Talk to the Doc

LET ME MAKE THIS PERFECTLY CLEAR…

Or maybe not so perfectly. How about adequately?

It should come as no surprise when I tell you that I love languages, especially English. My mother was an English teacher who once told me she'd rather I become a streetwalker than misuse the English language. I'm sure I'd have earned a whole other maternal lecture if I had become a streetwalker, but Mom's insistence on clear written and spoken communication was one of her greatest gifts to me, not just in my writing but also in my business career and social relationships.

Despite all that, I've had many frustrating encounters with other English speakers who couldn't seem to grasp my meaning no matter how plainly I felt I had expressed it. That's because effective communication involves more than facility with words. This truth came home to be during a lengthy, complicated business negotiation with the owner of a Japanese manufacturing company from which my employer bought steel components. Mr. Hota brought his own translator, but I suspected that he understood a fair amount of English because he sometimes replied to me (in Japanese) before his translator had begun to translate what I'd said. Mr. Hota was calm, his face perfectly blank, he spoke no English, and I spoke no Japanese; we met in my company's conference room, not his; and yet somehow he was gaining the upper hand in a negotiation worth $3 million. When I told my boss, "I can't communicate with Mr. Hota," he said, "Yes, you can, but not necessarily with words."

Communication can be difficult even amongst people who share a native tongue, be it English, Japanese, or Urdu, with results that range from comical to frustrating. When the other person is your doctor and 5 minutes of his/her time cost $200-$300, and your own most puzzling questions or symptoms are the topic of discussion, frustration can turn to fury. But what do you do with that fury? The doctor is an authority figure, an expert whose advice or care you urgently need. You could say, "That's it. I'm outta here!" and flounce out of the office. If the doctor were an automobile mechanic, it probably wouldn't be too difficult to find another mechanic to help you, but finding another doctor who's qualified, accepts your insurance plan, is taking new patients, and can give you an appointment sometime in the next decade….? That's not so easy.

WHERE DO WE GO WRONG?

Because of my interest in communication and my part-time retail job, I could tell you dozens of stories about communication problems. While I began this article complaining about people who can't seem to understand even the simplest sentence I utter, I could also complain about people who can't seem to make me understand the sentences that they utter. The fact that I'm hearing-impaired makes clear communication all the harder, but I can provide living, breathing witnesses to some of the funny and frustrating encounters I've had with customers at the department store where I work. I’ll do almost anything for a laugh, but when the communication is between you and your doctor and your health is at stake, the miscommunication story is not so funny, is it? So just whose fault is the failure to communicate? Yours, mine, your doctor’s, or Alexander Graham Bell’s?

SHOW & TELL

Back in the Stone Age when I was in elementary school, we had Show & Tell Days. Betsy (future veterinarian) showed us her hamster and described what he liked to eat. Joey (future geologist) showed a large piece of quartz he'd found and described what he'd learned about how it was formed. Jeannie (aspiring art teacher, future author) showed a potholder she'd made and gave a fascinating and heartfelt lecture on how to weave a potholder. Paul (aspiring magician, future attorney) showed us a card trick he'd learned.

As grownups, when we go to the doctor "presenting" (as the docs would say) with a symptom, we play an adult version of Show & Tell. If we have a rash or a bruise, we can easily SHOW the doctor what's wrong. But often the problem is invisible, even to x-rays and blood tests, and sometimes a rash is only the tip of the medical iceberg. In that case, the TELL part of our presentation is extremely important. Our doctors are not mind-readers, their patients are each unique, and graduating from medical school does not automatically make a person perfect or infallible. As far as I know, there are no sensitivity training classes or even bedside manner courses in medical school. So we patients are trying to communicate and connect with a scientist, not a fortune teller.

Communicating with doctors is a special interest of mine because of the extremely frustrating experiences I had while seeking a diagnosis and treatment for my chronic pain. It seemed to me then that my vaunted communication skills were completely ineffective when I was standing or sitting before a scientist in a white coat. I was slow to realize that many of the docs I consulted viewed me with suspicion because of my communication style. They distrusted me because I had "inappropriate" knowledge: how to pronounce medical terms, the correct names for various parts of my body, and the names of medications commonly used to treat symptoms like mine. I tried different approaches, different communication styles, as I went from one doctor to the next, until finally I found one who was at least willing to hear me out before passing judgment, and whose subsequent treatment of my pain has been very effective in no small part because of the way we interact.

WHEN YOU TALK TO YOUR DOC

On the face of it, communication is a simple process. It consists of a message, the sender of the message (who encodes the message), and the receiver of the message (who decodes the message and gives feedback about it). All three of those components have to be functioning in order for communication to take place. This is why I once got spanked for asking my father for $5 while he was asleep, then helping myself to his wallet: he neither heard my message (he was snoring too loudly) nor gave me feedback about it (permission to take the $5).

While communication is a two-way process, you can only control part of it, so when you talk to your doc, it’s your responsibility to phrase your message clearly (and politely). If you have trouble expressing yourself to your surgeon, consider bringing a more eloquent friend or family member with you to appointments. When you think of questions in between visits, write them down immediately, and bring your list to your next appointment (or telephone conversation). It is always OK to ask members of your bariatric team about anything at all about your weight loss surgery (questions, concerns, problems, symptoms, side effects, complications, frustrations, and even opinions), but don't expect answers to things like, "Are you a Republican or a Democrat?" If you're not sure if your question is related to weight loss surgery, go ahead and ask anyway. I always preface this kind of inquiry with, "I'm not sure who I should talk to about this, but maybe you can point me in the right direction."

I know that not every medical thing in your mind is easy to say out loud, but while the issue burning in your mind might be embarrassing to you, you're not going to get very far with it if you hold it inside. Your doctor isn't going to laugh at you or tell your next door neighbor what you said. What's the worst he/she could say? "I don't know"? Don't dwell on whether he/she thinks you're an idiot for asking this question. You have no control over other people's thoughts, only your own, and you're not a mind-reader either. If you are truly the most challenging patient your doctor has ever had, you may actually be fulfilling a medical school dream of his/hers.

If you need to make a critical comment, phrase it carefully and constructively. For example, instead of saying, "I'm sick of having to wait three hours to see you every time I come here," consider saying, "Could I avoid a three hour wait to see you if my next appointment is in the morning instead of the afternoon?" If that doesn't produce a satisfactory response, proceed to the next level with a stronger statement, like, "I'm extremely distressed about having to wait for three hours every time I come to see you." But don't burn your bridges with threats and accusations until you have another doctor lined up. Finding a new surgeon can be a time-consuming and expensive process (take it from one who knows that firsthand), so give your doc a chance to help you before you march out of the waiting room door and step alone into the big, bad bariatric world!