Going in the right direction?

Just came back from a good walk and had lots of thoughts swirling around in my brain that I thought I would deposit here so I can reclaim the brain space for other uses. I’m curious about the focus in the two formal education programs I’ve attended (business & medicine) on “hard skills” (i.e. technical skills like finance or biochemistry) vs “soft skills” (i.e. communication skills, other topics that fall more into EQ vs IQ). While obviously it is important that we learn for example what ulcerative colitis is, how it presents & how to treat it, we spend so little time focused on how to say things to patients and what not to say. All of our courses are focused on biomedical info, with only 1 course for 1 semester in 1st year dealing with communication skills. Who says that the best way to learn communication skills is to watch & learn? We don’t all learn like that. I think that being provided the info in a more formal way can help us leapfrog into being stronger communicators faster and with less causalities & legal proceedings (minor side benefits). Beyond these soft skills, I’m getting a bit saddened (though not surprised really) by the lack of any other treatment options besides drugs & surgery. That’s pretty much all they teach us about. Even now, when we’re focused on the gastrointestinal system (esophagus, stomach, small & large intestine, etc) we received 2 lectures on nutrition taught from a very mathematical & biochemical perspective. They don’t even get to the level of “refined carbs are bad” – and they certainly don’t give us any other tools to help our patients other than to direct them to follow the Canada’s Food Guide. While I’m sure a swat team of uber-professionals have devised the Canada’s Food Guide, I mean really – who in real life actually ever looks at it? No one. Here it is in case you’re having a sudden urge. So why not talk to us in terms of real food – what’s good, what to avoid? How about telling us some good cookbooks to recommend to our patients? Argh. Nutrition is supposed to be a curricular theme which is (in theory) to blanket our entire education. They have a portion of our student website dedicated to information on these curricular themes which also include radiology (x-rays, etc), oncology (cancer), professionalism/law, marginalized populations, infectious disease AND nutrition. All of them are jam-packed with info except for nutrition. Under the nutrition heading, there is no information. Zilch. Nadda. Nothing at all. I guess we’re on our own for that one. Happily, I met a fantastic Nutritional Consultant this summer at Inspire Health (formerly Centre for Integrated Healing) and shadowed her a bit. I think I’m going to do some more shadowing of her to try to supplement my education in that department. I desperately want to have more to offer patients than drugs or surgery. My other thoughts today were largely around quality vs quantity in medicine. Why do we expect to be able to drop into people’s lives in 10 minute chunks and in that time frame, build enough of a rapport to facilitate them spilling their most private thoughts and fears to us within those few minutes. Relationships take time to build. While I know that with some friends whom I’ve known for years, I can get into this ‘deep drop’ within seconds of talking to them - with others, it takes a little while to warm up & catch up before you get into the real ‘meat’ of what’s going on in their world. But all of those relationships require ongoing cultivation where I invest time, in greater than 10 minute increments. As far as medicine goes, I’ve been thinking it would be nice to have up to 1 ½ hours for a first appointment so that you can get to know all about the person when you first take them on as a patient (and they can get to know you, your philosophy & style). By spending that time upfront, you might be able to find out more than the bare bones. Instead of just their relevant family medical history, for example, you might learn about their current family dynamics, their childhood and any healthy/unhealthy patterns. While you talk to them, you could notice their communication style and a little bit about how they think about things – which could help in future for tailoring sensitive info in a way that they can best hear & understand. Are they direct or indirect communicators? Do they like to know all the details or just the big picture? With the 10 minute intervals, doctors are able to see a lot more patients but with much lower quality interactions. Don’t get me wrong, 10 minutes can be plenty for refilling a prescription but I just don’t think we should all & always get the lowest common denominator. That just sucks for everyone. Why, at school, do they fondly refer to Sir William Osler and his approach to patients (specifically recognizing the therapeutic value of the physician’s role as empathetic/sympathetic listener & the importance of taking a good history) and yet when we get out into the world, it’s not like that at all. This week, I told my family med supervisor that I have to take a complete history on a patient in her office (like they do in internal medicine) and was wondering if we could bring someone in for a 20 minute appt to do that. I was met with a guffaw and the words “Yeah, right – sorry I don’t think so.”. (In the meantime, the school recommends I use a 1 hour appt for this.) When I told her the scope of the assignment & that I’d go as fast as I can and do my best to fit it into 10 minutes, she came around a little and decided that I could probably go ahead since she could continue to see patients in the other rooms. Just to give you a sense of what a complete history is, here are the main headings: ¨ Chief complaint ¨ History of presenting illness (details about any pain or changes in habits) ¨ Past medical history ¨ Medications/herbals/supplments, allergies, sensitivities ¨ Family history ¨ Social history (relationships, kids, lifestyle (alcohol, drugs, sex)) ¨ A series of specific questions related to each system I think that her reluctance in my taking this time isn’t the doubt that it would be of value, but rather trying to make her practice financially viable. In fact, she said that by the end of the appointment I’ll probably know more about that person than she does. That’s unfortunate. But currently that’s what the system seems to be all about, quantity over quality. :(