On Tailoring the Explanation to the Patient
I recently treated an unfortunate young lady who suffered from the dual diagnoses of pulmonary emboli and cocaine addiction. Her last PE had almost killed her, but her social situation and drug addiction made compliance with a complicated medical plan difficult, so she seemed like a good candidate for a Greenfield Filter.When describing the apparatus itself, I used my favorite instrument - the analogy:
"It works like the steel wool in a crack pipe," I said.
"It keeps the lumps from getting to your lungs."
posted by scalpel at 3:39 AM
27 Comments:
So now she has a built-in crack pipe, cool.
LOL, good but strange analogy
Excellent!
It's a dandy little unit even for those without crack pipes or cocaine addictions.
That must've come through loud and clear. Good analogy! :)
I love it!
This post doesn't really portray you in a favorable light. In fact, you kind of look like an ass right now. What a cheap shot. It's really too bad.
If she ever gets her sh*t together, she'll remember how her doctor talked down to her.
And even if doesn't, I certainly will.
Or, nonplussed, you could develop a sense of humor.
Hopefully she'll remember that I helped save her life. The taxpayers sure got their $50 worth on that visit.
nonplussed: A) He helped her and B) he helped her understand the procedure...
I certainly don't think this is talking down to her.
Wow, nonplussed, are you serious? I think this is an example of why Dr. Scalpel is such a great doctor. He knows how to talk to his patients. Why would this be talking down to a patient?
I don't get your umbrage. At all. It seems totally misplaced.
V funny.
Q: How did you know about.... hmm... never mind, I don't wanna know.
Doc Scalpel: I hope she does, too, but I doubt it.
Other defensive people: I'm not sure this anecdote would be so funny if Scalpel had explained it to a plumber in terms of a drain and a sieve, or to a mechanic in terms of an oil filter and a whatever-doohickey-thingy in a car, or a cook and a strainer, etc.
What rubs me the wrong way is that the hysterical magic comes from poking fun at a crackhead. Yes, crackheads can be pretty darn funny. (Evidenced here!) I just have all these outlandish expectations of higher standards of behavior for doctors that insist they should be compassionate and sensitive every single moment of every single day. Not that it's realistic or anything.... (Dr. Scalpel, please don't take this as an affront-you must be an extremely caring person to do what you do every day, and we all have our moments.)
A doctor taking a sideways jab at a crackhead might be funny to you because A) crackheads are funny and B) crackhead was too goobed out to notice doc was sounding the depths of her obliviousness, but to a (non-medical) outsider like me, it just looks cheap.
People who work in medicine get crapped on all day, every day for a living by a lot of people who are not, shall we say, on their best behavior. I can understand why this kind of humor is a release. But I don't like it and since I don't work in your profession, I don't really have to.
That's all. I'm not flaming or condemning. Just disappointed.
And Zac: MY SENSE OF HUMOR IS JUST FINE, THANKYOUVERYMUCH. HA! See? LOL FUTHERMUCKER. (Seriously, though. Why the hell would I come here if I didn't like to laugh?)
It woulda still been funny.
I don't see how this was talking down to her - anymore than using a similar anology with a plumber would be talking down to the plumber.
And I don't think it was a sideways dig at all. I'd imagine she was pretty open about being a crackhead - at least in a medical setting and her need for the filter was largly determined by the fact she was a crackhead and thus would/could not comply with other therapy.
By using that anology not only was Dr. S explaining the device and how it worked in a way she could grasp immediately he was also conveying that he was not being judgmental about her crack habit but was prepared to deal with the issue of her addiction in a matter-of-fact way. I think it could very well have put it at her ease and created a rapport which could someday make it easier for her to ask for medical help to overcome her addiction.
It's "funny", in so far as it is funny, because of the juxtoposition of a something so "unhealthy" as a crack pipe with a medical procedure - not because anyone was being made fun of.
There is nothing like a good analogy!
Speaking as a former crack head (for a very long 3 months), I think it is spot on and very funny. I wouldn't have taken offense if my physician said that to me.
She's lucky to have a doctor give enough of a hoot to find a solution for her drug-addled situation.
It is funny, btw.
nonplussed,
I think you are reading way too much into this. Nothing in this demonstrates that Dr. Scalpel was talking down to the patient. For an analogy, you use what is understandable to both the recipient and the person doing the explaining.
A plumber receiving a similar analogy would be similarly funny. An auto mechanic having it explained as an oil filter would be funny, too. Had any of these been used, would you have been critical of the "cheap shot?" Would it have been "talking down to her?"
