I Understand

In my last post, I described the technique I used to write Only 10 Seconds to Care. As a teaching tool, I used the literary equivalent of an optical illusion. To illustrate this effect, let's talk about the phrase, "I understand."

The story entitled, "Misunderstanding Physicians," begins with a short introduction: "We grow up learning to say, 'I understand' after someone shares complicated or emotionally charged information. This expression of empathy encourages people to continue providing information and reassures them that their information is safe with us. Unfortunately in clinical settings this expression can cause trouble."

Now read the story, and see how it has a different message depending on if the reader is a clinician or a patient. Ever since writing this story, I have never heard the phrase, "I understand," the same way again.

Comments

[Carl Wilton]

Very perceptive, Wendy. A nuanced explanation of the different ways we understand the word "understand."

[Kairol Rosenthal]

I became so aware of this phrase when I was doing interviews for my book Everything Changes. Yes, I was interviewing young adult cancer patients and I AM a young adult cancer patient. But our stories are so different. I've never had a stem cell transplant, I don't have kids I have to find child care for when I go to the hospital... there are many things about other patient's cancer situations that I don't understand and that is okay. Instead of understanding, I just listen.

Kairol

Kairol Rosenthal
Blog: Everythingchangesbook.com

[Jeanne M Hannah]

Wendy, I agree wholeheartedly with your analysis of this issue. As a person who has been deaf in one ear since the age of 5, I have learned to read lips and other cues such as facial expressions and physical cues such as gestures.

I have also learned that I get my most reliable information through my eyes, not my ears, in other words by reading it. I have learned to make sure that what I "heard" is actually what the speaker said.

Thus, in a court hearing (I am a family lawyer) in a complex case with high conflict, after the judge ruled verbally from the bench on a motion, I stood and said "This is what I believe I heard you say . . . " and I repeated what I thought he had ruled. This technique could save my client delay and expense because I would not have to order a transcript before preparing the order.

Imagine my dismay when the judge interrupted me in a very rude manner. I explained why I was reiterating what I thought I heard. He said: "I did not know you were deaf in one ear. I simply thought you were being obtuse." I felt very hurt by his derisive manner and his unfortunate choice of words, but decided that the best approach was to remain cool, calm and collected in his courtroom and to insist calmly that he take the time to confirm my understandings.

It would be my hope that decision-makers and also my physicians would show greater temperance, tolerance and understanding that not all people communicate and take in information in the same manner. People have different learning styles and what is more important than patients learning the necessary techniques, procedures, and potential for treatment or cure? Of course we want them to learn from their treating physicians.

Evidence-based research shows that there is an unacceptably high incidence of readmission to hospital that is directly related to medication issues (wrong dosage, patient did not understand instructions, hospitalist did not communicate with primary care physician to ensure post-discharge follow-up, etc., etc.) Much of the problem relates to communication and lack thereof.

What does the physician say and what does he or she mean? What does the patient hear? Did the physician understand the patient's concerns, and did the patient understand the physician's recommendations? How can we realistically improve the communication process and eliminate "disconnect?"

This is a topic I'd like to see you explore in greater detail.