When I lived in Minneapolis, I loved Auto Talk, a call-in radio show from St. Paul, MN. The hook that caught me the first time I heard the host Paul Brand and his listeners was the show’s similarity to the doctor’s office.
Except for the subject, the conversation could have been between doctor and patient. Each caller described his car’s symptom. Mr. Brand listened carefully, but sometimes broke in to ask a few questions, just like a doctor taking a patient’s history. Then he described a variety of possibilities that might account for the car’s symptoms – a differential diagnosis. Mr. Brand clearly had the advantage of expertise, but his callers were knowledgeable participants, already the “wiser customers” he hoped to make them by “helping them understand more about their automobiles.” Substitute bodies for automobiles and you’ve got part of a mission statement for the doctor’s office.
In our new medical world, patients are urged to be active participants in their own care. The paternalistic doctor is out of fashion and the patient is an informed “consumer.” Like the callers to Auto Talk, who have a good working knowledge of automobiles, you are now supposed to understand your body and have opinions about what to do with your problems. But it’s hard to pretend you’re just seeking ordinary repair service from the doctor, so the consumer analogy breaks down and communication suffers.
When you go to a doctor you are a captive audience, not a car owner. You are there because you fear something is wrong with you. And unlike the car owner, you can’t get an engine overhaul or a new vehicle. The stakes are higher for a patient than a consumer, and the unknown is scarier.
Unlike Mr. Brand, who could close down his microphone at the end of the hour, the doctor has ongoing worries. He is responsible for the patient, he annoys the insurance companies who pay him, and he risks lawsuits every day. Right from the beginning, an adversarial tinge colors the relationship between doctor and patient. The conversation is more guarded and less collegial than it is on Auto Talk.
The callers to Auto Talk were a self-selected group who were interested in the language and mechanics of automobiles. Patients often escape any interest in their bodies until something goes wrong. And when they are sick, they are not likely to embark upon a home study course in anatomy and physiology. The easy flow of conversation that happened on Auto Talk runs an obstacle course of fear and language obstructions in the doctor’s office.
Mr. Brand’s audience was schooled, at least partially, in car language, but in the medical setting, the doctor has to be a translator who is sensitive enough to recognize when he’s gone off and left his patients behind. Medical language sounds complicated, but is just shorthand – a few words in medicalese convey paragraphs of information to anyone else involved in the patient’s care.
Practical knowledge about their own cars also helped Auto Talk callers understand where Mr. Brand’s questions were headed. Sometimes patients think doctors are rude when they interrupt and shift directions, but studies have shown that within thirty seconds of the start of conversation between doctor and patient, the doctor is already sifting the information he is hearing and seeing, and beginning his differential diagnosis. Be patient with him. He is just leaping to the next logical symptom.
Being an active participant in your medical care doesn’t mean you have to learn medical language or understand the relationship of seemingly unrelated symptoms. But you can be like an Auto Talk caller and know how to describe your symptoms. This requires no special language – just observation. Let’s say you have a pain in the abdomen. Can you tell where it is? What does it feel like? Can you compare it to another type of pain? How often does it happen? How long does it last? Is there anything that you can do to change it (like turning over, or burping)? What makes it worse? What makes it better? When did you first notice it, and what were you doing at the time?
AutoTalk callers knew a lot about their cars’ histories. You can be prepared to give your history without much trouble if you keep a written list of the medical problems and treatments you’ve had, and of all the medicines that you take (including over the counter pills). Nothing gets overlooked, and sometimes the answers lie in these details.
Because illness is distressing, concentration on a discussion is difficult. Slow down, take deep breath, and listen as carefully as you can. Above all, ask questions. Ask away until you have a clear idea what the doctor thinks your problem is and what the plan of action is. Most offices provide you with educational material and written instructions, but it is OK to take your own notes, and to bring someone trusted with you to help.
Mr. Brand’s goal was to expand knowledge so people get “longer service life” out of their automobiles. The word doctor means teacher, and the goal of medical care is longer service life of the body. Who better to guide patients to good quality information, rather than information designed to sell a drug or a product? What better way to facilitate communication than both parties attempting to build knowledge? Call it Body Talk.