Seeing and hearing

[摘要] Ask any doctor, and they’ll tell you that talking to patients can be difficult. Mind you, ask any patient and they’ll tell you that talking to doctors can be really difficult too. The Consultation, that mythical and commonplace occasion during which both processes occur, can sometimes feel like a shared illusion of communication,1 which leaves both parties none the wiser.Doctors are routinely trained in communication skills now, although there are times when what I really want is to send my patients on the course. Even as I listen, I find myself willing the person opposite to give me just a little more to work with, or a little less. There are so many potential barriers to understanding each other, from the lack of a shared language, verbal or non-verbal, to a divergence of expectations or simple time pressure. And yet, I have a suspicion that what underlies our difficulties is often something else.Patients sometimes talk in ways that make little sense to us, repeating seemingly unimportant details, abruptly changing subject, and even contradicting themselves. We sit patiently, waiting for ‘usable intel’, or grab hold of the first thing we can. Even when a coherent thread emerges and we offer a diagnosis and management plan, the response can be surprisingly cool. What escapes us is that people talk like this for the same reason they hold their hand in front of them on first meeting someone: not to have it scrutinised, but to bridge a gap. In general, people overestimate the extent to which this is necessary.2 We worry that strangers are different and won’t understand or like us, and this can make it difficult to talk about things that matter, especially with someone as famously busy as a doctor.Judging by their comments, patients regularly worry that they’re wasting our time or that we’ll think they are, and much of what they say is intended simply to engage our attention and sympathy. We tend to question our competence and fret about missing a diagnosis, but the person in the other chair is usually more concerned to know whether we’re listening and taking them seriously.3RAPPORT Connecting is the first of Roger Neighbour’s five checkpoints in the consultation,4 not just a verbal or literal handshake, but rather something that must be maintained in order for effective communication to take place. This is what is meant by rapport, a state of mutual responsiveness to which both parties contribute,5 but which in a medical context is primarily the doctor’s responsibility.

[学科分类] 卫生学