This article concerns what I call the poor conversationalist. There are several common versions of this, and all of them have corresponding parallels in nonmedical settings. Often the most basic difficulty is one of manner. A good conversationalist is a person who, no matter what he is thinking, outwardly projects an air of interest in what the other person is saying. The doctor who acts distracted, hurried, or even uninterested gets the conversation off very much on the wrong foot, especially if parents have been waiting a long time to see him. This sort of doctor may avoid eye contact with you. He often continually writes while you speak; although most of us take notes during an interview, parents not unreasonably expect us to look up at them now and then.
A poor conversationalist is impatient to get at what he assumes to be the crux of the matter and will interrupt parents, cutting off their explanations. It is true the doctor typically directs the flow of conversation, but he needs to do this in a way that does not stifle it. If he is too heavy-handed, the result is a very one-sided conversational exchange, which can, in turn, result in suboptimal medical care for the child. Knowing how to guide and direct rambling historians is a delicate skill for physicians. The poor conversationalist, however, often errs on the side of demanding from parents short, even yes or no answers only, to the questions he asks. He does not want all the details. As he sees it, like Officer Friday on Dragnet, he wants “just the facts, ma’am.”
Besides being annoying, the doctor who is a poor conversationalist of this sort will miss things, occasionally important things, because there are times when it is the details that really matter. A doctor like this often glances at the child or the chart and makes an early, snap judgment about which way to go with the interview when it has barely begun. Already convinced about what is important, he may then interrupt parents who he perceives as wandering from the key points of the history.
Our innate personal conversational styles can also interfere with the process. These are things which, although causing little problem in other aspects of our lives, can interfere with our roles as physicians. Some of us mumble, others of us gaze at the ceiling when talking, and still others of us use convoluted ways of expressing ourselves. Some of us present ourselves as amiable conversationalists, others of us come across to parents as unduly grumpy. If you find yourself trying to understand what a soft-spoken, mumbling doctor with an irritating facial tic is trying to say to you, remind yourself this person may well be an excellent physician for your child, exasperating as it is for you to understand what they are saying to you.
Parents who find themselves opposite a physician who is a poor conversationalist for any of these or many other reasons often become frustrated, and sometimes angry. After all, you have been waiting to see this person, sometimes for hours, or you may have made this evaluation appointment for your child weeks in advance. Now your concern is to get the most for your child out of an interview that seems to you to be moving in an unsatisfactory direction: how can you do this?
I think the most crucial thing is to remind yourself that you and the doctor truly are partners in the diagnostic and therapeutic enterprise, and most doctors, no matter how harried and frazzled at the moment, realize and understand this if given the chance. If you, as a parent and as a partner with the doctor, feel the interview is going seriously off-track, there are concrete things you can do to restore its direction.
For example, show you know how important it is to present your child’s symptoms in the order they occurred, what they were associated with, and what made them better or worse. Be as precise as possible in your words. Remember to stick to one symptom or complaint at a time. A doctor who is already a marginal conversationalist often becomes an interrupting, controlling interviewer if he perceives a parent aimlessly wandering around with disjointed answers to his questions. Once an interview goes seriously awry in that way it is very difficult to restore the situation.
Christopher Johnson is a pediatric intensive care physician and author of Keeping Your Kids Out of the Emergency Room: A Guide to Childhood Injuries and Illnesses, Your Critically Ill Child: Life and Death Choices Parents Must Face, How to Talk to Your Child’s Doctor: A Handbook for Parents, and How Your Child Heals: An Inside Look At Common Childhood Ailments. He blogs at his self-titled site, Christopher Johnson, MD.
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