Pattern Recognition Isn’t Always A Good Thing
A classmate recently recounted a story to me of some not-so-great assumptions one of her attendings had made about a young girl recently diagnosed with diabetes:
The girl, of Hispanic origin, was in clinic with her family and the attending was giving her family her diagnosis for the first time–diabetes. But what bugged me is that he told me he didn’t want to spend his time explaining the cause of diabetes to the family, because he assumed they weren’t educated enough to understand it in the first place.
Let’s assume, for the sake of argument, that this attending didn’t start off this way; I’m hoping this is a safe assumption to make, as I think it would be among my classmates. I hypothesize, then, that this is the downside of physician training. Physicians are masters of pattern recognition–one of the reasons we haven’t been totally run out of business by computers (yet). You start to see certain patterns of diseases, drug side effects, and diagnostic workups that things truly start to reveal themselves, and then burn themselves into your head. You tell me your list of drugs, and I can probably tell you which diseases you have. You tell me your dosages, and I can probably tell you how bad your disease is. Or show me a picture of someone with a certain symptom, and I could probably come up with a couple guesses as to other symptoms they’re having (I’m still working on this ability). We are predictors, trying to make sense out of the world with the clues we’ve gathered.
But there’s always two sides to a coin. Perhaps some of us (like the above attending) take our prediction powers too far, and use them not for diseases or treatments, but for people. Maybe the attending had seen several other similar girls before, and he tried explaining, and felt like he was wasting his time. Maybe he’s seen hundreds. Either way, I think we’ve got to separate one from the other. Otherwise, we risk missing golden opportunities with patients.
This is no easy task. I’d imagine the doctor spent his time getting something else done with the time that he saved–calling a patient with abnormal lab results, spending more time with another patient, etc. Were the patient white, would he have skipped the pathophysiology speech? We can’t say.
Maybe one solution is to give patients a handout to read over at first, so when the doctor comes in, she or he can answer questions about it.
Your posts always inspire a lot of thought and contemplation, and this one is no different. Remembering that each patient is an individual and will require different modes of communication for effective understanding is good advice for all physicians. In today’s age of overscheduled physicians, it is understandable that there may be some frustration in this regard; however, physicians need to keep in mind that one of their primary roles and job responsibilities is that of teacher.
Part of being Doctors is that we are not only professionals who diagnose and treat patients, but also we have a great oportunity; we can teach our patients.
We are, i mean, we must be the ones who trasmit information to our patients about their lives (in health or disease).
To make that possible we will explain them according to their cultural level, making sure that we are building a strong connection and a good doctor-patient relationship.
Docs also assume some folks know already. My brother PHD math: health analyst thought he could schedule a talk right after electrical conversion of AFib, not knowing he would be in post anesthesia haze. His cardiologist didn’t bother to tell him about the procedure.
I may add that with upwards of 40% of United States population below functional literacy level, (depending on location, see National Institute For Literacy website for info) printed material might not be the best process for dissemination of information. There is NOTHING like face-to-face interactive patient teaching. Incidentally, in my 30 years of experience, even those patients with post-grad educations appreciate specific, simply-presented information that they can process with minds fogged by drugs, fatigue and emotional stress.