A decade of communicating

It all started close to 200 blogs ago. July 28, 2014 marked the beginning of what has become a primary focus in my life and a creative obsession. Writing a regular blog, submitted to and published by the Medical Post, has been a distinct privilege afforded me. The subject matter has been at my choosing but, as always, the editors have the final word on the cutting room floor. I have written much about the patients who informed and influenced my professional career and experience. As a GP for 49 years, I had a robust clinical data base and rich patient history repository from which to choose. And, I wrote much about the unique and personal stories my patients shared with me in their finest hours and in times of dire distress.I wrote of medical politics, hospital and institutional interactions, inter-professional relationships, the sanctity of the patient-doctor relationship, the perils of systemic failures, the values of medicine lost in the fog of time, the incendiary ramifications and devastating career implications of burnout, all-things retirement-planning, implementation and survival, the longing for the comforts of the ‘doctors’ lounge’ of the past, the creation of a virtual ‘Retirement Lounge’ for those who had finally seen the light of day, the demise of bedside medicine and the loss of “human touch” as the cornerstone of medical practice, personal exploits of travel, fly fishing, the importance of family, and, occasionally, some outright ranting and howling at the moon. I almost forgot that I also wrote about COVID-19 and the Pandemic of 2020, enough said, enough written!If you look at the spectrum of subjects I wrote about, the commentary, opinions and reflections, there was frequently a common thread: communication. The initial blog in this decade-long series was titled “What we’ve got here is failure to communicate.” If it sounds familiar, it is a quote from the 1967 prison drama ‘Cool Hand Luke’ with this quote listed as #11 on the American Film Institute’s 100 years/100 best movie quotes list. In this blog, I wrote about a 60 year old patient with an aggressive, metastatic skin cancer of the scalp, admitted to hospital for wide surgical resection of his cancer. The initial uneventful postoperative course precipitously turned ugly when sepsis developed and subsequently, multi-organ failure ensued. In spite of “aggressive medical treatment” the patient succumbed, an unanticipated and tragic outcome given the positive pre-operative prognostic input from the attending surgeon. The “final summary.,” faxed to my office two weeks later, included a hand-written note from the surgeon which read “please fax a copy to Mr. G’s family physician.” Sadly, he didn’t indicate when to do so. “Stat” would have sufficed. No phone calls were placed to, nor received by my office from the surgeon or his resident-designate as a simple courtesy to inform me of the death. Although communication had become more conveniently enhanced with the introduction of smart phones and other portable devices, thoughtfulness, consideration and common sense were not positively influenced by these technological advances. Some things defy logic. I called my patient’s grieving wife and had a lengthy, heart-wrenching conversation, reflecting on the 30+ years I had been privileged to care for her beloved husband and the anticipated sorrowful process she and her children would be facing in the days and months ahead. I offered to provide support and counsel whenever needed for her and her children. I expressed how badly I felt not having attended the visitation or funeral, opportunities to personally express my feelings and respect. And then, I apologized, for the failure of the individuals and the system charged with the responsibility of her husband’s care and specifically, their ‘failure to communicate’ effectively the passing of their loved one in a direct and timely manner with his family doctor. To this day, I recall how distressed I felt having to make excuses for others, who in their thoughtless moment, ignored the principles of responsibility and humanity, veritable cornerstones of our profession. In my five decades of public service as a GP, there are countless examples of communication failures at multiple levels of care: patient/doctor, consultant/family doctor, patient/institution, patient/diagnostic facility, patient/government agency, patient/pharmacy and the list goes on. The introduction of virtual healthcare, a necessity of life in recent pandemic times, has not only persisted but has often replaced the direct, face to face clinical experience, relegating physical examination to the back burner of most clinical interactions. As the digitalization of medicine continues to expand exponentially, it is the patient who suffers in the silence of isolation. In my retirement, now almost four years in, I receive several calls a week from friends who have been stymied by the barriers imposed upon them by their family doctors or specialists. Most often reported, it’s the calls placed to the office not being responded to in a timely manner or at all: the doctor relegating the responsibility of responding to the patients’ calls to someone generally identified as less responsible; the failure for timely review of diagnostic tests despite the availability of results on electronic platforms, accessible but not readily interpretable by the medically-naive patient; the abject failure for urgent access to office care which often results in walk-in or ER alternatives because the office response is 24+ hours later and; the difficulties imposed by the modification of family doctors hours of operations given the fallout of pandemic virtual initiatives. These are only some of the frequently encountered obstacles which most patients perceive to be insurmountable. Admittedly, there may not be a suitable bandaid available to stanch the ooze of frustration and anger and distrust. I would be remiss if I didn’t acknowledge you, the reader. Over these past 10 years, I have been encouraged and supported by your comments following each of my blogs. I scrutinize carefully every submission that is posted and respond personally to most, if not all comments. These have become personal conversations, collegial dialogues and, in some cases have evolved into lasting friendships and for this, I am forever grateful. There are many ways in which we communicate, all vital, individually chosen, yet an acquired skill that occasionally needs honing. Perfection is not likely possible but worth aspiring to. Whether professional, clinical or personal, we must avoid, at all costs, the inherent failures of communication that can ultimately have disastrous implications and consequences both for us and our patients. In the words of George Bernard Shaw, “The single biggest problem in communication is the illusion that it has taken place.” Thank you for your many years of following this blogger’s “Piece of Mind.” It has been a singular pleasure for me to communicate with you. I look forward to continuing the conversation. With the utmost of respect for what you do every day,Howard

A decade of communicating

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Blog Author

HOWARD GOLDSTEIN

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