Extreme discomfort

There is nothing quite so discomforting as watching someone try and get themselves sued. Now after acknowledging that good and effective communication was an increasingly vital skill for doctors to possess, and one which had generally been badly taught in the older 6 year courses (if it was at all), the organisers of the new course introduced a number of tutorials and lectures to directly deal with issues of effective communication and conflict resolution.

Armed with this knowledge I often find myself cringing in the presence of senior, old course trained doctors, who in spite of many years of clinical experience, and obvious skill and knowledge in their chosen area of clinical practice, repeatedly do and say things which are in the “don’t ever do/say this” lists in our lectures.

  • Sometimes they don’t explain things adequately, and leave the patient confused.
  • Often they revert to confusing medical jargon so that they don’t actually have to tell a patient bad news, or even sometimes so that they don’t have to really talk to them at all.
  • Sometimes they don’t listen to or acknowledge the patient’s concerns.
  • Sometimes they tell the patient how things are going to be, and ignore the patient’s complaints.
  • Sometimes they barely acknowledge the patient at all, and just talk to the notes or the other nearby doctors, as though the patient were just another piece of the furniture.
  • And sometimes they are just so amazingly tactless, insensitive, and offensive that you want to leave the room before you find yourself being asked to testify in the lawsuit that is in the process of being started in front of your eyes.

I say this last one because they have done studies that have shown that poor communication and lack of patient empathy are the biggest predictor of whether a doctor will get sued, rather than anything at all to do with the doctor’s clinical competence. For that reason many medical insurers will decrease a doctor’s insurance fees if they attend communication training courses run by the insurers.

Anyway today I was in an outpatient’s clinic with this particular doctor, and spent the morning watching patient after patient leave confused and “talked at”, until finally one patient got such a rough deal that she stormed out of the consult. While the doctor hadn’t actually done anything clinically wrong in relation to the treatment of her medical condition, he was so offensive towards her as a person that I would be highly surprised if lawyers weren’t involved soon.

(And all along I just wanted 5 minutes afterwards with each patient to explain what had just been said and done, and basically tidy up the myriad loose ends, but sometimes it sucks being a medical student, because I couldn’t…)