The article became popular after President Obama read it and brought it into a meeting with several senators regarding health care reform. Since then Dr Gawande has increasingly been seen as an innovative voice in regards to improving health care quality while controlling costs.

Based on the speech I heard, that distinction is well deserved. He is an impressive speaker. He explains complex issues clearly and is a talented story teller. Most of all, he is inspiring. He sincerely believes that we can improve health care and he’s so passionate about it that you can’t help but want to come along for the ride.

One of his main points was that when examining outcomes and making comparisons in medicine the most useful comparison is not looking at good vs. bad, but rather good vs. great. Most physicians and hospitals in the USA fall somewhere along the good spectrum. Dr Gawande argued that the best way to to improve care is to observe who is standing out and doing the best, then examine why that is the case and how that can be emulated in other places.

At the end of the lecture they allowed a question and answer period. The questions were written on note cards by audience members during the lecture. My question was picked! I asked,

‘What can medical students be doing while in school to make sure that they become great?”

His answer was brief and basically touched on two points.

1. Medicine is become more and more collaborative, so the better you work in a team environment the better a physician you will be. Practice working with other people.

2. Take the initiative to learn things on your own.

Medical school starts next month. I’ll do my best to become a great physician, with Dr Gawande as a role model. Maybe someday I’ll write some bestsellers too!

Have you read any of Dr Gawande’s books? What did you think?

A focal neurologic deficit as I understand it is a deficit that is affecting a specific part or side of the body. Right sided weakness, a facial droop on the left side, or right arm numbness would be examples of a focal neuro deficit. Focal designates that the symptom is in a specific area.

Most people don’t know that, heck, it took me many months to figure it out working as a scribe.

So, naturally, it was surprising and frustrating when a physician I was working with asked a drunk guy coming in complaining of weakness-

“Do you have something focal going on? Anything focal?”

Wow. I think the blank stare would have been the response of 99.5% of the population in a similar situation.

Note to self: never ask someone if they have something focal happening to them, unless my patient is a neurologist.

A huge chunk of my day as an ER Scribe is spent observing patient-doctor interactions. Too often I’ve seen physicians use a medical word or phrase that 90% of the time the general population would not know. Unfortunately, some doctors completely miss the fact that their patients are utterly confused.  They feel they have adequately described what was necessary and leave the patient’s room even as the patient’s face clearly is asking, “WTF did he/she just say?”

In especially obvious cases I’m tempted to stay and offer a short explanation, but I’m basically tethered to the physician I’m working with so I risk being left behind and missing something important. Thus, I leave too.

This example of poor communication furthers the disconnect between patients and physicians. Patients nearly always are initially at a position lower than their physician, as they are coming in saying, “I don’t know what is going on, you’re the expert, please figure it out.”

Clearly there are times when certain terminology may communicate most accurately what a physician is trying to explain. But is it the most effective way to communicate? If you describe something accurately but the other party has no idea what you’re talking about, what is accomplished?

With this in mind, I’m keeping track of words and phrases that most often appear to trip up patients and their families. This is mostly for my benefit, so I can go back and read this list when I’m actually practicing medicine and see if I’m actually meeting my own ideals. My goal is to be able to use simple, clear language without coming across as patronizing. Some doctors I work with are great at it, and it’s their example I hope to follow.

My first word/phrase? Asymptomatic. It means without symptoms. Example that I hear often that throws people off: “How long have you been asymptomatic?”

This question is usually answered with a blank stare.

Alternative question: How long have you not had (such and such symptom, cough, fever etc)?

I hope you enjoy the series! I’m cooking up a post about a crazy story in the ER from the other day, stay tuned…

(Source Pic)