----- Original Message -----
From: "Robbie Coull"
Subject: Re: Decline of Anatomy

> (1) It's not that the patients believe your syllabically depleted spiel -
> they just figure that pointing out that disbelief to a monosylab is
> pointless. (They can always go to see their GP the next day to have their
> 'ideas, concerns and expectations' explored fully).

This might be true, if they could see their GP the next day Robbie. How
about next week, if they're lucky?

> (2) Litigation risk has nothing to do with medical knowledge or skill -
it's
> poor communication that gets you sued. So, far better to be a charismatic
> moron than a monosyllabic genius.

Poor communication may get you sued, but not successfully sued. If you're
medically sound, you will not get successfully sued...period. This is a
really important principle, if you wish to practise medicine
"non-defensively". And if I need something serious sorted, I'll take a
monosyllabic genius anyday rather than a charismatic fool. Of course if I
just want soothing words and my hand held, then my GP will do just fine...

> (3) Little of what we do makes any difference to patient's morbidity and
> mortality, and the little that does can usually be taught to a lobotomised
> monkey on a 3 day didactic course. So little point in having those pesky
> science subjects cluttering up the curriculum.

Ah, I think you're too far gone Robbie, you've been well and truly corrupted
by Balint!

> (4) There is little point in the SHOs knowing that the patient's limb pain
> can be relieved by elevation and analgesia if they are unable to impart
that
> information to the cerebrally challenged punter.

This is one of our greatest challenges, trying to convert our knowledge into
digestible form for those with IQs of 70 or less. These are actually the
most challenging patients to communicate with, as one's rational arguments
don't work! Those with IQs of 160 and above can also be a real pain, but for
completely different reasons. But students can learn this on the wards,
clinics and EDs; they won't do it in a classroom with an actor.

> (5) There is nothing wrong with medical student selection. They arrive at
> medical school with excellent communication skills, but these are removed
> during training to produce the brigade of cloned, fact-filled, sociopaths
> that eventually make their way to senior positions in the Royal Colleges.

You have a point here, the med student's life is incestous and parochial.
Their language is jargonised and they become pathology oriented rather than
people oriented. But I believe this is improving; am not sure if formal
communication skills training is responsible, or better role modelling.

> I certainly can barely remember any of what I was taught at medical
school,
> but find that soothing words and a bit of handholding means the patients
> almost never notice.

I don't know about your patch, but many of my patients don't want to be
patronised or humoured, they don't want false reassurances or platitudes.
Such patients will not thank you for this, they demand facts and figures,
skills and competence. This could just reflect the difference between
Hampstead and the Highlands. Your job is a lot easier in that respect, but
don't for a minute believe that your techniques will work on everyone.

> You are hardly the best communicator on this list, Adrian, and frequently
> get yourself into hot water with poorly scripted comments, so I'm not
going
> to let that go.

I never said I was a great communicator; pay attention Robbie! Remember I'm
the monosyllab you mentioned earlier; I'm on the side of medical knowledge,
not communication skills! And any hot water I get into is purely intentional
Robbie, or hadn't you noticed?

Regards

Adrian