Rule 13: Whatever subject the patient is most comfortable discussing...

...is probably not the real trouble

Talking is difficult. Or rather, talking about difficult things is difficult. Why? In the context of a doctor’s visit, the first answer that comes to mind is that specific emotions (embarrassment, fear, shame, etc) are attached to sensitive topics. Emotions like these require more energy. Therefore, your patient needs to use a lot more energy to discuss sensitive topics. And, using human nature as a guide, people tend to opt out of this – choosing the path of least resistance.

The job of a patient during a doctor’s visit is already difficult. They have to translate what they’re feeling into words with no compass to help. On top of that, when you add the fact that they’re funneling this message through naturally obstructing emotions, their job gets even more challenging. Fear, shame, other negative emotions associated with bodily symptoms make that “funnel” narrower – which further increases the resistance to speak…that’s the physics of language for you…

Here's a concrete example: I was in the outpatient clinic and an older man came into the office to follow-up on some lab work (cholesterol, sugar, etc). Everything was going well, our team went in and discussed with him our plan for improving his blood sugar. We were 2 minutes away from saying goodbye and scheduling a follow-up when he admitted what he was really worried about: erectile dysfunction. A common problem, many times easily solved, but he was still too embarrassed to bring it up. He was speaking through that pesky funnel and, thankfully, overcame the resistance to get his true worries out. Many people unfortunately don’t.

So going back to our question – I think emotions are part of the equation, of why difficult things are hard to talk about, but it doesn’t give the whole picture. After all, communication is a team sport. Part of the doctor’s job is to create an environment where you can talk about ANYTHING. It’s not the patient’s responsibility to blindly trust you and divulge every little secret and thought about their life. Let’s bear this out in the patient’s shoes one more time.

You enter the doctor’s clinic with an ailment you find embarrassing. You’re seated in a cold room a little bigger than a walk-in closet. You sit on a giant plastic recliner with one-ply paper covering. It’s a recliner built to seem comfortable, but you know from experience it’s not. The walls are taupe because they’re always taupe. After waiting for too long a time, some person in a white coat enters. They say they’re a doctor and, all context clues point to that being true, BUT – does that mean they can actually help you? You’ve seen people in white coats before…that doesn’t necessarily mean they can solve your problem. OR that they won’t judge you for it…

And now that I’ve rambled long enough, I think I’ve finally stumbled upon something meaningful this rule was getting at – judgement breeds resistance. As a doc, it’s imperative to take your patients as the people they are, not as who you want them to be. Acceptance cancels out judgement, lowers the energy needed to communicate (so there’s more left over to focus on solutions), and makes it more likely your patient will speak about the “real trouble.”

Thanks for the help, Dr. Meador.

See you all next Wednesday!