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Explaining things to patients is like eating an elephant

When the Jobbing Doctor's patients report problems with their clackers and going to ground, all is not what it seems.

When the Jobbing Doctor's patients report problems with their clackers and going to ground, all is not what it seems.

In my locality there is a special way of talking. It is more than an accent, it is a dialect, So I had a very interesting initial experience at the start of my career in General Practice adjusting to a different way of speaking.

Some I my early time as a doctor in training was based at two separate hospitals in Surrey. It was a very leafy area where the prevailing accent was definitely what you would call ‘Hooray Henry'. As a working class boy from the poor part of the Midlands, I struggled to understand the patois, and also never really settled, and so when I decided to change careers (and move a little nearer home) I didn't think I'd have a problem with language - but I did.

After a couple of weeks sitting in with my trainer, I was let loose on the community. The first man came in, sat down and said in a thick accent:

‘Oi cor goo to grouwand'

I asked him to repeat it, and got the same answer. I was flummoxed. So I pretended that I didn't have a prescription pad, and then rushed into the next room to ask one of the partners what he meant: he told me.

‘I am constipated' is what he means. ‘Going to ground' is local dialect.

41227952I use this illustration on my local GP Vocational Training scheme to illustrate the difficulties in communication - in understanding what the patient says. They sometimes talk about their clackers. As in ‘my clacker is sore and painful'. Some of you might expect the patient to be unbuttoning their trousers, but don't worry - the clacker is the uvula (the dangly thing that hangs down the back of the throat).

This can, however, work both ways. Most readers will know what Sarcoidosis is. It is a ‘multisystem abnormality of unknown aetiology and uncertain prognosis with little consensus on treatment, which exhibits itself as non-caseating giant cells in the abnormal tissues'. Try telling that to the bloke on the top of the bus.

So one of the exercises I use is to get the young doctors to learn how to explain Sarcoidosis to an unemployed steel worker, a kurdish asylum seeker and a barrister (i have all of these types of person in my practice).

They really struggle, as it is a really difficult exercise. There are ways around it, and many clinicians opt for a blizzard of leaflets, but these don't always help my patients. So I am clearly left with a problem. The nuances of uncertainty are not what my patients want to hear.

Neither do they want the ‘don't-worry-your-pretty-little-head-my-dear' approach. So there has to be a middle course. This is compounded by the fact that, on average, a patient is only ever likely to remember about 20% of what you say in any consultation.

Some I colleagues in hospital tend to use their nursing colleagues to paper over their inadequacies: ‘You have got Sarcoidosis, my dear. The nurse will tell you what it means'.

My preferred way is the ‘eating an elephant' approach. The easiest way to eat an elephant is in small pieces, and trying to help people understand a baffling condition like Sarcoidosis is best done in little sections. So communication is two way. What the patients say to you, and what you say back to them.

I would sometimes like to take the approach of an elderly doctor, who when asked by a patient about some new tablets by a patient:

‘My dear, they are for you to take, and me to worry about.'

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