Communication

By Dr. Jim Ferguson

Communication is a delicate art, and unfortunately, too often taken for granted. Do words adequately convey our thoughts? You can read my words, but they are, at best, a reflection of my thoughts. Plato’s illusion of the cave comes to mind.

Direct conversation is better than the written word because the additional dimensions of hearing nuanced spoken words and observing body language are added. And though conversation affords a closer approximation of another’s thoughts, there are perhaps greater risks if you choose the wrong word or convey incivility by indelicate tone inflection or body language.

I once read that direct conversation with another person stimulates more areas of the brain than a crossword puzzle and certainly more than a TV program. I suspect this is true because dialogue requires hearing, seeing, memory retrieval, speech patterns, muscle coordination and modifying social graces.

Each year I am required to attend a conference for medical malpractice prevention. The skeptic might say that the purpose is to protect doctors from lawsuits. Actually, the conference is designed to protect patients as well as doctors by promoting good communication. No rational person wants to be injured or resort to a medical malpractice lawsuit. And no doctor sets out to cause harm to his patients.

Simply defined, malpractice is said to have occurred when there is a violation of medical standards of care and the patient comes to harm as a result. It is a tragedy for the patient and also for the doctor because winners are hard to find in a court of law.

I have never been sued for malpractice, and this is unusual after more than forty years of medical practice. Perhaps I’ve been lucky. Perhaps I have communicated with my patients that I’m competent yet human and fallible. Perhaps I’ve conveyed that I genuinely care for their well being and work hard to provide their medical care.

I see medical practice as 50% science and 50% the artful application of that science. It boils down to a combination of competence and compassion. At one time in my career I viewed competence as more important than compassion. No patient would see a doctor who was incompetent. I now view compassion as equal to if not more important than my medical expertise.

In medical school and training I was taught the art of taking a medical history. It was said that 90% of diagnoses are made by talking to the patient, augmented by a careful examination. Later I learned that patients would “tell” you what was wrong with them if you would just ask them what they thought was wrong or just listen carefully.

There are exceptions to every rule. I once had a patient who came to me for a consultation. After a careful history and physical examination I told Mrs. Jones that I was quite sure of her diagnosis. She then told me that she agreed with me, and that my diagnosis was the same as Dr. Smith’s. I asked her why she did not tell me she had seen Dr. Smith and of his conclusion. She replied, “ I wanted to see if you could find it (the diagnosis).” As in the movie Cool Hand Luke, what we had was a “failure to communicate.”

It is my belief that doctors do a better job when you tell them where to look. However, that supposes they’re listening and that they are not so high minded that they discount the layman’s perspective. Perhaps because I am a doctor my doctors listen to me and take time to answer my questions. You should insist on no less. In fact, poor communication is dangerous to patients and to doctors.

At its most basic level, communication is an act of love. To listen you must suspend your own desires and give to another your precious time and attention. Doctors and spouses who don’t understand this suffer the consequences.

In a book I’m reading the author makes the point that few people are persuaded by your argument, no  matter how logical or correct your position. However, people sense your concern for them when you listen and consider their perspectives. This does not occur in TV panel discussions on politics. In fact, I now bristle at the word “conversation” because it is anything but.

I prefer the term dialogue between people. Perhaps I prefer this term because Plato’s introduction of “dialectics” or debate 2,500 years ago. Plato described back-and-forth discussions between Socrates and various interlocutors through which higher planes of understanding resulted. The 19th century German philosopher Hegel furthered the dialectical method introducing the notion of a thesis or position, countered by an antithesis.  Eventually this interplay arrived at a synthesis of a higher order. Hegel envisioned the synthesis producing another thesis and then another round of dialogue evoking higher levels of truth.

The problem in our modern polis – where we derive the word politic – is that all sides are prejudiced and fundamentally opposed to each other. There is no respect, no listening and no thoughtful consideration of opposing views. Therefore, there is no communication or possibility of synthesis and higher orders of rational thinking.

I then pose the antithesis: is communication or debate even possible or rational when confronting evil? Of course this would presuppose you acknowledge the existence of evil as the antithesis of good. I admit that I am a theist and an absolutist because I think of God as being the absolute standard of good. We moderns might measure a door with the the standard yardstick or meter stick. I am just shy of 5’8” in the morning (though weighed down by the events of the day a bit shorter by evening).

So, would you, in a courteous and loving fashion listen to views opposed to your own? Would you reach across the aisle to what you perceived as horribly wrong? Did Jesus cross the aisle and compromise with the Pharisees or with Herod? No, he didn’t, but we are not Christ. We don’t have all the answers and as a result we should be respectful of other’s opinion even when we consider them blatantly wrong.

Someone needs to explain this to college snowflakes who demand safe zones or riot when confronted by perspectives which challenge the dogmatic indoctrination they received from their professors.

 

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