Can We Talk?

Rebecca Bechhold, MD

When dinosaurs roamed the Earth and I was a resident, the best, most fun part of the day was when we were all sitting around doing our charts. For those of you who never knew a paper chart, I will explain that, as the resident, you were in charge of making sure that all information was properly organized in the physical chart, which included handwriting the flow sheet with all lab results. If you were a real suck-up you might also include imaging results and relevant vital signs, “I and O,” and daily weight. I remember team leaders who threw charts across the room when they failed to live up to expectations. So, we spent a lot of time sitting in the nurses’ station organizing data in ring-bound charts for morning rounds.

All that time together let us discuss our patients in detail and pick the brains of fellows, nurses, and social workers who drifted in and out of the room. We would share journal articles, resources, and pearls of knowledge learned in the trenches, and of course gossip. No internet, no computers-ancient history I know!

When I now walk through the room where residents work on computers, it is totally silent. Every person is online either studying, documenting, or swiping right. Is that fun? If you put me in a room with my two best friends from residency we would have a million stories to share about our time together, including specific patients we all remember. I learned so much in that informal setting. In my opinion, doctors in training now are missing out on a lot by relying so heavily on Dr. UpToDate and his ilk. I use those resources as well, but I also still discuss cases with trusted colleagues at least once a day. Bull sessions can be enlightening, confidence building, hilarious, and stress relieving.

The other part of personal interaction is the art of conversation. What do most patients complain about-“He didn’t tell me anything!” Effective communication is not a natural skill for many doctors. Based on calls I have made to referring physicians, many of them struggle to have a decent conversation with another treating physician. My point is, we need to foster more personal interaction among physicians, not just for educational reasons but also for the social sensitivity it develops in people who by definition are highly technically educated but may lack the ability to appreciate the nuance of verbal and physical feedback during conversation.

As a corollary to the talking theme, why don’t medical oncologists have a form of chart rounds the way radiation oncologists do? Tumor board is not the same thing at all. Having a morning huddle with the office team and reviewing even briefly which patients are coming in and what is going on with them can reveal a host of issues and allow a check of, “Is this the right way to be treating this patient?” Don’t tell me you have never looked at a chart on someone else’s patient and thought, “What the heck?!” I try to put my thought process and overall treatment planning in my notes as a reminder, but we have all gotten off track at times and maybe initiated a treatment plan that could stand to be adjusted or abandoned altogether. Are we afraid of scrutiny? When approached as a team effort to make sure the patient gets the very best care without rebuke of the treating physician, medical chart rounds could lead to more awareness of clinical trial availability, appropriate therapy, and even psych-social needs that may have been overlooked. For patients with poor performance status, it might even give the physician the confidence to stop ineffective treatment and refer the patient and family for hospice care.

Doctors are not rock stars. We do not entertain tens of thousands in stadiums in a single evening. We effect change for individuals one-on-one. It is truly an incredible privilege and requires our best intellectual talent, but it is even better when we give part of ourselves. That occurs not by keystrokes but by language.

Talk to me.