Last week I praised my internist’s therapeutic communication skills and promised I’d write about some bad experiences soon that I’ve had during my nearly 15-year history of fibromyalgia. So today is the time to give you one example that still floors me years later.
Some back story. When I taught nursing, therapeutic communication was my favorite module, both in a beginning concepts course and in a senior level mental health nursing course. Part of teaching that module included learning therapeutic nonverbal communication.
The doctor in my example could have benefited from taking my class and learning about SOLER skills for his nonverbal communication or body language.
S=Face your patient squarely. Adopt a position that indicates involvement.
O=Adopt an open posture. Crossed arms and legs can be signs of lessened involvement.
L=Lean toward the patient.
E=Maintain good eye contact. Communicate “I’m with you.”
R=Try to be relatively relaxed while engaged in above behaviors.
The following example is of a visit to a GI (gastrointestinal) consult about pain under my right rib cage. My internist at the time wanted an opinion from a specialist in this field.
Waiting for the doctor, I was heartened to see on his diplomas that he graduated from the same university as I and must be about my age. Naively, I thought, since he got an MD and I got a PhD in nursing about the same year, age-wise that would raise my chances of liking him.
The minute he walked in the room, I sensed this was not going to go well. Dressed in a crisp white lab coat, he passed my back and sat behind a humongous desk that separated us, grunted hello, adjusted his glasses, and, without looking at me, read the forms I’d filled out.
He confirmed I was there for pain on my right side below my rib cage. Then he told me to go across the hall and put on a gown. There he pummeled my abdomen without saying a thing, or looking at me, and then said to get dressed and meet him back in his office.
Once there, he leaned back in his chair and said in a clinically efficient, detached manner, “I don’t deal with pain above the waist, and yours is above your waist.”
Duh. Pain above the waist was why I was there. So what does a patient say in that setting? I get tongue-tied, a problem I rarely have, but it strikes me in doctors’ offices.
When I recovered from my shock, I asked, “Can you give me any idea of what may be causing this pain?”
Leaning back even further, plus crossing his arms, he said in a dismissive tone, “Over 50 percent of my fibromyalgia patients have irritable bowel syndrome, so you probably have it. I’ll give you a prescription.”
I tried to tell him I did not have any symptoms of that disease, but he waved me off, wrote a prescription, stood up, handed me the prescription, and started to walk past me out of the room.
Tongue-tied again, I stood, feeling the color drain from my face, and feebly said Thank you. For what, I still don’t know, but suspect my childhood programming to be nice automatically kicked in.
Walking zombie-like down the hallway to the elevators, I felt sandblasted. When the elevator door opened and I saw that I was alone, I pressed the lobby button and burst into tears. And I wasn’t a kid; I was around sixty.
Now why couldn’t I have confronted this pompous fellow? What could make me slow on the draw in these settings? I have no problem thinking up things to say once I’m retelling my experiences.
What about you? How is your doctor’s nonverbal communication? If not good, do you confront, or are you temporarily stymied, like I am, when he or she doesn’t meet your expectations of a caregiver who cares?