Using common ground – simplifying how you talk to patients

By Carl Robinson, senior cardiac physiologist working for the NHS, specialising in EP and pacemakers

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A Crocodile and a Shark are talking, when conversation quickly turns to dinner.

“This evening I think I am going to have toad” snaps the Croc.

“Oooh I have never had toad” replies the Shark, “What does it taste like?”

“Oh it’s divine, sumptuous, ubiquitous flavours, very toothsome! ” explains the Croc.

The Shark looks blankly at the Croc.

The Croc has a rethink…

“It tastes a bit like turtle!”  

“aaaahhhh” says the Shark, you lucky bugger “I’ve got Sushi again tonight!”

 

Whilst I am sceptical as to whether this conversation ever actually occurred, it does raise a good point about finding common ground when communicating, either with colleagues or patients. Over the years I have learned that a nodding and smiling patient is just as likely to be desperate to get home or concerned about car parking costs, as they are to be digesting every word that the doctor is saying.

The problem stems from efficiency. Medical professionals are amongst the most efficient workers in the world, and efficient language is paramount to this.  Not only is it quicker to say ‘Mitral Valve’ than ‘the valve on the left hand side of the heart between the top and bottom chambers’ but it is often more accurate… “Who’s left? My left or your left doc?”

You know this though; all doctors and healthcare professionals are aware of this and most speak in words that the patient will understand. I want to take this one step further though. By using language they understand, you are halfway there, but if you can find a source of common ground, this can give a memorable understanding of what is happening to or within their bodies.

Let me explain what I mean.  A woman is found to have palpitations because of a re-entrant circuit around her A.V. Node.

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The doctor starts to explain…

An electrical signal travels from the top of your heart to the bottom during each heartbeat. In your heart every now and again the electrical signal goes round and round and round causing a much faster heart rate and this is what causes your palpitations.  We aim to burn a tiny bit of your heart so that this can no longer occur.

Pretty understandable I agree, but no real common ground with the patient.

Let’s try again…

An electrical signal travels from the top of your heart to the bottom during each heartbeat. Think of a car travelling down a road from A to B – this is like the electrical signal travelling through your heart every time it beats. Unfortunately on your road you have a roundabout, and every now and again your car gets stuck at this roundabout, continuing to drive around and around, causing your heart to beat very rapidly. This is what causes your palpitations.  Using heat we are going to burn off part of your roundabout so your car has no option but to carry on, as it should do, to its destination.

Whilst this is quite a crude analogy, the salient points are there and your patient will remember it. The reason your patient will remember it is because they have a car and they have been on a roundabout – they have probably even got lost and been driving round looking for their exit. This enables them to link a new concept to something they are already familiar with, a technique used by memory champions for centuries.

Why is this so important? Well, when the patient walks out of your room, they do not just evaporate. They get into their car and return to their family. The first question they will face is “what did the doctor say mum?” You can be sure that your patient can remember all about cars and roundabouts.

In my work, I liken the heart to tubes of toothpaste, stress balls, skeleton leaves, football stadiums and anything I can think of to use as common ground. I encourage you to do likewise; you will probably even enjoy coming up with different analogies! However, most importantly of all, it will improve the patient’s clinical experience – after all they should always come first.

 

Check out Carl’s website at: www.thepad.pm / @thepadct

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