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On Call: Meet Them Where They Are

Thu, 10/14/2021 - 10:46

In my medical career there are few things that I am as grateful for as the fact that I spent several years teaching college writing and literature before going to medical school. Essay-writing is not everyone’s cup of tea, and to be good at teaching it, you have to find a way to meet the learner wherever they are, in terms of literacy, logical thinking, argument development, style, and grammar.

It’s hard work on the best of days, not least of which because many people simply don’t enjoy writing essays, and, not surprisingly, this translates to frequent opportunities for miscommunication and frustration.

Of all of the life skills that I have, this ability, which also helps me recognize where a patient is in terms of medical literacy and understanding and meet them there, is among the most valuable. 

We spend a good amount of time in modern medical education discussing the idea of medical literacy, the degree to which people can access, hear, understand, and act upon the information relevant to their health. It does me little good to explain to a patient that their coronary arteries are suffering a partial plaque rupture with resulting unstable angina if they’ve never been exposed to this vocabulary. On the other hand, that language might be exactly the words I need to use with an interventional cardiologist.

It seems like a simple concept, a no-brainer, but I find this mismatch in the physician’s education, experience, and vocabulary to be one of the most significant areas of breakdown in medicine. Time after time, patients come to me in my primary care office and cannot fully explain the ins and outs of their care, why they are on a certain medicine, or why they were in the hospital recently. Not only does this lead to the potential for miscommunication and errors down the road, but to no small amount of frustration, uncertainty, and erosion of trust in the medical system as well.

Not that I am completely blaming my errant colleagues who may have not spent years trying to explain a five-paragraph essay to somnolent college freshmen; to a certain degree, we all as patients have a personal responsibility to speak up and ask questions if we do not understand the choices and actions that someone is offering us to improve our health.

But at the end of the day, even as we all move forward into a modern medical world where we are partners in finding health instead of paternalistic physicians in ivory towers simply curing disease, the powerful gatekeeping dynamic of the medical system often makes patients feel as if questioning their physician can result in negative consequences. 

This should not be the case. Whether a patient is asking for a more straightforward explanation, more time going over the ins and outs of a planned surgical procedure, or wanting to talk about something they found on Google, physicians must remember that the knowledge gap between those of us who have spent tens of thousands of hours of studying and on hospital wards and patients who may only have a basic understanding of their bodies, the language we speak, or the steps it takes to get care, is sometimes enormous. We must remember that and do our part to bridge that gap patiently, fully, and compassionately.

One of the aspects of primary care here on the East End of Long Island that has impressed me since I came to do my residency training here is how many of the local providers are very good at this. I think that many more physicians are better at it than they or their patients realize, as well. If you ever find yourself sitting in a doctor’s office or being admitted to the hospital, don’t be afraid to ask for more explanation. Your doctor may not have an entire hour to explain every little decision, but they almost certainly have a few minutes to engage in that most critical aspect of good clinical care: teaching. 

After all, this is how the word “doctor” came to us, from the Latin verb “docere,” to teach. 

Joshua Potter, D.O., a physician with Stony Brook Southampton Hospital’s Meeting House Lane Medical Practice, oversees the practice’s Shelter Island office. He specializes in family and neuromusculoskeletal medicine. Opinions expressed in this column are his personal and professional views and not necessarily those of his employer.

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