Fighting, battling, and beating: combat metaphors in medicine are just wrong

by Carolyn Thomas    @HeartSisters

Are you “battling” heart disease”? Have you “beaten” cancer? Are you “fighting” a chronic illness? These wartime references are metaphors as described by Dr. Jack Coulehan, a physician, an award-winning poet, and editor of the 5th edition of The Medical Interview: Mastering Skills for Clinical Practice, a best-selling textbook on the doctor-patient relationship.(1)  Dr. C explains that there are several basic metaphors used in medicine that to a large extent generate the vocabulary of doctor-patient communication – but can also unintentionally objectify and dehumanize the patient.

Here are three of the most prominent metaphors you’re likely to encounter in health care:  Continue reading “Fighting, battling, and beating: combat metaphors in medicine are just wrong”

Should you bring that list of questions to your doctor?

by Carolyn Thomas  ♥  @HeartSisters

In a recent essay published in the New England Journal of Medicine, Dr. Suzanne Koven* recalls many conversations she had with her father (like her, a physician) in which he loved to reminisce about his own long career in medicine. But there’s one reminiscence she still bristles at, as she explains(1):

“The story was about ladies – always they were ‘ladies’ – and something he called la maladie du petit papier: ‘the disease of the little paper.’

“They would come to his office and withdraw from their purses tiny pieces of paper that unfolded into large sheets on which they’d written long lists of medical complaints. ‘You know what I did then?’ Dad asked. I did, but I let him tell me again anyway. ‘I’d listen to each symptom carefully, and say ‘yes’ or ‘I see’. 

“That’s all. And when a lady finally reached the end of her list, she would say: ‘Oh doctor, I feel so much better!’

“The point is, all those ladies needed was someone to listen.”

The notion that whatever was bothering these silly ladies was all in their heads was once a long held truism within the medical profession.  Continue reading “Should you bring that list of questions to your doctor?”

Why patient stories actually matter

Most of our medical visits start with some variation of this opening question: “Why are you here today?” Connecting with and understanding patients thus requires doctors to listen to what’s called the patient narrative.  The importance of really hearing this narrative is beautifully described by U.K. physician Dr. Jeff Clark, writing in the British Journal of General PracticeBut the problem, as Dr. Clark reminds his peers, is that patients and doctors see the world in very different ways.  He also warns that the stories patients tell their physicians about why they’re seeking medical care may all too often be seen by doctors as merely a time-wasting distraction from “getting to the bottom of things.

The urge to get to the bottom of things may also help to explain what’s known as “The 18-Second Rule”.
Continue reading “Why patient stories actually matter”

Is your doctor talking to your other doctors?

talking-illustration-2f787e24f86ed57d0b8d5d3bb93f5b9320b5af44-s6-c30While I was in my hospital’s Coronary Care Unit recuperating from a heart attack, my longtime family physician knew nothing about what had just happened to her patient of over 32 years. At some point, a hospital report signed by the cardiologist in charge of my care was sent off to her (probably by fax – and by the way, can you name any other profession that still uses the fax machine as a mode of such sensitive, important and personal communication?)  Continue reading “Is your doctor talking to your other doctors?”

Is your doctor paying attention?

by Carolyn Thomas    @HeartSisters

When Mayo Clinic’s Dr. Mary O’Connor published her compelling essay called The Woman Patient: Is Her Voice Heard?“, she raised some frightening questions, particularly for those of us carrying the XX chromosomes.  Examples of what she calls the medical profession’s unconscious bias” against female patients include:

  • women are 22 times less likely to be referred for knee replacement surgery compared to men presenting with the same symptoms and diagnoses
  • girls on pediatric kidney transplant lists are 22% less likely to get a new kidney compared to boys
  • women in their 50s and younger are seven times more likely to be misdiagnosed and sent home from Emergency compared to their male counterparts of the same age presenting with comparable heart attack symptoms(1)

But perhaps the most disturbing lesson was the pervasive sense that somehow docs are just not getting it, and worse, that this “unconscious bias” is affecting medical decision-making – and even doctors’ ability to pay attention. Continue reading “Is your doctor paying attention?”

When doctors can’t say: “I don’t know”

Mimi and Euniceby Carolyn Thomas     @HeartSisters

Pity the poor Emergency Department physician who first studied the results of my cardiac diagnostic tests. Despite my textbook heart attack symptoms of central chest pain, nausea, sweating and pain radiating down my left arm, all of my test results that day appeared to be “normal”. So instead of admitting this puzzling discrepancy, the doc seized upon an alternative hypothesis as he pronounced confidently to me:

“You are in the right demographic for acid reflux!”

I was sent home from hospital that morning (feeling very embarrassed about having made a fuss over nothing) with his directions to make a follow-up appointment with my family physician to get a prescription for antacid drugs (to treat what turned out to be a misdiagnosis of indigestion).

Part of the problem with this scenario is the reluctance of some physicians to admit that they just do not know. Continue reading “When doctors can’t say: “I don’t know””