes, they can be unsettling: like that time I had felt I was being cross-examined by a patient’s relative about a clinical decision I had made. Other times – like those midnight conversations about life and death, and uncertainty – they can be arduous. Rarely, the conversation can spiral into abuse. There are, of course, the lighthearted conversations, made so by our combined humanity.

But whatever the circumstance, whatever the prognosis, whatever the patient’s beliefs, suspicions, political views, state of mind, we talk, and, in 2023, that’s an accomplishment.

In an essay last month in The New Yorker magazine, Hua Hsu, writer and professor of English, looked at the art of conversation and how it has changed over time. “Our culture is dominated by efforts to score points and win arguments. But do we really talk any more?” the sub-headline asked.

In his essay, he highlighted the work of Paula Marantz Cohen, also a professor of English, who argued that we have become less adept at conversation. “In past eras, daily life made it necessary for individuals to engage with others different from themselves,” she is quoted as saying. “Nowadays, she (Cohen) argues, we are sectarian and 'self-soothing,' having fallen out of such practice,” Hsu wrote.

Describing “true conversation,” Hsu added: “In its ideal form, it involves no audience or judge, just partners; no fixed agenda or goals, just process.” Good conversation was worth it, he wrote, pointing out a study that showed people who engaged in good conversation reported higher levels of satisfaction.

What about conversations at the bedside or in a doctor’s office? How have they changed? And are we talking more or less?

Treating patients requires us to have true conversations. The doctor-patient relationship thrives on good conversations, not on smart doctors nor obsequious patients. Bad conversations lead to bad decisions and, in the end, everybody loses out. At the bedside or in a doctor’s office, we cannot afford to talk less.

The covid19 pandemic brought this reality to the front. With all the information and theories that were shared, with people getting sucked in by online algorithms that functioned on beliefs and interests rather than accuracy and reliability, it felt as though the doctor-patient relationship was being threatened. Consequently, some bedside conversations became laborious, but they happened. Unlike WhatsApp, there was no easy exit; unlike social media, there were no points to score.

A conversation from that time, which I had witnessed, stands out as an example. I was working in a kidney transplant clinic and Mr X wanted a kidney, but not the covid19 vaccine. He trusted science for the transplant, but when it came to the vaccine, hearsay trumped science.

At the time, the Ontario hospital had a policy: no vaccine, no transplant. The nephrologist had the option to dismiss Mr X – one less name on a long waiting list. Instead, they spoke – there was “no audience or judge…no fixed agenda or goals, just process.”

It took time, but in the end, conversation triumphed, the web of misinformation was untangled, and Mr X agreed to get the vaccine and was placed on the transplant list. The doctor had to compensate for the spread of misinformation by talking more.

Pandemic and misinformation aside, the widespread availability of reliable information has also produced more talk at the bedside. The traditional, paternalistic conversation, where the doctor spoke and the patient listened, has been thrown into the dustbin for good. Instead, conversations now take place on a more equal level, with patients feeling more empowered to actively participate in clinical decision-making.

I see this especially among patients who have lived with chronic, irreversible diseases for years. Many such patients actively participate in online support groups, and scour the internet for the latest research on their conditions.

Recently, I saw a patient with Parkinson’s disease. He told me about special silk sheets that made turning in bed easier. I asked him where he had heard about it. “A Parkinson’s group on Facebook,” he said. “Good for you. It’s the first time I am hearing about it,” I said. “Happy to teach your something, doc,” he replied.

Good for him, and good for me.

Taureef Mohammed is a graduate of UWI and a geriatric medicine fellow at Western University, Canada