One of the things I like best about the practice of medicine is talking to people and getting to know their life stories. Patients tend to treat their doctor like they would their priest-confessor because they know we are sworn to confidentiality, with few exceptions. Medicine, particularly internal medicine, relies a lot on history-taking to make the diagnosis. Early in medical school, we were taught that 90 percent of the time, you can figure out the diagnosis from the medical history alone, and the other 10 percent you can get from the physical exam. Labs and imaging are just to confirm your suspicions. The best medical histories are so detailed that they don’t miss anything, from childhood illnesses to allergies, sexual histories, and familial illnesses. In other words, medicine is for nosy people. My theory is that the reason Filipinos make such good doctors and nurses (who also do medical histories of their patients) is that we love hearing people’s stories. In a word, “marites.”

They say communication is a two-way street. While it is easy enough for doctors like me to talk to patients about their health, a lot of times what doctors tell patients in terms of medical advice can easily get lost in translation. I will be the first to admit that I am sometimes guilty of using medical jargon that I assume the patient understands, but in fact, does not. The patient doesn’t say anything because they are just being polite. I am acutely aware of this danger, and I do my best to explain to patients in non-medical terms as much as I can. However, when it gets busy, it’s easy to forget that we aren’t talking to trained medical professionals, and we easily lapse into technical language.

Just this morning, I went into a hospital room on my usual rounds and proceeded to update a patient on her urinary tract infection (UTI). She had been admitted to the hospital three days before with some urinary discomfort and fever, signs and symptoms consistent with a UTI. We started her on intravenous (IV) antibiotics and sent several laboratory tests, including a CBC (complete blood count), a urinalysis, and a urine culture. She was a nice lady in her 70s who gave me a sweet smile when I entered.

I said, “Good morning po! How are you feeling this morning?"

“I feel great!” she replied.

“Your WBC count is improving on your repeat CBC, and you haven’t had any more fever. We are just waiting for your cultures to come back, and hopefully we can switch your IV antibiotics to an oral one and discharge you soon.”

Her smile widened, and she said, “That’s great news!”

I smiled back, gratified that I had made her day, and turned to walk out the door to the next patient room. But before I could leave, she added,

“But can you please tell me what that means?”

I stopped in my tracks, appalled at how I completely failed at communicating with my patient. I walked back and sat down on the chair next to her bed, leaned toward her, looked her in the eye, and said, “Mrs. Y (identity withheld for privacy), I’m sorry that I didn’t make myself clearer when it came to talking to you about your health. My name is Dr. Salvana. I’m one of your doctors, and I specialize in treating infections. Let me try again.”

She nodded and waited expectantly.

“Do you remember why you came to the hospital?”

“Yes, I think it was a UTI.”

“What were you feeling?”

“Some pain when I went to the toilet.”

“Is your pain better?”

“It’s gone.”

“That’s most likely because we gave you antibiotics for the UTI, and the medication is working.”

“Thank you! When can I go home?”

“Your laboratory tests are looking good, and we are just waiting for one more test, which will tell us what antibiotics we can send you home with.”

“That’s great! Thank you, doctor.”

“Do you have any other concerns or questions?”

“None at this time.”

Mrs. Y is elderly, and she may have also been a bit hard of hearing, but this doesn’t excuse what I did wrong. Medicine has evolved substantially from the days when the relationship between a doctor and a patient was “patriarchal,” which consisted of the doctor making all the decisions for the patient. The rationale was that the doctor had specialized knowledge and knew what the correct medical decisions were better than the patient. Many patients accepted this then, and until now, I still have a few patients who ask me to make all the decisions for them. Medicine has evolved into a partnership between the patient and the doctor, and there is no way a patient can participate in this partnership if he or she doesn’t have an idea of what is going on.

During my residency training in the US, our program held special training sessions for properly communicating with patients. This included seminars on how to properly listen to a patient and how to break bad news. For instance, in the case of Mrs. Y, I used some of these lessons (when I realized my mistake) by going near her, sitting down to signify that I was ready to listen, looking her in the eye, and leaning forward to signal that I was engaged. I also used simple language and short sentences, avoided jargon, and gave her a chance to ask questions. A study looking at patient perceptions of how much time a doctor spent with them showed that if a doctor sat down and spoke to a patient at eye level, patients felt that more time was spent with them than if a doctor was standing over the bed. This was despite the fact that the two study groups (sitting and standing) spent the same amount of time with the patient.

Doctors in this day and age are much more aware of the importance of good patient communication. But we sometimes forget to do so because we get so busy. If you are a patient and you feel that you are being left out of the conversation, please do remind us. We don’t mind. After all, it is your health that is the reason for our being here.