Tell it to Me Straight, Doc

WHAT HAPPENED TO GIVING A PATIENT a dose of the truth? The old kick in the pants, get up off your duff, stop killing yourself slowly with cigarettes, fast food, reckless behavior and so on. Are we so politically correct that we are becoming ineffectual healers? As a new practicing physician, I feel well trained on how to over-order labs and studies, document defensively, and practice limited disclosure under the guise of HIPAA. What I do find myself wanting to do more is speak my mind to patients on issues I feel strongly about that pertain to their health.

I am currently taking a faculty development course to improve my leadership and interpersonal skills. One theory we have been discussing is the left-hand column/right-hand column construct. The left-hand column is your internal dialog (i.e., what you think) during an interaction, and the right column is what you actually say.

This kind of material is nothing new. The incongruence between the two has been fodder for movies (think What Women Want with Mel Gibson) and sitcoms (Wonder Years, Malcolm in the Middle). Conversely, when someone speaks from his or her left-hand column uncensored, that can be a load of fun, too (think of the sitcom House, MD or Kevin Nealon as "Subliminal Man"). Thinking about our left-hand columns can help us understand our patient encounters better.

For example, how often do you tell patients that they are "a bit overweight," "should think about quitting smoking," "might want to set better limits for your children," "might want to use contraception a little more regularly." Meanwhile, your left-hand column screams, "You are overweight and we need to do something about it," "You need to quit smoking or it is going to kill you," "Your kids are out of control, and you need to set clear and specific limits," or "You must use contraception more regularly unless you want an unexpected pregnancy."

If we do not regularly vent our left-hand column, it will build up like steam in the pressure cooker. Clearly, this is not healthy. We may feel burned out, unappreciated, ineffectual, and misunderstood. We may try to relieve the pressure in other ways, by ranting to colleagues or loved ones.

The left-hand column is also useful in eliciting a patient's agenda and feelings. How often do we see a patient physically frustrated or agitated when we feel we are being very attentive and caring? We often leave the encounter thinking, "Gee, what a sourpuss. I hope he doesn't come back soon." Or, "They really don't give a damn about what I have to say."

Instead, try casting your line out for a piece of their left-hand column. "Mr. Jones, you seem quite agitated today when we talk about this. What is on your mind?" Or, "Mrs. Smith, you don't seem very pleased with the treatment I am proposing. Is there something else you had in mind?"

I hope someone finds this as useful as I have. Consider the left-hand column as your last problem on the list after health maintenance. Don't let it stay hidden and festering. Seek it out, expose it, deal with it, be active, and be a more effective healer.

HitzemN@sutterhealth.org