Tuesday, 14 August 2007

The UK's Foot In Mouth Epidemic

Small talk is pretty difficult in medicine. It's not like doctors and patients get together to discuss the day's events over a pint. The situation's pretty simple: one of you has information to give, or something unpleasant to do, and the other one wants you to get on with it. Any conversational interlude just delays the inevitable.

But is silence really an alternative to awkward chitchat?

I went to a pre-assessment clinic today. This is where, 8 weeks before their surgery, patients are told whether or not they are fit enough for the operation. The clinic is run by a Nurse Practitioner, who runs through a checklist of questions written by doctors and does some blood tests. Some of these blood tests have a "sell-by date" on them - usually less than 6 weeks. So, when the patient comes to hospital, I have to repeat them anyway. This sort of thing is the reason why your doctors look overworked, and why your wards smell of mould.

This clinic was for morbidly obese people seeking weight-loss surgery. When you weigh more than 150kg, and you need special equipment just to get onto the operating table, surgery can be risky. I needed to take an arterial blood sample, which is trickier (and more painful) than a normal blood test.

Cue the small talk.

This time, I had an ally: Sarah, another junior doctor, trained in communication skills, who would distract Irene, the Morbidly Obese Patient. What I hadn't counted on was her desperate opening conversational gambit:

"What's your favourite food?"

I frantically tried to signal that another topic might be more appropriate, and we moved onto safer ground: Irene's son.

And then, inexplicably, his favourite food.

Sarah probed and explored the culinary preferences of everyone Irene knew. I wanted to lessen our little trio's communal pain, preferably by taking the needle out of Irene's arm and sticking it into my eye.

Irene had already been through a battery of medical tests by this point, as well as psychological screening to make sure she didn't have an eating disorder like bulimia.

I'm no expert in bariatric surgery, but I would imagine that having a junior doctor talk about what you like to cook for your family in the evenings is not what you need to hear.

But finding the right words on the wards isn't easy at all. I just can't give patients what they want. When "You're going home today" is the only phrase that counts, it doesn't really matter if I've inadvertently trodden on some cultural toes, brought up bad memories, or stumbled into a family argument.

As soon as patients realise we won't be going for a pint any time soon, they stop listening to me anyway.

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