Healthcare Between the Lines

Are we so busy recording what others say that we’ve lost the ability to listen, hear and respond?

Conversation is music. And half of all music is written between the lines. What’s not said – and how we don’t say it – is just as important as what we say. Inflection, nods and unspoken thoughts carry more meaning than words can ever say. A while back a doctor didn’t say things in a very nice manner. I doubt if we’ll ever meet again.

Walking into my exam room with a smile and his electric clipboard [only 25 minutes after our appointed time, which I guess is a good sign these days] he exclaimed that my key numbers had been descending for the past year – an unusual trend when he’s used to prescribing active procedures for people with rising numbers. I told him about the supplements I was taking and the complementary practices I was following. He nodded and typed on his tablet. Then we discussed some of his previous recommendations.

Previously he’d told me to seriously consider a bone scan to see the extent of a possibly recurring cancer. I did my homework and found that the margin of error for the procedure is rather large. When I told him what I found after hours of mind-numbing internet searching, he said that the scan wouldn’t pick up the microscopic cells we were looking for anyway. I looked at him. Unspoken was “Why the hell did you mention it when you knew it wasn’t going to be an appropriate procedure?” He returned my look and then went back to his tablet, appearing to be more concerned with the glare on his screen than with me. And the rest of the conversation went like that, with different tests and different approaches. The only constant was his attention to his tablet and his inattention to me. We reviewed other procedures and their significant side effects. He typed. We discussed my continuing good health, lifelong lack of symptoms and lab numbers showing improvement. He didn’t type. He asked me when I wanted to schedule my next test. I said how about next year. He said fine. Then he suggested that I should call him if I ever get symptoms which I’ve never had.

I won’t. He knows.

This doctor is relatively young. I don’t know how much training he’s had in listening, making eye contact or giving patients the illusion of control. Or in recognizing that quality of life is, for many people, more important than quantity of life. Listening to him, I recalled the adage, Tapir - -5-2“If your only tool is a hammer, every problem becomes a nail.” If his toolkit contains tools other than cutting, nuking or chemo, he didn’t offer to share them. He seems like a nice person, but it’s clear that I’ll be looking for another caregiver – a musician who knows what they’re listening for and who knows how to keep their patient in tune.

A while back I heard about a professional musician who was told by his doctor that he might never play again. Twenty years later he’s still playing a full schedule. His solution? “I got a new doctor.

Harmony is important.

4 Comments on “Healthcare Between the Lines

  1. Jim, We have all had these experiences with our providers. I agree, most never get any training in the “people skills.” And, most who gravitate toward medicine, for some mysterious reason, are missing these skills upon arrival at med school. Fortunately, I had a much better encounter last time out (walk-in for URI which had dragged on six weeks). It was a Physician’s Assistant. Excellent people skills. If there is a way to “specify” her for my next visit, I intend to find it.

    Love your “Scene On My Way.”

    • Pete, while I’ve obviously focused on one – of many – providers who’ve lost their caregiving skills somewhere along the way, there are some good ones out there that I’ve been fortunate enough to encounter. Some even have the letters M.D. after their names! I’ll talk about them in an upcoming blog. Thanks for your compliment – and for your consistently well-thought out comments.

  2. “Bedside Manner” is something that can’t be taught in med school. The importance of keeping accurate electronic records makes the human connection all the more difficult.

  3. well written Jim. I hope you are enjoying yourself in the Emerald Isle. Tip a Murphy for me.
    Hugs,
    Mark

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