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Network for Peace through Dialogue

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March 8, 2010

Developing the Doctor-Patient Conversation: Doctor, May I Have a Word?


Initially, a brief explanation Re: Debate versus Dialogue was provided by our NPD Group Facilitator:

Debate: Listening, learning - (This appears to be a win/lose communicative interaction).

Dialogue - Listening/learning/further exploration; life experiences; humanity of the Issues. This is similar to what makes a good dialogue in doctor/patient relationships.

After participants introduced themselves to the group, Dr. Susan Massad, guest speaker, shared that she had received her medical training at the University of California in San Francisco. After graduating in l962 and subsequently completing her residency, Doctor Massed became a physician teacher. She introduced an innovative approach to the doctor/patient relationship within the medical profession.

Dr. Massad, addressing what she saw as a need within the scientifically oriented population of medical doctors, changed the course of doctor-patient communication training. By doing so, she became a part of the health care changes and transformations that emerged in the country. E.g., in the 1960's an emergence of a new movement in health-care entitlement programs for the elderly and retired surfaced. Dramatic changes took place and class/cultural bias was questioned with regard to Medicare/Medicaid. The entitlement of medical benefits had a transformative effect on the medical profession as well.

Prior to the introduction of Dr. Massad's new two-way communicative doctor/patient teaching philosophy, only measured cognitive training was provided within the curriculum of medical training. Doctors were directed to address particular situations in a pre-formatted manner. E.g., in this particular situation, say this, etc., etc. However, this pre-Dr. Massed teaching technique fell short. The "softness" (bedside manner so to speak) was lost when doctors were faced with an overwhelming amount of work. Medicine alone, it was found, did not produce effective practioners and mal practice was a reflection of this reality.

Dr. Massad introduced new concepts in the field of medicine. She learned that patient involvement in conversation affects health and healing. A doctor who directs the conversation and does all the talking is not one who is listening to his patients. In one-sided communication, patients subsequently suffer the consequences of not being heard. Conversation is more than a performed activity; communication is more than just imparting information. It is awareness, creatively building activity. It is creating something together between a doctor and his patient. Patients need to participate in the decision-making process; they need to spend time talking about choices and verbally participate in the course that is to be taken in their care. Doctors need to involve the patient, rather than just transfer information and take a know-it-all stance; the doctor needs to include his patient in the conversation, in the decisions that are to be made. He/She must acknowledge and respect patient feelings, desires and choices.

A doctor educated under Dr. Massed acknowledges the intelligence of patients and the right of patients to be verbally involved in choices made that may ultimately affect their healing and life. A trained doctor might effectively ask: "Where are you on these options, decisions?" What do you think, etc? Effective two-way conversation is central to the process of meaningful communication. Doctors need to use language of performance: listening/building/creative actions, rather than just transfer medical knowledge. This mode of communication lends itself to healing and more effective conversation. It also affords an opportunity for patients to take an active part in the direction taken and choices made on their behalf.

Winding Down

Nearing the conclusion of the gathering, Dr. Massad and participants shared some insights, personal experiences and feelings:

Patients need to be part of the conversations; negotiation is needed, as well as empathy and time to build a trusting relationship with their doctors. Doctors need feedback from their patients as much as patients need to share their feelings and realities. Doctors must be able to admit that they do not know all; they do not have all the answers. What keeps patients from revealing their reality? The group identified lack of trust, fear, and intimidation as barriers to effective patient-doctor relationships.

Submitted by Cathy Deubel, RSHM

notes by Hayato Nakayamo, intern


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