Monday, 11 July 2011

Communication - dilemma and success

Not long ago, I took an extensive history in oncology from a man who completely reminded me of my other half's dad. It was uncanny.
From thoroughly taking the piss for calculating his age from his date of birth embarassingly wrong, and his little jokes throughout, to the way he put down his wife whenever she tried to chime in and add to the history. Admittedly, some of her additions were irrelevant, but some were likely to have been useful, and either way, if you're going to build a rapport with the patient, you need to consider the accompanying relatives within that; it's no good building a great relationship with a patient and ignoring the relative sat in the corner.

It brought me on to a dilemma - how to encourage the wife to contribute, without publicly contradicting the patient telling her to shut up? Openly contradicting him (eg, "no, it's fine, that's [what wife just said] a useful thing to know"] could be detrimental to any rapport that I was building with him, but at the same time ignoring his comments firstly worsens any rapport with the wife, and secondly may prevent her from chipping in with more vital information for the history.
I also need to recognise my own innate "don't talk to her like that!" reaction which would automatically favour the encouraging the wife/contradicting him response, even if that isn't overall the most appropriate. Keep personal feelings and reactions in check! (more on that another day)

Probably a mountain out of a molehill, but I like examining the minutiae of communication. Whether that's productive or not is a different matter.

An achievement that I was a bit proud of - during my time with this patient, I learnt that he didn't want chemotherapy, or was at least very wary of it. We discussed why (a friend's experience) and we discussed that chemotherapy isn't just one drug, but many different drugs, and different people get different types of chemotherapy, with different side effects. That felt like a good discussion, he seemed reassured.
Of course, I passed this on to the oncologist discussing the patient's treatment plan with him. I was a bit disappointed that oncologist didn't take it on board and went straight in with "we will give you chemotherapy and it will be like this, fait accompli". No mention of "I heard you had some concerns about chemotherapy..." Oh well, tried my best!

Said oncologist was at a presentation in which a student discussed burn-out in doctors in oncology. Having a good relationship with your patients is a risk factor for burn-out, apparently (though I did meet a wonderful palliative care lady who explained why she thought the complete opposite was true). I wonder if oncologist already knew this, and was putting it in practice with my patient...

Just another occasion on which I wonder why all the extensive communication models and doctor-patient relationship psychology that came up in general practice theory is restricted to general practice. Surely it should be universal?!

All in all though, it was a good learning experience, boosted my confidence, and I build a great rapport, despite the patient's put-downs grating me.