Medical schools are generally efficient and effective places to learn aspects of the art and science of medicine, and the more luminary schools now provide additional components relating to professionalism, ethics, and sometimes even the fiscal aspects of health care systems.
The problem is that the disciples of most medical schools, like the inhabitants of Garrison Keiller’s homes, are mostly well above average, and that creates a problem. While it is stimulating, entertaining and even fun to hang out in med school with bright, creative, driven (and often somewhat aggressively self-focused) young people with IQ’s north of 140-150, that doesn’t really help a practicing physician to deal empathetically and effectively with a substantial proportion of the patient population. There is a clear inequity in health care, such that people with less education, fewer resources, and often those from the lower socio-economic classes unfortunately sustain a major proportion of health care needs. There are many reasons for this, including diet and nutrition, heavy patterns of smoking, less health education, and workplace or occupational exposure, among others. Surveys of patients indicate that many find physicians to be somewhat intimidating, sometimes aloof, and frequently given to using complex algorithms and jargon to explain many aspects of medical care and the problems facing the hapless patients. Although the Socratic method of medical teaching is focused on the concept that an experienced and altruistic physician will imbue his fledgling physician trainees, by personal on-the-job demonstrations, with a fine style of personal communication, that concept is limited by the fact that some physicians, trained by standard medical schools, simply don’t prioritize those skills, lack empathy, and thus teach them poorly. This, in turn, really harms the doctor-patient relationship at several levels.
So back to the topic that has been requested by Linked-In…. When I was in medical school, decades ago, as was common practice in my peer group, I acquired a taxi driver license and spent some of my medical school years on the evening and weekend shifts behind the wheel of a cab. The original plan was that it would help to pay the bills, and reduce my post-college debt, while also avoiding fiscal demands on my parents. What actually happened was the development of an epiphany – viz. as the heterogeneous population of transient back-seat dwellers passed through my cab, I came to realize how important it is to develop a social contract focused on personal relationships quickly, to express oneself in plain and simple terms, and to communicate at a level that reflects the background, social situation and education of each customer. As a cabbie, it was important because it allowed me to get to the desired destination more efficiently (viz. by getting the details right the first time), avoided my being beaten up or robbed (by developing a superficial yet personal relationship in the few minutes we were together), and often resulted in a better “tip” because a connection had been established even within just a few minutes. When customers are in the cab, they are paying for your time, and thus they “own” you, and many use the time to ventilate their fears, anxieties and fiscal or other concerns, and the wise cabbie learns to listen, empathize and share advice freely…problem-solving on the go!!!
It turns out that this training has served me exceptionally well as a physician in practice, and also as a medical administrator when handling patients or carers with concerns or complaints. The ability to set a new patient or family at ease within the first few minutes of a clinical encounter, makes a huge difference in moving the clinical situation along, in reducing fear and anxiety, in facilitating clear and accurate communication, and improving the whole experience (both for the patient, the family AND the physician). When patients and families feel rapport and are at easy, they give information more accurately and completely, the receive guidance and explanations in a much more positive and effective fashion, and it creates a situation of mutual trust and rapport. My firm belief is that physicians are better for taking on simple, lower socio-economic roles during their training, which can teach them about communication, the range of problems encountered and communication styles engendered in different socio-economic situations, and can lead to a lifetime of empathetic medical practice.