Full of Questions

When I have questions for my doctor, I write them out in advance.  There are a few reasons for that.

  1. If I don’t write the questions, I’m likely to forget something I meant to ask.
  2. If I take time to write the question coherently, then I clarify to myself what I want to know.  It’s hard to ask my doctor a question when I’m not even sure what my question is.
  3. If it was important enough to write, my doctor knows that this is something to which I’ve given some thought, and am not just asking spur-of-the-moment questions.

One copy of the questions goes to my doctor, the other is for me to take notes on.  It’s amazing how well this works.  I get clear answers to my questions, and I have notes to which I can refer when I forget what my doctor said.

A recent post on KevinMD‘s blog got me to thinking about this.  The author points out the obvious fact that medical jargon can cause miscommunication.  No kidding?  I don’t speak Chinese, so when someone tries to explain something to me in Chinese, I don’t understand.  Likewise with French or Italian or Swahili.  If people don’t understand the words spoken, they don’t understand.  It really doesn’t matter if it’s a foreign language, or a specific field with its own technical vocabulary.

This can lead to problems in the medical sphere.  When doctors speak doctor-ese, patients might nod their head and pretend to understand even when we have only a vague idea what the doctor is talking about.  Either patients need to learn medical terminology, or doctors need to avoid undefined jargon when giving explanations to patients.  Some patients will go on to learn the terminology needed to understand better, but many won’t.  If doctors want their patients to understand, explanations need to be tailored accordingly.

There are enough doctors stating (on multiple posts, on multiple blogs) that patients often don’t understand/remember what’s been told to them, that it’s obviously a common problem.  Doctors explain something, patients claim understanding, then ask something that demonstrates they obviously don’t understand.  Patients blame doctors for not being clear; doctors suspect patients aren’t listening.

Does it really matter whose fault it is?  Wouldn’t it make more sense to come up with a solution?

When I was teaching, we had a saying:

The teacher hasn’t really taught until the student has learned the lesson.

If one person teaches, it implies that another learned.  If no learning took place, then there might have been a lecture or a discussion or a demonstration, but not any teaching.

I’m reminded of my eighth grade science teacher.  It seemed like every concept was explained by being compared to the workings of a car.  Cams and cranks, gear ratios, levers, combustion…  For the people who were fascinated with the workings of the automobile, it really helped clarify things.  They thought he was a great teacher.  For other people, however, who neither knew nor cared anything about the mechanics of how cars worked, those explanations were useless.  Asking questions usually resulted in a repetition of the same incomprehensible car words.  Sometimes a different car explanation was given.  There were other ways to explain the material, but he didn’t ever try a different tactic.  It’s not that what he said was inaccurate, or that some people didn’t find the explanations fascinating.  It’s that half the class had no idea what he was talking about and he never found a different analogy.  One had to go to a different teacher to get an explanation that didn’t rely on a prior understanding of auto mechanics.

You’re wondering how this could possibly be related to patients getting their doctors to answer questions.  Part of what doctors do is educate their patients.  They teach.

Good teachers have more than one way to explain things.  They don’t limit themselves to lecturing; that provides only auditory input.  Understanding increases dramatically when more senses are involved.   Show by drawing an illustration to add in the sense of sight.  Use manipulatives, a hand-held model, or a tactile board to involve the sense of touch.  When the learner gets involved, for instance by repeating instructions, that helps solidify the material.

I can’t help but think how easily this would transfer to medical explanations.  It was really helpful when my doctor used a model of a rotator cuff to explain what’s going on with my shoulder.  One doctor had a dry-erase board mounted on the exam-room wall and drew a very good sketch to illustrate what she was trying to explain.  Showing patients how to do self-injections, then giving them the opportunity for supervised practice works very well.  This is basic teaching methodology.

So when patients don’t understand, how much of the confusion is the patient’s fault, and how much is the doctor’s?  Does it even matter?  Instead of placing blame, wouldn’t it make more sense to find a way to solve the problem? 

Simply encouraging doctors to avoid jargon short changes both doctors and patients.  Nobody needs to be told to do what they’re already doing.  People need new tools.  Doctors who are already providing simple explanations might benefit from asking themselves if they’re like my eighth grade science teacher.  A simple explanation with analogy is useless if the patient doesn’t understand the analogy.  Do you have multiple methods of explaining things?  Do you have models that patients can touch and see to better understand?  Do you provide web links for further explanation?  Do you hand patients paper & pencil so that they get the idea they’re expected to remember what you’re telling them?  Good teachers are always looking for ways to improve, and are happy for ideas that are working for others.

It’s not all the doctor’s responsibility.  Patients need tips, too.  I’ll leave it to the doctors to provide suggestions of things that patients can do to better understand their doctor’s explanations.

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6 thoughts on “Full of Questions

  1. When I was teaching, I must have used 15 or 20 different ways to explain a concept when students had questions. I found that if I used enough different analogies or examples and enough different kinds of terms, my students “got it” a lot faster.

    So, DOH! Of COURSE docs need to use lots of different ways to explain the same phenomenon.


  2. I agree! I have homeschooled six children for 22 years, and I switch my method of communicating to a manner that particular child can understand. I realize in a big classroom this would be impossible, but on an individual basis it is quite possible. I feel compelled to do whatever it takes to cause the “light bulb” moment.

  3. @Laurie – thank you (was – past tense – I’m no longer in the classroom)

    @Elizabeth – the difference, I think, is that teachers have some freedom in how much time to spend on a topic. I only had kids for 50 minutes per day, but we could take two days for a lesson if that’s what the kids needed. Kids could come in before/after school, or on their lunch break if they needed more help. Doctors, on the other hand, only get 15 minutes.

    @Alice – It’s not impossible to use a variety of methods in a classroom setting. Not as easy as sticking with one presentation, but it’s much more effective to use at least three. I never lectured the entire class period. 10-15 minutes is usually all that was needed to explain new material, then the kids got time to practice, and I’d be available to help anyone who still needed a little extra assistance.

  4. Actually, I was quite deliberate in the use of the present tense: you’re still a great teacher, as evidenced by all of your posts about how patients and doctors can better interact with each other! :) L

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