October 2013

The Medicine

Ill communication

By Karen Hitchcock
You can learn the science of medicine, but what about the human aspects?

At my hospital we’re interviewing medical students for their first job and I feel sorry for them, all dressed up in their best suits, hair washed and shiny, fingers still aching from their final exams. I’m no good at scoring humans out of five. How might a “one” present? A three? They’re all smart, hard-working and know what to say, so don’t tell me the score hinges on much more than the panel member’s prejudice. The first had a handful of extra degrees, spent her summers saving lives in scary countries and was confident, articulate and gorgeous. She was definitely a five. The administrative representative on the panel hit the roof. Apparently, no one gets a five. Ever. “In that case it should be out of four,” I said, then pulled rank: “She’s a five.”

I’ll probably always give the intimidating girls a five.

I came to medicine straight from the English department so that I could become a psychoanalyst and bill Medicare. I didn’t tell them that in my interview (and I ended up a physician). What I told them was inconsequential as there was a push to get more humanities graduates into med school: apparently we’d make better communicators; apparently we’d be more humane. I don’t know who started these rumours, but they mustn’t have met the boys from my philosophy tutes.

The move to medicine was a bit of a shock: one minute I’m quietly reading, smoking Sobranies, the next I’m dissecting a dead torso. It was like high-school science class, with gore. At that time, around the country, medical students were being taught and examined on the skills of communication. Laudable, in theory. According to the course literature, communication skills seemed to mean every aspect of being a doctor that wasn’t based on hard science. In practice it seemed to mean “how to tell the patient ...”. Despite my coveted humanities background, each year I’d barely pass. In my final year I was examined by one of the course co-ordinators, a middle-aged man who had a habit of rolling his eyes up into the back of his head whenever he had to speak or listen to someone. He also wore huge glasses that he’d push up and down his nose as he spoke: anything not to meet your gaze as he taught you the essentials of human interaction. In the exam he was the patient and I’d be looking at him, trying to explain in a caring, open-ended yet honest and supportive way that he was going to die from colon cancer, and away his eyes would fly, leaving me to stare at a pair of boiled egg whites. Eye contact, I wanted to scream, Have you ever heard of eye contact? Instead, I gave him his prognosis and he gave me my feedback: two point five.

Most of the communication-skills tutors disliked medical students. Once, standing in a shower cubicle at the university pool, I overheard a couple of tutors making fun of one of us: “You should have heard him explaining to the actor why he needed to do her pap smear. It was disgraceful. He had no idea.” “Yeah,” said the other, “it’s the same every year. You wonder where they get them.” The tutors came from other departments, ones with less funding for innovative programs to teach students how to communicate. I would have hated us, too.

I wondered if “communication” could be taught at all. Say it like this and don’t cross your arms, lean forward ever so slightly and nod your head. It was as though they were teaching robots to resemble humans, and meanwhile our work would be piling up and we’d all be shitting ourselves about biochemistry. The fact that medical schools were trying to select the more communication-savvy students at interview suggests they had the same doubts. Suddenly more women got in than did men: hooray. But if you only let in students who are warm, empathic, excellent raconteurs, who’ll do the lab-based and management jobs? Who’ll teach communication skills?

The science part of medicine can be taught. But the rest, the human aspects – how to listen, how to be present, how to help your patient bear their suffering – you can’t quantify, distil or institute. You can’t even teach someone to pretend. It’s hard to say what the essential aspects of human connection are, but I’m picturing Marina Abramović, the Serbian performance artist; in 2010, she sat on a hard chair in the centre of a room at New York’s Museum of Modern Art, from nine to five every day for three months. You took a number and, when it was your turn, you sat in front of her silently, and she would look into your eyes – attend to you – for as long as you wished. Some people sat for three minutes, some for five hours. When you left she would close her eyes and rest until the next sitter came. I have the book that documents in photos the faces of those who sat with her. Most of them are crying, cracked wide open by her offer of a benign, focused attention, by nothing more than Abramović opening her eyes.

Karen Hitchcock

Karen Hitchcock is a doctor and writer. She is the author of a collection of short fiction, Little White Slips, and the Quarterly Essay Dear Life: On Caring for the Elderly.

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