Monday, July 23, 2012


I received something curious in the mail.  It appears to be a brochure for “America’s Top Physicians” offering a variety of plaques that can be ordered and engraved with your name, sponsored by the “Consumers’ Research Council of America”.  If this is a legitimate organization, someone please let me know.  I doubt it though.

It reminds me of mailings that I used to receive from a vanity press.  They lost track of me after I moved (or realized I would never give them money and dropped me from their list).  I forget their exact name now, but it was something very similar, like “America’s Top Poets”.  Their letters would claim I had been selected to submit my work to an “exclusive” anthology, which would give me the recognition that I “deserved”.  Their true agenda, as far as I could tell, was to induce people to buy the anthologies.  The quality of your work did not really matter, as long as you were willing to pay to see it in print.

Now I seem to be on the mailing list of the doctors’ equivalent of a vanity press.  I am offered the opportunity to buy “Honors of Distinction and Excellence”.  The options are quite amusing in their extravagance.  I could get one that looks like a fake magazine cover or one that resembles a diploma.  I can’t decide if my favorite is a huge crystal cup on a pedestal, a silver globe, or an engraved glass plaque standing between marble columns. 

I had a laugh at the pretentiousness of all this, and the shallow ploy to extort money from doctors.  It also gave me pause, though, to think how vulnerable we might be to this kind of vanity.  As doctors, we are used to being high-achievers and received academic awards throughout our education.  Once we get out in the world, that phase is over, for the most part.  In practice, there are no more mentors or supervisors looking over our shoulders and telling us when we are doing a good job.

On days when we are worn down by the less satisfying aspects of medicine, we may start to feel underappreciated.  Maybe a fancy award is just the thing to cheer us up.  But what does it mean?  If it’s not an honor that is earned, but a purchase that is marketed to us, what is the point? 

I will stick to the internal reward of knowing that my hard work is helping patients.  It may be less tangible than a “distinguished ebony piano wood plaque with a sculpted three-dimensional plate” that is “laser engraved with your personal information regarding your accomplishment”.  But it is much more valuable.

Sunday, July 15, 2012

Three of my favorite things

I have been away from the blog for a few weeks, due to travel and the crush of work that comes before and after any attempt to get away.  I attended the annual COMET conference, which one might think is an astronomy event but in fact is an academic meeting on the subjects of Communication, Medicine, and Ethics.  It gives me a chance to go beyond my usual sphere (dominated by medical professionals) and meet social scientists, linguists, and other researchers who share my interests and approach them from a different perspective.  It is a truly international and interdisciplinary experience.

The conference reminded me how central communication is to the practice of medicine and how important its ethical implications can be.  No matter how reliant we become on blood tests and fancy imaging, the tasks of eliciting and interpreting the patient’s story remain the key to diagnosis.  Explaining the diagnosis to the patient, negotiating a treatment plan, and answering questions are equally vital duties of physicians. 

Our education tends to focus heavily on the clinical decision-making that occurs within the physician’s mind: weighing evidence, drawing conclusions, and discerning how best to proceed.  The step of translating this medical knowledge into a form that is understandable to patients receives much less attention.

We may assume that talking to patients is the easy part of medicine.  However, this is often not the case.  We forget that our jargon is a foreign language to most people.  We overestimate how well we are understood.  Patients may agree with what we say, not because they really do but because they are afraid to speak up or ask questions. 

Medical encounters are a prime setting for misunderstandings: two (or more) people who do not share the same vocabulary or frame of reference, with an unequal power dynamic.  Furthermore, in medical encounters, misunderstandings can be particularly damaging.  These conversations are fraught with peril.  Bad news broken badly can make an already difficult situation much worse.  Patients’ concepts of their illnesses, treatment options, and prognosis may have a profound effect on their lives.  But their physicians may be oblivious to the subtleties of tone and word choice that convey meanings, which may or may not be intended.

What we say (and how we say it) has the potential to do much good or much harm.  I am encouraged to see the breadth of research being done in this area, but there is certainly a great deal more to do.  How healthcare professionals do communicate, how we should communicate, and how to teach ourselves and our trainees to do better, are questions that merit attention.