The mysterious effects of what we say – a physician coach considers our intention and our patients’ experience

On a recent plane ride, I sat next to a man who told me his harrowing, near death story of remaining in a coma for weeks after suffering a catastrophic medical condition.  Screen Shot 2015-04-23 at 8.37.10 PMFortunately, due to excellent care and a dose of luck, he recovered enough to be enjoying life again.  One of his clearest memories of the ordeal is when the physicians came into his room after he had awakened and was lucid again. They shook their heads and remarked, “We thought we had lost you.”  As a physician, I understood that the doctors were struck by the mystery of his recovery and were grateful that their fears for him had not materialized. Interestingly, the patient found their comment extremely unsettling.  It underscored the chasm that frequently exists between our intentions and what our patients actually experience.

Many years ago, I treated a patient’s varicose veins.  While our modern treatments are usually successful, a small number of patients don’t respond perfectly to one treatment. At his followup visit, my patient remarked that he was happy with the treatment and felt that things had gone well.  After examining him, I felt that things had not gone very well.   “Actually,” I informed him, “this result is not as good as I had hoped, and not as good as I think we can accomplish for you.”  I explained what we would need to do to obtain a better response.  To my surprise, he never returned.

During physician coaching sessions, my clients and I engage in deep and life changing conversation.  There are many times I say something that provokes sadness, confusion, excitement or a variety of other intense emotions.  I’ve learned to ask, “what do you notice when I say that?”  It’s a simple question that allows them to identify what emotion, image or other memory has been stirred up.  And it affords me a window into their experience that bridges this gap between what I may have intended and what my client is actually experiencing.

In a recent medical school class about delivering bad news, a colleague wisely remarked that we never know what our patients perceive to be “bad news.”  Learning they need to be in a cast or take a particular medicine may feel catastrophic to patients.  Perhaps my travel companion, awakened from his coma, was unsettled by the realization that life is so fragile.  It’s possible that my patient lost confidence in me or couldn’t accept that another treatment was needed.  In both situations, our communication was lacking two important ingredients – an expression of our intention and an inquiry into the patient’s experience. Facial expressions or body language may tip us off to the fact that our patients are struggling with our message and we might be prompted to ask what they’re feeling. Even in their absence, our relationship will be stronger and we will be wiser if we explain what we hoped to accomplish and ask how they feel about what we’ve just said.  It tells our patient that we want to know them and it provides the foundation for clear communication.  And that’s good medicine.

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About Helane Fronek

Over the past 28 years I have had a fascinating and fulfilling career in medicine, initially practicing as a general internist and then as a procedural specialist, caring for patients with vein disorders. As Assistant Clinical Professor of Medicine at UC- San Diego School of Medicine, I’m thrilled to be teaching medical students crucial communication skills along with many other aspects involved in the practice of medicine.
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