By Ong Chooi Peng and Cheong Pak Yean
The single biggest problem in communication is the illusion that it has taken place.
——George Bernard Shaw
Blah, Blah, Blah
A doctor had just attended a lecture on dietary strategies in patients with elevated cholesterol. He enthusiastically put his new knowledge to use with the next patient he saw, who had raised LDL-cholesterol, and delivered a discourse on how to make better food choices at the hawker centers. When he finished, the patient looked at him and said But doctor, I do not eat hawker fare.
—- A/Prof Cheong Pak Yean
Aaah, Aaah, Aaah
She announced her presence in the clinic by a succession of loud, agonised groans. A series of strokes has left Madam W severely dysarthric and dependent. Over time, we learnt that she groaned the most when she was unwell with fever and urinary infections. Doctors like to say that patients are our teachers. I learnt to be humble from Madam W.
—-Dr Ong Chooi Peng
Commentary
Time was when the doctor said and the patient did. The framework was unapologetically authoritative. Doctors, teachers and parents all knew best. Those were the days of a legion swift consultations, and the good doctor depended on touch and telepathy to reach his patient.
Communication frameworks have changed. Mindsets have altered radically. Patients expect — and sometimes we doctors tell ourselves patients expect even more — detailed discussion before management. We tell patients the options available. We tell them the expected consequences of their potential choices. Also, we tell them all material foreseeable problems! What we talk about has changed. If you don’t watch your sugar I will have to start insulin, we said. Here’s what we can do, we say instead, now. What are your goals of care? What values matter to you? Do you want antibiotics? Do you want tubes? How are you doing in school? What does your partner think?
The languages have changed. It’s no longer just the four main languages and the usual Chinese dialects. Patients come from all manner of other places. Some come with all manner of expectation of politically appropriate language too. And of course, doctors’ language capabilities have changed. The old doctor who spoke any number of Chinese dialects and Tamil to boot has given way to the modern graduate, schooled in proper English.
What has not changed, I think, is us doctors thinking we communicate effectively.
—-Dr Ong Chooi Peng
Cheong Pak Yean is an internal/ family physician and psychotherapist. He is an SMA honarary member, past president SMA, College and adjunct associate professor of NUS. His current interest is in medical communication and humanities.
Ong Chooi Peng practices in a polyclinic and also in a community hospital. She counts it her blessing to have been part of Family Medicine in Singapore through a time of formation and growth.
The commentary and vignette were reproduced with permission from the book “Being Human, Stories from Family Medicine” edited by Cheong Pak Yean and Ong Chooi Peng and published in 2021 by the College of Family Physicians Singapore.
Pictures of illness experiences were drawn by NUS medical students in workshops conducted from 2012-2017 by A/Prof Cheong Pak Yean. Senior family physicians subsequently shared vignettes and commentaries based on the pictures.
