Tale from the Front: A Physician’s Story

By Karen E. Edison, M.D.
Columbia, Missouri

I was in the Dermatology Clinic at the University of Missouri caring for a 75-year-old male veteran who had a biopsy proven basal cell carcinoma. I was explaining to him that he needed more surgery to completely remove the tumor, but I didn’t seem to be getting very far with him. He just didn't think it was necessary. Then, remembering a tip I picked up from a colleague, I described it to him as having a little rust on your car. How the rust/tumor wasn’t a big deal now, but it could continue to eat away at the paint/skin if you didn't get it all off. The light bulb went off in his head, his eyes lit up and he said, "I understand, do what you need to do."

Another episode that stands out was a visit with a very sun-damaged patient who needed to use 5-fluorouracil cream on his face for three weeks in the winter to clear up his many actinic keratoses (pre-cancers). At first I told him, "this 5-fluorouracil will selectively destroy your pre-cancerous tissue." He looked quite confused and I immediately realized my mistake. I then said, "what I meant to say was that this cream will kill the bad skin and leave the good skin alone". Again, I saw the spark of recognition in his eyes and he said, "now I understand."

The biggest lesson these experiences and others like them have taught me as a physician, is that the most important tool I can use to foster clear communication between my patients and me is simply to listen carefully to what the patient is saying. Listening is the only way to not only establish trust, but also to learn from that individual what I couldn’t possibly know on my own. I am now able to communicate in a way that lets my patients know I care about and understand them. And a strong foundation is being built.

I do utilize a variety of practical strategies that serve to enhance communication with my patients, ensuring it’s a two-way street. I often use the "chunk and check" method whereby I convey a small amount of information and then stop to make sure the patient understands it before moving on. I have found that if I just ask "do you understand?" the patient will often say yes whether they do or not. Instead, I try to say something like, "am I making any sense?" In this way, the responsibility for clear communication is on me and not on the patient.

I also try to use real world analogies to which the patient can relate, tying concepts to their jobs and hobbies if possible. Careful listening enables me to learn enough about an individual to do this effectively.

I feel confident that I have done a good job when my patients can describe – in their own words – what is wrong with them and what we are planning to do to make it better. I feel confident I have done a good job when I see the power of clear communication benefit a patient before they have even left the room.

Karen E. Edison, M.D is the Philip C. Anderson Professor & Chair in the Department of Dermatology, Medical Director of Missouri Telehealth Network, and Director of the Center for Health Policy in the University at the Missouri Health System. You can contact her directly at EdisonK@health.missouri.edu

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