The importance of good communication is underrated.
I’ve now been at the Palliative Care unit for two weeks, and noticed a theme about the value of communication remerging. I briefly discussed this topic in my last blog, but I felt it deserved its own entry.
Meeting Dr. Rodrigo
Just like with Dra. Juliana, Shravya and I shadowed Dr. Rodrigo, an emergency doctor at the unit, and observed him during his consultations with patients. In his meetings, Dr. Rodrigo would ask the patients about their physical and emotional well-being, in addition to updates on treatments, exams, and medication.
The first patient we saw with Dr. Rodrigo was new to the clinic and was too weak to go to his office; the meeting was held in the patient’s small area at the unit’s ambulatory. After introducing himself, the first thing Dr. Rodrigo asked the patient (even before asking basic questions about her age, background, condition., etc.) was if she knew why she was seeing him. This question seems to be the key to the start of good communication between a doctor and the patient at the hospital. Dra. Juliana had also mentioned this to us last week when she explained that many patients are kept in the dark about the reasons why they’re referred to a Palliative Care unit. I think this question is useful for the doctors so that they can not only find out how much the patient knows about their situation, but also begin a dialogue about their expectations and their hopes for the days, weeks, and months to come.
Throughout the conversation, Dr. Rodrigo asked his patient several other questions that were useful for establishing a good communication and relationship: 1. He asked her about her feelings in dealing with her illness- this allowed Dr. Rodrigo to understand the patient’s deeper concerns and struggles, as well as consider additional aid such as medication for anxiety and depression. 2. He asked her about how much she already knew about her illness- this helped Dr. Rodrigo understand the extent to which the patient knows the gravity of their situation and the possibilities that are left for her. 3. More importantly, he asked her how much she wanted to know- Dr. Rodrigo explained that sometimes patients prefer not to know about their illness, so it is important that he knows where his patient stands on the subject so that he can respect their wishes.
Between patient visits, Shravya and I asked Dr. Rodrigo some questions about his work and the obstacles he encounters. In response to our question about the largest problems he sees at the hospital, he said two things: bureaucracy and communication. Bureaucracy is a common problem for public institutions like the hospital. Specifically, Dr. Rodrigo referred to the amount of paperwork that the doctors must complete for each patient and medication. I was curious to learn more about the issue of communication.
Dr. Rodrigo explained that sometimes it’s very hard for patients to understand the extent of their illness. He said this happens because of two reasons. The first reason deals with the background of the patients. Since the hospital is public, many of the patients come from low income families and have a limited education, which makes it harder for them to fully comprehend their situation. The second reason is that some doctors, knowing that many patients have only a basic education, don’t explain the situation to the patient (because they claim they won’t understand) or don’t try as hard as they could to explain well to the patient.
From my interactions with both Dra. Juliana and Dr. Rodrigo, clearly communication is a skill that is extremely important for doctors to master and should be studied as thoroughly as any medical procedure or condition. With that in mind, there is a quote that Dra. Juliana shared with us that I feel is very appropriate for this topic:
A doctor who communicates well will always be remembered. A doctor who communicates poorly will never be forgotten.