Saturday, January 21, 2006

What Dr. Helen hears

...when her doctor speaks.
I have to admit--I am afraid to go to the doctor. I have always hated hospitals--they seemed so depressing and scary--which is why I have a PhD and not an MD...I can usually interpret with fair accuracy what my own clients are trying to tell me but my translation of what a doctor is saying about my medical condition is so far off the mark, I sometimes wonder if a diagnosis of 'medical psychosis' should be added to my chart. My translation goes something like this:

Doctor: Hi, I'm Dr. so and so, nice to meet you.

My Translation: I'm here to give you your last rites.

Doctor: Your potassium is a little low.

My Translation: You're lucky your heart is beating at all.

Doctor: Your heart is beating a little fast, are you nervous?

My Translation: Your heart is pounding out of your skin, you'll be lucky to make it out of this office without a major heart attack..."
It sounds like the doctor did notice her anxiety. How to calm an anxious patient? Often we'd like to be reassuring, but we have to be careful. My (brand new) risk management newsletter says:
It is a common and appropriate practice of medical providers to address the worries of patients regarding their symptoms with words of reassurance....But beware, sometimes "reassurance" can backfire on us when an unexpected diagnosis turns out to actually be involved. There are going to be times when we miss a fracture or inflamed appendix or MI or brain tumor because it did not have a typical presentation. What is the best way to include reassurance in your conversation with the patient and in your documentation without setting yourself up for later criticism of missing a diagnosis?
· Be sure to include in your conversation and documentation of the reassurance that
o you have considered the more serious possible diagnoses but,
o at this time,
o with this presentation of signs and symptoms,
o you think the more serious diagnoses are unlikely, and,
o advise the patient that if the symptoms worsen or change he/she should come back in.
· Include important warning signs in the follow-up instructions to the patient.
· Do not diminish the patient's concerns. Do not say, "I am not impressed" with the patient's symptoms. This tends to be misunderstood by laypersons and can erode the relationship.
· For example, "I can see that you are concerned about this severe headache and what might be causing it. We have done the standard imaging test and there is no abnormality found. It is very rare that a headache is caused by something so serious as a brain tumor and in your case this is very unlikely. I would like to work with you to find ways you can cope better with these headaches. And, it is important that you let me know if anything changes such as worsening pain, etc..."


Anonymous Anonymous said...

Before trying to teach doctors the right hting to say, try teaching them to say ANYTHING meaningful.

Doctor's don't generally say much of anything to the patient. They ask where it hurts, maybe look down your throat, then write a prescription (or not) and leave. I have actually had to chase a doctor down the hall and ask him what the diagnosis was.

7:06 PM  

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