Communication Breakdown

Led Zepplin has a song called Communication Breakdown:

communication breakdown

its always the same,

I'm having a nervous breakdown

Drive me insane

I think that all areas of life are filled with miscommunication and it is no different in the physician - patient relationship. Often I am able to be an observer of the attending physician treating / talking with the patient. In this role I get a unique perspective where I can listen and see the doctor and patient communicate. It is very easy in this role to see where communication breaks down and a misunderstanding occurs. 

Often a patent presents a symptom or tells how they feel and the physician may or may not understand exactly what the patient is thinking. The physician does his / her best to interpret the information and then go down a particular  path to help the patient. Unfortunately many people (including physicians) are horrible listeners, so they do not get the whole story which potentially leads them down the wrong path. Often the patient does not want to interrupt or question the physician so the chosen path may not be corrected.

Today we were seeing a 25 y/o female who had presented earlier this week with lumps in both breasts and a small amount of discharge. She was worried about breast cancer. After examining her the doctor and I both thought it was fibrocystic change / fibroadenoma which is a benign fibrous growth. In young women this is very common and most often it is the diagnosis when a young women complains of finding a lump in her breast. However, to cover everything we did a full blood work up and ordered an ultrasound. This patient was coming back to discuss the results.

We looked at the results before she arrived and as we thought everything was completely normal / benign. The ultrasound showed that most likely these lumps were fibrocystic change (benign). Basically she was completely normal. The only way to 100% confirm fibrocystic change is to perform a needle biopsy of the lump but it is not usually done unless the patient is overly worried or there is a strong history of breast cancer in the family. 

When the patient arrived we met in the exam room and I just watched and listened as the doctor presented the good news  to the patient. I could tell that the girl was very nervous about receiving the info. As the doctor explained the findings I could tell that she did not understand exactly what he was saying. She was really looking for reassurance and the doctor was trying explain the ultrasound and the results. I was just observing. I could see that there was a breakdown in the communication and that the patient was still very concerned. She tried to clarify with a couple of questions bit the doctor misinterpreted the questions and failed to really provide the comfort that the patient needed and in fact deserved.

Doctor: Hi, so how do you feel?

Patient: Fine

Doctor: Well we have the results of your blood work and your ultrasound. (long pause as he re-reads the ultrasound report)

Patient: Ok (more pause)

Doctor: Your blood looks good.

Patient: it looks good?

Doctor: You have a disease, (pause) It is called fibrocystic breast disease. (pause) 

Patient: Ok

Doctor: So we can never be sure and the only way we can confirm it for sure would be a biopsy of the breast. 

Patient: oh...... Do I need to do the biopsy today.

Doctor: If you want to go down this road, we can set up a biopsy. Do you want a biopsy?

Patient: Well, what is it for? Do I have to....

Doctor: No, no I suggest you come see me in 2 months and we examine you again. If you notice any changes or I notice changes the we can go from there. 

Patient: Ok 

Doctor: Great, have a good day and I will see you in 2 months.

Doctor leaves the room feeling great. I stay in the room with the patient who is on the edge of crying and not quite sure if she just heard good news or bad news. She looked scared and confused. So I asked "do you have any questions" she did not say anything and so I began to explain what exactly these things meant. I reassured her that this was good news and that she wanted to continue to follow up with exams (next one in 2 months) and to continue her self exams. I explained that fibrocystic change is fairly common in younger women and that she should not panic. I could see the anxiety melt from her entire countenance. I asked her if she had other questions and told to ask everything she wanted to ask and that nothing was a stupid or bad question. She had several more questions that I addressed.

I think that it was easy for me being the observer to sense the miscommunication. So this experienced reinforced a couple of things for me. I need to make sure that I listen and watch for the patient's non-verbal cues. Also, as a patient I need to not worry about asking all the questions I need to ask. Just interrupt and ask the questions. You can worry about annoying the doctor for 2 - 3 minutes or you can leave worried with a lack of understanding and maybe even on the wrong therapeutic path. I would annoy the doctor 2 - 3 minutes.