Once you enter the door of the polyclinic or hospital, anyone can snap at you – from the “sanitary”, who washes the floors, and you embarrass his actions by the simple fact that you are there, to the surgeon who tells you in a brutal manner, without no preamble, that you need to have a breast removed, or the imaging doctor making sexualized comments during the checkup.
As much as we would try to choose the words so as not to upset the powerful medical guild, the truth is one – communication with patients is the dead horse in our medical system. No matter how much you try to revive him, there is no point. Because he’s dead. He’s been dead for years and it’s hard to say now if he was ever alive and well.
Paul Kalanithi was an American neurosurgeon and writer who, diagnosed with lung cancer, wrote a harrowing memoir about his path leading inevitably to death. In his book, entitled “With the last breath”, Paul Kalanithi talks a lot and at length about the importance of communication between the doctor and the patient. Especially when it comes to a diagnosis with uncertain prognoses. Especially when you have more hope to announce than years or even months of life.
…informed consent – the ritual whereby a patient signs a piece of paper (which) authorizes surgery – has not become a legal exercise in naming all the risks as quickly as possible, like the voice in an ad for a new product pharmaceutical, but an opportunity to make a covenant with a fellow sufferer: here we are together, and here we will go through—I promise to guide you, as best I can, to the other side.
Author: Paul Kalanithi, “With the Last Breath”
Studies show that good communication with patients has a major impact on treatment outcomes. Patients who report good communication with their doctor are more likely to be satisfied with the care they receive, to follow advice and adhere to prescribed treatment, and most importantly, to share information pertinent to the correct diagnosis of their problems .
Moreover, studies have shown a direct relationship between the feeling of control over the treatment, which the patient gets only in effective communication with the doctor, and the ability to tolerate pain and successful recovery from the disease, and even a decrease in the length of hospitalization. Positive communication with the doctor is also a primary condition for a better mental state of patients.
Good communication builds trust, which is much needed in the patient-doctor relationship. When the patient can speak openly, without fear of being judged – that he has not been to the doctor for years, that he has an unhealthy lifestyle, that he does not have enough money for treatment, that he is anxious – and beyond to be a man who, first of all, can allay his fears and hold out a thread of hope for the patient to cling to, the suffering diminishes.
And then, being human means being vulnerable, and it’s so unethical, unhumane, when doctors take advantage of patients’ vulnerability for their own benefit. Either to feed their pride or for money.
I want to close with another quote from Paul Kalanithi’s memoir.
What patients are looking for is not the scientific knowledge that doctors possess, but the existential authenticity that each person must find for themselves. Getting too deep into statistics (that provide a prognosis of disease) is like trying to quench your thirst with salt water.
Author: Paul Kalanithi, “With the Last Breath”
