A squib on The Post's Health pages led me to send a self-addressed stamped envelope to the American Society of Internal Medicine. In return, I received a good-looking gray and turquoise pamphlet titled "Communications: It's Good for Your health."
As a long-term patient, I agree wholeheartedly with that sentiment. Communication with your doctor -- the subject of the pamphlet -- is not only good, it is downright essential for the patient's well-being. Without it, you are left swaying in the erratic medical winds, lonely and afraid, not knowing whether to take the advice of the latest Reader's Digest revelation or the retired nurse down the block.
I agree, too, with the pamphlet's internist-authors when they say that we patients should stop holding back information from our doctors. They say about 70 percent of correct diagnoses are made simply through communication (what a waste of lab tests!). So I don't even mind being scolded for assuming that if the doctor needs to know something, he'll ask; for not wanting to look uninformed or to talk too much; for not being completely honest (I never fibbed about cigarettes when I smoked 10 a day, 20 years ago -- only about taking one drink a day when I had wine with dinner, too).
But there is another side to the story, which the pamphlet tends to brush off. It places almost all the blame for faulty communication on the patients' ailing shoulders, except for a few sentences toward the end that advise us to change doctors if ours is abrupt or does not answer questions thoroughly. It admonishes us to remember that half the responsibility for a good relationship rests with us.
So the other half -- sometimes I think it's three-quarters -- must rest somewhere else.
And it does -- squarely with our physicians. For doctor-patient communication is a two-way street, badly in need of repair in both directions. If there are potholes on the patients' side, it is because we patients are too often loathe to speak up to our healers, in whose awesome hands our comfort and even our lives lie. We want them to like us. We don't want them to think we're pests, taking their precious time with our "stupid" questions, asking them to repeat directions or explanations, betraying our fears and our need for encouragement. Don't they have more important things to do?
*No, they don't.
Nothing is more important in our doctors' working lives than communicating with us, their patients. One might argue that medical competence is more important. But there can be no true medical competence when the doctor is not getting through to us, or is getting through in a way that leaves us confused or wretched.
Who among us has not arrived home from the doctor's office unsure about the pills and other treatments that have been prescribed? These pink ones are supposed to cure our flu. Will they mix with the capsules we are taking for our blood pressure and our back pains? Will alcohol or sex or a heavy meal interfere with their functions?
It would take legal as well as medical training to prepare us chronically ill patients to ask all the questions we should ask nowadays of all the different doctors ordering high technologies for us. ("How can I get rid of the barium that test left in my gut?" or "Should the radiation be making me woozy?") And it's a bit hard to ask such questions when the doctor looks at his wristwatch suggestively just when we thought we'd finally got to talking.
But there are more subtle issues involved in healthy patient-doctor communications, requiring even greater judgment and skill. These center on the style in which doctors choose to communicate.
Such issues usually arise when doctors fail to strike an adequate balance between the necessity to tell patients hard truths and the equal necessity to tell these truths carefully, compassionately and at the patient's own pace. This happens especially when young doctors have not been trained to listen to the cues patients invariably give as to how much they want to know and when they want to know it.
So while a few doctors tell too little, others -- to my mind the greater number -- tell us too much, loading us down with details about possible, as well as actual, diseases and giving us the bad word about the exact date of our departure from this planet.
The experts say we hanging-in patients need a feisty hopeful attitude to live lives of quality, perhaps even to survive. But it is hard to maintain such a positive stance when you are told -- as a patient was told in a Washington hospital recently -- "We want you to go home now and enjoy what little time you have left." Or when you are shown an X-ray and advised: "This is where your abdominal cancer is now. It won't kill you. What will kill you is when it gets here, to your liver."
Some doctors know intuitively what to say to us patients. They realize the power their words have over us, that they can leave us devastated or can set the stage for a courageous response. But we cannot rely on intuition in this day and age. Talented physicians must teach the crucial skills of using words properly. Until they do, there can be no truly healthy doctor-patient communications.