January 22nd, 2011 by Bryan Vartabedian, M.D. in Health Policy, True Stories
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So I’m in the exam room recently with a new patient. After some initial dialog with the child and family, I launched into the business of problem solving. Ten minutes into my history the mother politely asks: “I’m sorry, and you are?…”
I hadn’t introduced myself. I had left my ID badge at my workstation, and by order of some innocent distraction with the child or family, I hadn’t identified myself immediately on entering the room. This is rare.
Sometimes I assume people will know who I am. But I don’t wear a white coat and my stethoscope is concealed. I wear clothes only good enough to sustain the barrage of regurgitation, urine, full-frontal coughs, and sloppy hugs that mark a successful clinic day. A colleague once told me I dress like an algebra teacher. I haven’t quite processed that one, but suffice it to say it’s easy to fall into a mistaken identity.
So I apologized and made a proper introduction. What’s remarkable is how far I went without the mother having any idea about my identity. I can imagine that it took a certain amount of wherewithal to interrupt the person she suspected was the doctor to ask such a basic question. Read more »
*This blog post was originally published at 33 Charts*
January 16th, 2011 by Bryan Vartabedian, M.D. in Better Health Network, Opinion
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I used to think they didn’t, but they do.
Clinical judgment is the application of individual experience to the variables of a patient’s medical presentation. It’s the hard-worn skill of knowing what to do and how far to go in a particular situation. It’s having the confidence to do nothing. Clinical judgment is learned from seeing lots of sick people. Good clinical judgment is when the gifted capacity of reasoning intersects with experience. Some doctors have better judgment than others.
Aristotle called this phronesis — or practical judgment.
Patients have practical judgment. We often can tell when something’s amiss with our own body. Things feel different or look different. Taking action on these observations is how we exercise judgment as patients.
Parents of children with central venous lines, for example, can often identify the early signs of infection before fever has ever appeared. They know the subtleties of their child’s behavior. The same goes for children with epilepsy. People with diabetes increasingly have the latitude to apply judgment to the management of their disease. This tends to be quite defined, however, with fixed variables and limited options for intervention. Read more »
*This blog post was originally published at 33 Charts*
January 12th, 2011 by Bryan Vartabedian, M.D. in Better Health Network, Opinion
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I can’t say that I enjoy the patient encounter as much when it involves a translator. There’s just something about communicating through a third party that changes the experience. But there are some things you can do as a provider to bridge the language gap:
Look. Even thought the translator is doing the talking, look at the patient just as if you are asking the question yourself. There’s a tendency to let the translator act as a surrogate with respect to eye contact and visual feedback.
Smile. A smile doesn’t need translation. It conveys very clearly that have a sincere interest in making a connection.
Touch. I never leave the exam room without some type of sincere physical contact. A firm handshake or a hand on the shoulder go a long way in closing the language barrier.
Say something funny. Patients don’t expect jokes to come through a translator. And there’s nothing better than watching a silly, lighthearted remark make its way into another language. It’s powerful and fun.
It’s important to think about how we can recreate the elements of a one-on-one dialog. What do you do to make a connection beyond spoken language?
*This blog post was originally published at 33 Charts*
January 7th, 2011 by Bryan Vartabedian, M.D. in Better Health Network, Humor, Opinion, True Stories
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In the movie “The Sixth Sense,” there was that kid who saw dead people. I’m like that. But I see patients and their parents instead. They’re all around me.
They’re watching at the grocery store when my kids act up. We meet during anniversary dinners, at Christmas Eve service, and on the treadmill at the Y. I bump into parents when buying personal effects and even during the early morning coffee run in my oldest sweats. I see patients.
The follow-up dialog between the parents might go something like this:
Dad: “Marge, don’t you think Billy’s colitis might be better managed by a doctor capable of pulling himself together?”
Mom: “Don’t be ridiculous, Frank. DrV’s bedhead has nothing to do with his ability to care for Billy. And besides, I’ve heard that he can intubate the terminal ileum in under 10 minutes.”
It’s not that I necessarily mind being seen in the wild. I’m pretty comfortable in my own skin, even when it’s glistening after a workout. I’m bothered more by the fact that patients may be repulsed by my occasional bedraggled appearance. If I knew they were good with it, I might be less caught up with the whole matter. Read more »
*This blog post was originally published at 33 Charts*
December 30th, 2010 by Bryan Vartabedian, M.D. in Better Health Network, Opinion
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We sometimes forget that public transparency can be scary. I’ve found this particularly true for doctors. And they tell me so. This tweet from MD Anderson’s Dr. Garcia-Manero hints that the daily digital repartee that I take for granted isn’t so easy for the newbie:
And this comment came in today from a rheumatologist, Dr. Irwin Lim of BJC Health. It illustrates nicely the hesitancy physicians sometimes feel:
Our clinic’s business manager was pushing me to blog as a means to improve the profile of our group musculoskeletal clinic. I found myself quite afraid of this, as I had not previously participated in social media. I was also wary that I could not control patient comments. Eventually, I tiptoed into LinkedIn. I then started reading blogs and came across yours. Your posts have been very useful and have improved my resolve. A few days ago, I posted my first blog, and have since written a total of 6. It’s been quite enjoyable so far. The social media consultant engaged by the clinic wants me to now create content for YouTube. Some fear has returned, but I’ll hopefully be able to get over this, too.
Is fear specific to doctors? No, but I think the issues are magnified with medical professionals. Image, social voice/personality, permanency, and fear of legal repercussions are among concerns that are disproportionately felt by doctors. So can we mitigate this fear in any way and break the barriers to entry for doctors? Read more »
*This blog post was originally published at 33 Charts*
