I am increasingly struck by an almost universal and very puzzling facet of physician-patient communication: the doctor almost invariably addresses the patient’s companion, whether that be a husband, wife, boyfriend, girlfriend, even more nondescript “friend,” child, brother, sister – anyone else in the room rather than the patient. It’s as if, by virtue of being ill, the patient has become incapable of receiving information directly. They are spoken of in the third person. Eye contact is with the companion.

Why is this? It’s not because the patient is honestly incapacitated; it would be reasonable enough if the patient is delirious, comatose, or demented. But it happens equally when the patient has a simple fracture, or poorly controlled hypertension, or newly diagnosed diabetes, or even shingles! (Speaking of the most annoying patient ever: an MS patient with a passive-aggressive approach to life, upon being asked why he was there, complained of tingling pains. Where? All over; or actually, in his waist; but pretty much everywhere, really. For how long? Forever; actually the last week or two; but it’s been so long, years and years, since he was diagnosed 15 years ago. I decided it was time to call the attending in after about two minutes of that.)

It seems that physicians, although ostensibly trained to deal with illness, are uncomfortable at having to diagnose someone with a problem, so we’re ashamed to address them directly. It’s more palatable not to have to look them in the eye, or say “you have xyz,” “you need to do xyz.” It’s easier if we imagine an invisible wall between us, so we don’t have to look at them, and can just talk about them with another healthy person.

Is it that we are uncomfortable at giving bad news, or is it that it’s shameful, in this health-conscious society, to be ill, and thus to have to receive a diagnosis and instructions? Are we shielding ourselves, or, in our imagination, the patient?

(And does this paradigm hold true for nurses as well, or are they more obliged to address the patient personally, since their job is also more hands-on?)

I hope I can avoid this, as well as so many other pitfalls in patient-physician communication that I’ve witnessed; but it seems very contagious, just like using big words and forgetting how long it took to figure them out yourself back at the beginning.

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