If the information had been presented as a physician might explain a Greenfield Filter to a colleague in a different specialty, would that have avoided your concerns about being condescending? Would the patient be better off if we all just pretend there is no crack problem?
There is nothing to complain about here. This was an example of creativity in obtaining informed consent. Of course, a less clear explanation might be more politically correct, but is it providing the information in a way that allows the patient to make a truly informed decision to consent to care, or to refuse care?
I think you are reading way too much into this.
I had a comment with a similar thought written and abandoned it.
I also note that the first to call the patient a "crackhead" was nonplussed. Look back at Dr. Scalpel's entry. He referred to her in a compassionate way.
Nonplussed is reading something in his words that just is not there.
Teresa said...
"Nonplussed is reading something in his words that just is not there."
Which is not suggesting that I've never done that. :-)
Which is not suggesting that I've never done that. :-)
We're all guilty of misreading things occasionally. There is a group of people, however, that does it as a matter of habit.
I have observed that some people employ a direct style of communication; others communicate in code. Those that communicate in code are constantly looking for encoded messages in the words of others, even those that are direct communicators.
If you look hard enough for an encoded message, you'll find it.
Here's an example: "That's a really pretty dress you're wearing today" gets interpreted as "she hated the dress I had on yesterday" to someone looking for a hidden message.
Way to get on your patients level and avoid medical jargon, bravo!
sarcastic smart ass humor.
we all took the message differently it seems. In reality it is how the patient took the message that matters.
i dont think we can really rely on scalpel's interpretation of that honestly as he isnt one known for empathic sensitive cuddly, wuddly care.
tina said...
"sarcastic smart ass humor."
Nothing wrong with that.
"we all took the message differently it seems. In reality it is how the patient took the message that matters."
True.
"i dont think we can really rely on scalpel's interpretation of that honestly as he isnt one known for empathic sensitive cuddly, wuddly care."
Wow! Calling Dr. Scalpel insensitive and a liar in the same sarcastic sentence. We can certainly rely on your unbiased interpretation.
I have not felt that Dr. Scalpel is lacking in empathy or sensitivity. Being blunt with some people does not mean being blunt with everyone. Or do you approach everyone with sarcastic accusations of abrasiveness and mendacity?
I suspect that you don't approach everyone this way. If I were to claim that this is an example of your behavior, I could make that suggestion, just as you are suggesting about Dr. Scalpel.
Not everybody deserves to be treated gently.
That does not mean that everybody gets rough treatment.
To the poster who makes reference to plumbers and mechanics and people like that... My dad what a mechanic / self-employed carpenter, and he was always asking me about my BIO courses in college. He would make these analogies himself and marvel at how easily he could compare functions of some organs/systems in the body to things he used in his every day work. I think analogies like this are not demeaning, but are in fact some of the best ways to explain conditions to a patient who has never studied the human body. Good job to scalpel on the analogy.
After reading scalpel's blog for a year or so I would not classify him as being extraordinarily empathic. Sure he cares but it isn't the same thing as empathy. Empathy measn to feel another's pain. If he was highly empathic he would have a real hard time giving the chronic pain, weak passing out folks the crap he does.
However he also would be a crappy ER doc if he was higly empathic. He needs to be quick witted, clever, be able to think on his feet, be able to detach from highly emotional situations, and maintain a professional demenor with bloods and guts everywhere. A highly empathic person would suck at that.
My comment was not that he lies. It's that he likely lacks the empathy and ability to read others' emotional state to interpret if his comment was taken incorrectly. He wouldn't pick up on cues a very empathic person would so he might think the payient was fine, while she was actually heartbroken over the comment.
This is why so many drs come across as total jerks. They are selected via the med school admission process not to be highly empathic or caring but rather clever. They would all make good scientists. Yet never would you expose a scientist to people in the real world for 10 hours a day. They LACK people skills.
There you go...
Tina,
So basically, you are claiming to be so highly empathic that you are able to intuit what Dr. Scalpel feels. Your internet connection must be much better than mine.
If he is sarcastic in some of the comments he makes in his posts, does that mean he is sarcastic with everyone?
You seem to be making leaps of logic here. You discount the possibility of empathy, because of occasional sarcasm.
If you had originally read empathetic material, would you discount his sarcasm?
I don't know what he is like, but I enjoy reading his posts because he is perceptive, something that goes along with empathy (and sarcasm).
You make a lot of assumptions about whether emergency physicians can be empathetic. Maybe the job just requires the ability to compartmentalize empathy. You seem to have decided that nobody could do that and be a good doctor. I disagree.
I think that was an excelllent way to describe the filter in a way she can relate.
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