by Helene W. Stein, PhD
January, 2003
Foreword
A very common complaint from professional colleagues in regard
to medical practice is "there just isn't time."
In the following article, Helene Stein acknowledges those
pressures. They are imbedded in the fabric of contemporary
medicine. On the other hand, for physicians to be effective
in how they deliver care and for them (and their patients)
to feel a sense of satisfaction from the practice of medicine,
they need to find ways to combine the "science"
of medicine with the "art."
The following article suggests some ideas to consider in
the current practice environment. Incidentally, most insurers
will reimburse physicians who encourage patients (or parents)
to return for a follow up visit in order to help resolve some
of these issues.
- Dr. Howard King
Responding to Pressure for Fast Answers
When I was a psychology graduate student, there was a raging
debate in the field about the nature of psychology. Was it
a science or an art? I was reminded of this debate when I
met with a client who recently had some significant medical
problems. It seems the debate is relevant to the physician's
work as well as the psychologist's.
In conversation after conversation, the client spoke of
all the specialists he had encountered in his efforts to get
his ongoing medical problems under control. As I listened
to his reporting of these experiences, it became very clear
that some of his physicians were highly skilled in navigating
his problematic psychological history and could give him information
and advice in a way that he could hear it and use it. Others,
however, simply irritated him to the point that he could not
use the information they had to offer, no matter how well
intentioned they were. What was the difference? It was certainly
not due to the general message. Some of the most successful
physicians had to tell him information that was very painful
to hear.
In all fairness, the constraints on physicians these days
are enormous. The pressures on their time for increased productivity
and cost-effectiveness often make it difficult for physicians
to remember why it was they went to medical school. It's a
high stress job with even higher stakes. The necessity to
be careful and get it right is always present, while the demands
for increased patient contact are unrelenting.
However, getting it right with my client did not seem to
be a factor of time or the amount of hand-holding. It seemed
to have more to do with the art of "reading" him
quickly and effectively.
In other words, the physicians who worked well with my client
seemed to have mastered the art of using a few clues to tune
into all those irrational, illogical, non-scientifically substantiated
factors that influence how a person will respond to a given
situation.
No one who is ill is at his or her finest moment. Illness,
particularly serious illness, can be frightening and overwhelming.
Some people tend to act more as they did when they were children;
others behave stoically, masking the fear and distress they're
feeling. Still others intellectualize the experience and use
debate or anger as a way of coping.
The most effective physicians were those who were able to
sort my client's more childlike responses from his healthy
adult questioning of the physician's information, and not
react to either stance with a defensive posture or with disrespect.
The other distinguishing feature of those physicians who
were successful seemed to be how comfortable they were with
themselves. They weren't necessarily more gregarious or sociable.
Some my client described as shy and quiet. They were, however,
at ease with the necessity to use aspects of their own personalities
to connect at a personal level with my client - in other words,
to say what they had to say in a way that expressed genuine
connection.
No one has the right response all the time. No one connects
successfully with every person he or she must encounter. However,
when time is limited and you basically have one or two shots
at getting your point across, you need to figure out what
about your own style works for you and what gets in your way.
If the patient is making you feel defensive or attacked, why
is that? Take a moment to figure it out. Acknowledge that
what you are saying has significant ramifications for the
patient's life or is information that's very hard to digest.
You may be accustomed to saying it, but the patient isn't
necessarily accustomed to hear it.
Listen to the words you use to explain yourself. Are your
words ones that anyone could follow, regardless of their medical
sophistication? If not, how can you say what you have to say
clearly, no matter how complex it is? If you say it accurately
to the patient in language that he or she can follow, you'll
save yourself a lot of additional time explaining it all over
again.
Art, it seems, is even more essential now as the science
becomes more and more exact and precise. The greater the pressure
for fast answers and brief, targeted encounters, the greater
the necessity for mastering the art of connecting and using
a fuller repertoire of your personal responses than just your
intellectual ones.
It increases the likelihood of your medical practice being
more effective and also increases the likelihood you'll feel
greater satisfaction from the tough job you have.
Helene W. Stein
is a licensed psychologist. She has a private practice in
Newton and consults to businesses and other professional groups.
A version of this article was first published in the Boston
Globe on November 1, 2001.
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