Feedback

I had volunteered to interview a 'patient' (an actor) in our communication skills class today. It was nerve-wrecking. It started with me waiting for the patient, and when she came in, i stood up, asked her name and mumbled something about taking a seat.

The introduction was standard, and i began with the prerequisite open question. Got a bit of the history from the open question but 2 minutes in my ears were turning hot and i had run out of things to ask. What to do you ask a patient with a history of non specific epigastric pain brought on by stress and large meals? I couldnt even phrase the questions about bowel movement questions right.

And the whole empathy thing makes me feel like such a hypocrite- as part of 'good communication skills' we have to say things like 'i understand how you feel' and 'im sorry to hear that'. There should be a glimmer of genuine empathy when saying it, but really, i feel like a faker. Im just saying these things because i know i have to show the patient im listening and i care. Its not that i dont care about the patient, i just think saying a phrase doesnt necessarily mean you care. It just appears as if you do. I felt so fake- during the interview i was thinking, "oh yeah, say that, sound empathic..."

My ears were burning and i was running out of questions fast. I was going through my mental list of questions and trying to tick then off, which by the way, is not the way to do a consultation. I did the classic stalling technique- quick recap of information gleaned from the patient, hopefully it'll trigger either fresh questions from my point of view or a comment from the patient. Didnt work for me though. I was stuck, and stuck good.

I did get the patient to open up a bit more, but i had totally missed a clear clue/flag in what the patient was saying. I was so harried, i didnt really listen and picked up that her symptoms were brought on by stress. It was my cue was to ask her to elaborate about the stress- i missed it instead and so didnt get a whole chunk of information.

By this point i was looking at my tutor (the very fit, yummy and slighty quirky young lecturer) with a desperate 'come and save me' look. He ignored me the first time, but the second time he got a hint and ended the session. Relief.

What was really surprising was i didnt get shot down, criticised or screamed at for being such a twat. The feedback was mixed. It was like criticism wrapped up in lots of candy floss and fluffy cushions so i wouldnt feel the slight slap on my wrist or terrible the burn of embarrasment (there were 7 other people, my classmates, watching me do this).

It bothered me, because i work better when i know exactly what how i've screwed up, where and when. I can fix something when i know what, where and how badly its broken. I dont really like 'lets look at what was good' approach to feedback- hell, if im doing that ok i dont have to know about it. I wanna know where i suck. And how to fix it.

What ive learned is that i gotta 'signpost'- a fancy way of warning people subtly that a sensitive question is coming up. Just so that the patient knows its coming and is not surprised by the bluntness of these personal questions. Also, signposting can also be a show (read:show) of empathy.

i also have to learn to be comfortable with silence. Ask a question and let the patient think. Not to be so quick to lead the patient, offer ideas or alternatives. Instead, allow the patient a good 30 seconds to mull the questions and formulate their answers- if they're still stuck, then yeah, either clarify the question, rephrase it, or offer up some vocabulary to kick start the patient's brains.

And most important is to not get so hung up on the symptoms. Most of the time i find im asking questions to confirm my diagnosis. In a sense im being biased because im looking for the 'right' answer from the patient. I ignore or pay less attention to other things the patient is saying that doesn't support my diagnosis. I close my mind to other options or alternatives explanations and in this lies the danger. I might miss something important because it didnt fit in what was the diagnosis in my mind. Worse, if i do that im caring more for the disease than the patient.

There's a lot more things, but these to me are probably key issues i gotta address. Sigh, the suffering of a witless social retard.