Berks County Medical Society Medical Record Summer 2018 - 5

Editorial CommEnts

Forward
by Lucy J. Cairns, MD

uman beings are
fundamentally social.
We depend on regular
interaction with other humans
to survive and thrive, and verbal
communication plays a central role
in most interactions. Anyone who
avoids frequent communication
and with others is viewed as
aberrant: just consider the image
conjured up by the term "hermit." How many of us go through
even a single day without speaking to someone? In this edition of
the Medical Record, we focus on several communication challenges
faced by physicians.
The practice of medicine would be impossible without
communication in the form of conversations with our patients.
Through conversation we strive to learn what the patient is
experiencing to aid in making the diagnosis, we engage the patient
in devising a plan of testing and treatment, and we demonstrate our
care for the patient. If we communicate effectively we can hope
that the process builds trust that will result in a partnership with the
patient as they follow through with treatment. I imagine that most
physicians find few aspects of their work as rewarding as this process
when it goes well.

Medical Education. One free resource for evidence-based education
in this area is the nonprofit VitalTalk, which offers both online
and in-person programs. Sir William Osler's insightful statement
"The good physician treats the disease; the great physician treats
the person who has the disease" is now reflected in the standard
approach to medical education.
Delivering bad news is not the only communication challenge
in the life of a physician. Part of what makes the profession a
source of endless interest is the uniqueness of each person one
encounters upon entering the exam room. I find that I am most
confident in my own communication skills when I am with a patient
whose cultural and educational background is similar to mine,
since I can better intuit the style of communication that will be
effective and well-received. The more distance there is between my
own experience and that of the person in the exam chair, the less
confident I am and the more likely I am to let my communication
style be influenced by implicit bias and false assumptions. Alexandra
Santoro's synopsis of her dissertation, in which she examined the
effects of physician knowledge and attitudes on clinical decisionmaking with patients with Intellectual Disability, adds to our
knowledge in this area and resulted in findings which were
unexpected.

Naturally, not all conversations go well and some are inherently
more difficult than others. Every physician is regularly faced with
the need to convey bad news to a patient, ranging from mildly
unpleasant (such as the need to lose weight or prescribe additional
medication to bring diabetes under better control) to extremely
distressing (such as a cancer diagnosis). When a life-altering
disease or event must be communicated, the way in which the
physician approaches and structures the conversation can make all
the difference to the patient's subsequent wellbeing. An effective
strategy is one that is sensitive to the individual patient's cultural and
spiritual background, respects the patient's preferences regarding the
type and amount of information desired, checks for understanding,
and demonstrates empathy.

Physician-to-physician communication involves a different set
of challenges. One of the most difficult conversations a physician
can have with a colleague is about suspected substance abuse-an
illness that strikes physicians just as often as any other group. Since
a physician with a substance use disorder (SUD) is at increased risk
of doing harm to patients, a colleague who has reason to suspect
its presence has an ethical obligation to act. Intervening when
substance abuse is suspected is vital not just to prevent potential
harm to patients, but may also save the life of the afflicted physician.
Depression and anxiety are frequent co-morbidities in those
with SUD, and the combination is associated with a significantly
increased risk of suicide. Dr. Larry Rotenberg served as Chairman
of the Reading Hospital's Physician Health Committee for more
than three decades, and his advice for exactly how to handle this
difficult situation is clearly presented in his article.

Historically, medical training has emphasized the acquisition
of knowledge and technical skills without devoting space in the
curriculum to interpersonal skills such as communicating with
patients. This has changed with the accumulation of evidence
regarding the importance of effective communication for improving
health outcomes and patient satisfaction. "Interpersonal and
communication skills" is now one of the six core competencies
required for all specialties by the Accreditation Council for Graduate

Rounding out this edition is Dr. Dan Kimball's article on endof-life planning using the tools available from The Conversation
Project. Having this type of conversation early and repeatedly
with older relatives regarding their wishes, and with the family and
friends who might be involved in our own care as we near the end
of life, is truly vital in order to live out life on one's own terms and
relieves loved ones of the burden of having to guess at the choices
we could have made for ourselves.
SUMMER 2018

Berks County Medical Society Medical Record Summer 2018

Table of Contents for the Digital Edition of Berks County Medical Society Medical Record Summer 2018