Today in our Ecology of Health class our lecturer (who is a rural general practitioner) brought his 2 patients in so that we could learn some interviewing skills hands-on in order to get a complete patient history. I think it was a very useful exercise because oftentimes as doctors, you can forget about how patients see you so it's good to think things from their perspective. For example, the patient said that she would actually be more reassured/ appreciate more if the doctor admitted that he or she did not know what specifically was wrong with the patient rather than give false reassurance that the patient will get better. Also, the teenaged patient revealed that it would be better if the doctor talked directly to her rather than to their parents during the consultation.
For this past week we have learned some interviewing skills and non-verbal communication skills. For example, the way your practice is set up is important to make them feel dominated / reassured. Sitting across from the patient makes them to likely feel intimidated because you assume the dominant position. Seating them in a corner makes them feel less threatened and is more conducive. Seating them beside you, you are then assuming a more co-operative position. We also watched a video showing us the importance of the way you greet your patients before they enter the room- how much eye contact you give them, your body language (are you leaning forwards, or crossing your legs, or are you seated too far away from the patient, are you turning your back against your patient when they walk in, do you seem interested in them as an individual). I think these things are more important than what people make it out to be because it was just eye-opening to realize the differences in practices that I've been to in Singapore (GP vs specialist) vs that in Canada (GP vs specialist). Many of the practices in Singapore that I've been to have placed the patient across from the doctor, and to be honest, it did make me feel intimidated like the doctor is dominating. I think these things, though they appear to be small/ sometimes seemingly insignificant, makes the difference in providing the ideal environment/ circumstances for potential patients to open up and really tell you about their conditions. (Also apparently many doctors tend to cut off their patients within 15 seconds of them talking and don't get the full picture of what's going on so the key point here is to listen more than you talk).
Also, in class today it was mentioned that patients don't actually have an accurate way of judging how good of a doctor you are. They usually gauge that by how much you seem to care about them as an individual. So I mean it really comes down to how you present yourself for that first impression and also your interpersonal skills.
Though it sounded very common-sensical, I think it's a lot harder to master than it looks or sounds. It's certainly challenging I think sometimes to reassure potential patients with regards to their conditions, try to figure out what you think is causing their symptoms and at the same time to watch what you say (how you word things basically). I think it's amazing how just asking for their medical history, social history, family history, their current symptoms, how that's affecting their daily lives, what they expect from this consultation and what their allergies are can tell you so much about their lives and who they are as as individual. And to know that some of the things they are telling you, sometimes even their significant others don't even know. The trust they put in you is quite empowering. Also we were taught to reinforce what they just said to make sure you are on the same page as them and to show to them that you are in fact listening. Some good questions to ask would be like:
- What brings you here today? (like a good greeting message)
- How is this condition affecting your life?
- What kinds of treatment have you gotten for it and how have you responded to it?
- Who have you seen about this?
- What have you tried to do yourself to relieve these symptoms?
- Have you done something out of the ordinary recently that you think might have caused this symptom?
- How long have you had this symptom/ these symptoms for? Does anyone from your family have this condition?
- What is the pain like? (asking for quality of pain)
Finally when you do offer them the range of possible treatments, ask them how they feel about it (also have to read their body language and respond accordingly)
I think what intrigues me the most when given all this information is how it's similar to putting together a puzzle basically. The best part is that every patient presents with different symptoms (even if they are diagnosed with the same disease) because even though there is a normal range in things (like normal BP is usually 120/80), different heights and different individuals present with different blood pressures and can still be considered to be "normal". Also, often I think it would also be interesting to treat certain conditions when they have other conditions affecting them because it would definitely affect how you manage their condition and the advice they give you.
We also talked about the shift towards a more teamwork based healthcare system rather than the traditional view that the doctor is the dominant person in healthcare/ center of healthcare.
I'm really looking forward to that general practice placement in Melbourne this June where I'll hopefully observe a GP and help take some patient history. And that's the beauty in it :)
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