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Published 11/1/2011
Charles N. Hubbard, MD

Beach musings …

“I don’t mean to be rude,” she said, “but sometimes I don’t think you listen too well.”

“You’re not the first woman to tell me that,” was my reply and I sat down. The she was a patient in her mid-30s whose fate it was to have a host of orthopaedic problems with a complication always waiting in the wings. One procedure begat another and so it was with me. The fact that I had company in this regard mattered little, and now, some years later, I rather doubt she would have much good to say about me.

From my perspective, the only good things to come from this were that eventually she did heal and perhaps just as importantly, I was forced to take a hard look at how I talk with and to my patients. Studies have shown that my impressions of my “people skills” were pretty typical; 80 percent of orthopaedic surgeons consider themselves good communicators. The same studies, however, show that patients peg the number quite the reverse. High tech/low touch is how a majority of the public looks at us.

This dismal grade is not, of course, news. The Academy has for some years recognized that our public image was not what it should be. S. Terry Canale, MD, in fact, made improved communication skills the theme of his presidential year. John Tongue, MD, now AAOS first vice-president, took on the task of developing a Communications Workshop that is now offered at every Annual Meeting, while training others to put on the course for groups upon request. The problem is, even now, too many of us either fail to recognize that we could use some help or decide our CME is better spent taking a course on the latest new thing. But maybe not.

How doctors think
I was in our doctors’ lounge a few days ago when I overheard two medical colleagues discussing the book How Doctors Think (by Jerome Groopman, MD, Houghton-Mifflin Co., 2007). Having recently obtained a Kindle e-book and having no particular selection in mind to start out with, I downloaded it. While geared primarily to practitioners of general medicine, I found there were some observations that very much pertain to us boneheads.

Most of us would take offense at being tagged doers, not thinkers [see “strong as an ox and almost as smart”]. But admittedly, diagnosis for us is usually not a problem. Our schedules are filled with patients with similar complaints with similar diagnoses requiring similar treatments. If a plain X-ray doesn’t reveal the answer, modern imaging almost surely will. Aside from a few basic tests, blood work is pretty much a foreign language for us requiring translation.

This is not a bad thing. If nothing else, straightforward problems are crucial for staying on schedule and we all know that next to competence and caring, patients appreciate promptness. It should come as no surprise, therefore, that studies show we interrupt the patient’s story after only 18 seconds, having already diagnosed their problem. We spend a good bit more time deciding what to do about it, but too many patients leave feeling their complaints have not received a proper airing.

But dealing with more than mere dissatisfaction, How Doctors Think is filled with instances of how miscommunication between patient and doctor can lead to error. Of a particular patient whose case was marked by faulty diagnosis after faulty diagnosis despite a wealth of modern diagnostic procedures, the author remarks, “it was her words that [finally] led to the correct diagnosis.” Accordingly, he observes, “language is still the bedrock of clinical practice.” In his workshops, Dr. Tongue advises, “patients come to us with a story to tell and we should let them tell it. Sometimes they’ll tell us what’s wrong.”

Editor’s note: This editorial is reprinted with permission from The Georgia Orthopaedic Society NEWS, August 2011. Charles N. Hubbard, MD, who edits the publication, practices in Carrollton, Ga.