7.01.2012

Heard on the ERCast podcast... 

"What you do speaks so loudly that I cannot hear what you say" - Ralph Waldo Emerson

Dr. Rob Orman passed  a few tidbits he learned at the foot of his mentor.  While he put these in the context of doctoring, I like them as good ideas in any human interaction, so I summarize here...

1. Treat patients as you would want to be treated.  The golden rule for doctoring.  Substitute 'customer', 'co-workers', 'subordinates', and the universal golden rule still applies.

2. Give the patient the opportunity to 'talk down' to you.  Doctors almost always are in the position of being the one talking down to the patient.  This is natural, and for good reason.  The doc has all the knowledge and background, and is in a position of authority, giving diagnosis and counsel to the patient who is in an inferior information position.  Orman's mentor always takes a moment to ask about the patient's profession, something he or she is an expert in, and gives the patient the opportunity to use their unique knowledge for a moment to talk down to the doctor.  "So you're a mechanic?  What do you think about those new run-flat tires?"  This establishes for at least a moment, a two-way emotional dialogue, with the patient in a superior position.  This can open up the patient's receptiveness to the important message the doctor wants to provide, and can improve the chances the patient will ask questions.

3. Examine your prosody.  I was glad he explained this one.  Prosody is the rhythm, stress, and intonation of speech.  It is the emotional subtext you project that may or may not agree with the words coming out of your mouth.  Doctors need to be able to convey confidence all the time, and sometimes urgency, or calmness.

This seems especially important for doctoring.  They deal frequently with patients who are conscious but cognitively impaired, either by medication (prescribed or abused), medical issues (low blood sugar, concussion), or simple stress.  Orman's mentor makes the point that the very impaired patient may not understand a word of what you are saying, but if they are conscious, they will definitely understand the emotional content your face, voice, and body language convey.  The textual and subtextual messages should match, though they frequently may not.

I think this is also important in everyday interpersonal exchanges, and find myself post-facto realizing how my emotional subtext differed from the words coming out of my mouth.  We non-doctors may not frequently deal with the cognitively impaired (though more than we suspect!) matching our prosody to our message strengthens the chances the message will be received as intended.

ERCast is a great and entertaining podcast intended for emergency medicine physicians, and the technical stuff frequently goes over my head.  But I still get an awful lot, and enjoy Dr. Rob's delivery and interviews.  I recommend it if you have any interest in medicine.  Good starter podcasts on his site are "The Athlete's Heart", and "The Constipation Manifesto".