“You can have all the knowledge in the world inside your head, but if you can’t explain it to other people, you are useless as a doctor.”
I remember ranting to a friend one night about the terminology, lingo and semantics that run through medicine. When I started studying medicine, I found the language fascinating. Most physicians seem to appreciate the language of medicine because truly understanding it is proof that after years of studying, working, and putting nose to grindstone, you made it in to the exclusive club that utilizes this jargon. However, what I’ve come to realize as a resident is that although I may have broken through the proverbial glass and become fluent in the language, it remains a major barrier between patients and the medical world.
When I first applied to medical school, I also applied to teacher’s college as my backup. It was only while preparing for medical school interviews that my commitment to the profession was solidified. I had a real “aha” moment when I realized that the Latin word for doctor, docere, literally means, “to teach.” I moved through medical school with the ‘doctor as teacher’ motto in my head. Still, I could feel it getting pushed to the back as I was trying to master knowledge, techniques, and work on research without any time to fine tune my teaching style.
Upon entering residency, I came to see that the best teachers were not the slickest with their hands or those most widely regarded as research superstars; the best teachers were those who sat down next to a patient, looked them in the eye and asked, “So, what do you do for a living?” The best teachers were those capable of building rapport and translating the complex mix of Latin and science into accessible language that allows the patient to access the world of medicine. These teachers transformed the ‘clinical encounter’ so that it looked simply like a conversation between two people trying to understand a problem together.
I had to wonder, do we really have time for this? Aren’t we too busy to do this during our day? And does it even matter if the patient understands the finer points? I believe the answers to all these questions are “yes, of course.”
The best analogy that I’ve used was for a patient recently discharged from the hospital after suffering from an acute bout of diverticulitis requiring a bowel resection, whose course was complicated by sepsis and an anastomotic leak. For most in medicine, that one line story is clear enough. However, the patient’s family did not fully comprehend the picture. “I think they cut out some intestine and now she just needs antibiotics to get better,” they explained when I asked if they knew what happened in the hospital. In fact, the patient was being transferred back to a nursing home for palliation and would receive antibiotics that were not going to make her better. My question revealed that the family was still anticipating a cure in a case where there was little likelihood of the patient getting over this illness.
In an attempt to clear the confusion, we went back to the beginning of the illness. “The bowel is no different than a pipe,” I explained. “It’s a tube and the colon’s main job is to act like a sponge and soak up water to help liquid stool become solid stool you can poop out. The colon is like this long balloon. Normally if it’s full of food, it squeezes evenly and food moves along. Yet if the food is too hard or if the muscle squeezes too hard, you can get little pockets that pop out of the side of the colon. These are called diverticula. Now in some people, these little pockets hold in bugs and bacteria, and these bugs can cause an infection in the pockets called diverticulitis. When the pockets become infected, the bowel swells causing narrowing of the pipe. Sometimes the little pockets can become very thin and even burst. If they do ,stool spills into your belly and you can get very sick. What the surgeons did for your mom was to take out the narrow portion of pipe and put the two other pieces together. Unfortunately, a leak developed in your mom’s pipe where the two ends were joined, and because she is too sick to have it repaired, she is leaking stool into her belly. When this happens, the body has no way to protect itself and often people will pass away because they can’t fight the infection well enough even if they are on antibiotics.”
After this analogy, a few more questions, and some pictures, the patient’s family felt like they had a better understanding of what was happening with their mom. They understood that antibiotics could not be used to make her better, and that she was likely going to pass away from this illness. They ultimately felt empowered by this understanding and the ability to explain the situation to their other family.
Even though I was unable to find a cure, I did remember and reconnect with the main reason why I initially wanted to become a doctor. This is why I spent all those Saturday nights studying and all those nights on call: to help patients understand and alleviate the suffering of not knowing. This is what it really means to be a doctor.
I know it’s cliché to say “knowledge is power!” like a 1990s cartoon, but it really is for patients. Knowledge is the key that opens the door to the inaccessible world of medicine. By giving patients the key, we can give them a semblance of control. Medicine has come so far with so many technological advances over the years and often as trainees we don’t get to be the ‘primary operator or chief resident,’ but if we can empower patients, we can become the doctor our patient needs.
Image credit: My bed by Mark Hillary licensed under CC BY 2.0.