Published on KevinMD on April 16, 2021, “Difficult” patients: Is it them or is it us?” by Laila Kind should be mandatory reading for medical personnel and patients alike. Dr. Kind is studying a new field of medicine called Narrative Medicine.
What I used to call “taking a good history” is now referred to as Narrative Medicine. A primary tenant of Narrative Medicine is listening to the patient and recording the history of why they are in the office in their own words, letting the story unfold on its own.
The author states, “Patients’ feelings of dismissal by providers is a rapidly growing problem. A 2019 study found that patients were interrupted after a median of 11 seconds, about as long as it takes to sing Happy Birthday, once.” Despite the fact that this information is not new, the behavior is almost impossible to extinct. I have witnessed it myself since becoming a patient and have been guilty of it as a physician.
My profession has ruined itself with the insertion of the EMR (electronic medical record) into every facet of medicine. The EMR has a workflow that demands patient and physician input in a fixed way. Patients, who tell their stories in highly personalized and often random ways, create havoc in an EMR atmosphere. One of the reasons physician interrupt us so early into our conversations is to force us into divulging what the EMR wants in the order the computer program wants it.
Another reason why it takes only 11 seconds for a physician or his staff to interrupt our story has to do with time management. As physicians sold to large corporations, their role changed from doctor to provider. The MD’s time was always limited by patients in the waiting room who needed to be seen. The provider’s time is managed by an employer who pressures the provider to see large numbers of customers efficiently and expeditiously.
In the last paragraph of this excellent paper, Dr Kind suggests a solution to today’s problems that, unfortunately, I think are unachievable. As patients, we need to take control of the narrative in our physicians’ offices. My suggestion is that, in advance of your visit, you should outline what information you want to relay. The whys, hows, whats, whens and wheres of your ailment so that you can succinctly deliver the information your physician will need to understand what you are experiencing and how to help you.
While you are writing out your summary, also make a list of the medications you are taking and how you are taking them. A list of allergies and a family history will be helpful as well. Take copies of everything to give to the doctor.
I have written about the art of listening in the past. If you notice that your physician is not listening, you must point that out to him or her! I know that is difficult but two-way communication with your MD is critical.
Now for a couple of jokes:
They say sex is a killer…
Do you want to die happy?
A judge was interviewing a woman regarding her pending divorce and asked, “What are the grounds for your divorce?”
She replied, “About four acres and a nice little home in the middle of the
property with a stream running by.”
“No,” he said, “I mean, what is the foundation of this case?”
“It is made of concrete, brick and mortar,” she responded.
“I mean,” he continued, “What are your relations like?”
The woman replied, “I have an aunt and uncle living here in town, and so does my husband’s parents.”
He said, “Do you have a real grudge?”
“No,” she replied, “We have a two-car carport and have never really needed one.”
“Please,” he tried again, “Is there any infidelity in your marriage?”
“Yes, both my son and daughter have stereo sets. We don’t necessarily like the music, but the answer to your questions is yes.”
The judge tries again, “Ma’am, does your husband ever beat you up?”
“Yes,” she responded, “About twice a week he gets up earlier than I do.”
Finally, in frustration, the judge asked, “Lady, why do you want a divorce?”
“Oh, I don’t want a divorce,” she replied. “I’ve never wanted a divorce. My
husband does. He said he can’t communicate with me.”