Yesterday, I had a role playing class in which I had to play the role of a doctor who had to persuade his unconfident patient to work on losing weight (because the physical checkup showed that she had borderline DMII and metabolic syndrome).
To be honest, I was a bit shocked when I saw the demonstration weeks ago. We were first told to praise the patient for writing his own self-monitoring sheet and to show appreciation for his every effort. Doctors should never deny what the patient says (we just accept it and nod with an understanding attitude) and we patiently suggest what might be a good method for the unmotivated patient to lose weight while he complains why he is unable to do such and such. This all seemed too much to me. I mean, we're talking about the patient's own health! Why does the doctor have to show appreciation? It's first and foremost the patient's responsiblity. I'm really interested if this is a very "Japanese" class or if doctors abroad are also expected to treat their patients like "clients".
That said, I am prepared to do whatever it takes for a patient's health. So in yesterday's class, I did exactly what I was told to do, and the supervising doctor pretty much loved my act but commented that he would not want to get in an argument with someone who talked like me. One of my peers told me he wouldn't want to see me next time if he had been the patient and had failed meeting the set goal (which was simply not to lay out snacks in the basket where she could see them). He said he would seriously consider changing hospitals in the case of failure. According to the doctor, I was straightforward, eager, to the point, and was really good at casually cornering the patient into a situation where she could no longer say no. In short, I was talking more like a lawyer than a doctor. I have yet to see my "legal background" come into good use...
So do I consider my previous education a waste? This is not a question I've ever really asked myself because it's nonsense. I am aware that going the long way was partly necessary for a human being like me, and I just happened to pick up a law degree along the way. But of course, if there had been a way to avoid all the twists and turns, I would like to know. I actually asked this question to another blogger who seemed like an efficiency-prioritizing father very much devoted to his son's education:
...But many student do change their mind after entering college. In some cases, they gradually realize what they really want is different from what they had thought they had wanted. So my question is, do you think there is a way to avoid this kind of "mistake" and to know your calling at age 14 or even younger? In other words, is there some kind of formula we can use to lead an "efficient life" without having to go the long way?
He gave me a response that made me realize (again) how lucky I am to have had parents who provided me with good education so I could choose whatever I wanted to do when the time came, but my own question led me to another train of thoughts.
As a child, I never liked memorizing formulas -- I would pretty much obsess over how they came to be and get kind of upset when I didn't understand. But my mother told me I would realize some day that those stuff were not really important in living my life (unless I was some kind of genius who planned to live in academia). If I could pass my exams required to do what I ultimately wanted to do, then it didn't really matter if I fully understood everything. She repeatedly told me my life wouldn't end just because I didn't understand! In fact, life goes on no matter what. Formulas were created by smart people -- boneheads can leave the difficult part to them and just use their legacy without furthur thoughts.
Although our lives can't be determined by a simple math formula, it seems to me like some people are good at living their lives according to a kind of formula. They are flexible and some of them use it in a creative way to lead an efficient and happy life. On the other hand, I'm still not really good at "accepting" an existing formula right away and using it. I have to experience trial and error to confirm that the formula is "right", or maybe it's like I'm trying to create my own formula. Either way, it's not that different from how I used to write down all the thinking process that would lead me to a formula I had learned. It's luxury; it was only possible because I could find the time one way or another -- the time to probe into matters and take them hard. My mother still has to tell me that's not the only way to live a life. "Self cornering is not the only philosophy," she says. "You don't have to be special. Being mediocre is enough. You ask too much from yourself." I totally agree. If I ask less from myself, I would ask less from my patients, and then they wouldn't have to change hospitals just because they can't stick to a small goal.
A formula I should keep in mind: no one is perfect = everyone needs an escape
I didn't know you had a background in law too, that's amazing!
返信削除I was reading something similar about persuading patients to lose weight. I think the doctor can only say it in a round about way. I think they have to say "Are you concerned about your health?" and wait for the patient to mention their weight. I wish I remember where I read this. :(
Sorry for the late reply. I never really thought I was especially bad at communicating with strangers but I guess it depends on the subject. I don't think I'm good at addressing delicate stuff that doctors often have to talk about :( At least I have more time to work on it. I assume teachers sometimes have to face some similar difficulties when they talk with students?
削除First of all, your English is so good, I thought you were a medical student in the U.S..
返信削除I would like to say what I would like to hear from my doctors...in all circumstances.
1) To be completely open and honest about everything, good news or bad.
2) To never use euphemisms and to never attempt to psychoanalyze that which professionals in the field cannot do in the short period with the patients afforded medical doctors (and NEVER automatically think that just because you don't know the underlying reasons...that it is somehow a psychosomatic cause).
3) I would want to know the most probable diagnosis and prognosis (and all of the supporting evidence for the decisions), and all of the available treatments and their side effects (and then all of the other possibilities and why the doctor had ruled them out or at least lessened their order of probability). To be able to make a rational decision, one must have the variables and the parameters of the argument. I am the master of my body and of my future, not the doctor. I need ALL of the information to come to the decision which would best benefit my future, as derived from all of the things which I know, and which many of which a doctor could not (as he or she would not know my actual priorities or me...and NO...a medical history and a short interview does not nearly afford the opportunity to the doctor to understand them).
4) I would want the diagnosis built upon objective tests instead of on the probabilities of statistics (when possible...I know many diagnoses are built upon probabilities as presented by the symptoms and what had been ruled out). However, I am not a statistic. I've had to overrule many a doctor in my life when he had attempted to make a snap decision (where none was needed) based upon a bell curve instead of running the necessary tests to show the evidence he would have needed to know for sure. They would frequently cite stats for the norm in the US for people my age...shortness of time per patient...etc. Sometimes changing doctors was necessary, other times, a simple rational argument would prove myself correct, and had saved me a body part, being put on a correct course of medication, being spared unnecessary side effects for the rest of my life when medication was not the answer...etc.
Never be the doctor who plays god. The patient NEEDS to hear all of the truth and ALL of the options and what to expect.
You are absolutely correct... the patient's health IS his responsibility, and he should, more than anyone else, care about it...and be responsible for it.
What a patient needs is not motivation, but clear and concise evidence in a logical and rational form about his condition, the causes and consequences, the possible remedies, and any support networks available so he may take the appropiate path to wellness. Armed with this information, the patient then must take responsibility for motivating himself, especially when it comes to healthful habits, and the cessation of unhealthful ones.
Most people can understand most medical conditions, the causes and the treatments. The concepts are simple enough. It is usually the unfamiliar terminology used to explain things which confound so many.
Always remember, as a doctor (a type I would like to have)...if you know your material, you should have the ability to fully explain it in a very simple and rational manner.
I actually wish all patients were like you but I don't think they necessarily are. Some don't even know what they want to know. Some are less motivated, and some appreciate the "paternalistic" style in which the doctor decides for them. Maybe the difficult part is figuring out which type the patient is. But I will definitely keep in mind all the things you've said. Thank you so much for taking the time to give me such a detailed advice!
削除I'm doing some volunteer teaching now -- my class was all Japanese last week. One of the students said to me twice "I wish I could be in your class" but I didn't know what to say. She could switch, but I don't want to make my other classmates (it's volunteer teaching) uncomfortable...!
返信削除I suppose you mean that if that student switched classes, it would be like you stole a student from your classmate? I wish I could be in your class too!
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