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When Doctors Are Bad Conversationalists

This article concerns what I call the poor conversationalist. There are several common versions of this, and all of them have corresponding parallels in nonmedical settings. Often the most basic difficulty is one of manner. A good conversationalist is a person who, no matter what he is thinking, outwardly projects an air of interest in what the other person is saying. The doctor who acts distracted, hurried, or even uninterested gets the conversation off very much on the wrong foot, especially if patients have been waiting a long time to see him. This sort of doctor may avoid eye contact with patients. He often continually writes while they speak; although most of us take notes during an interview, patients not unreasonably expect us to look up at them now and then.

A poor conversationalist is impatient to get at what he assumes to be the crux of the matter and will interrupt, cutting off explanations. It is true the doctor typically directs the flow of conversation, but he needs to do this in a way that does not stifle it. If he is too heavy-handed, the result is a very one-sided conversational exchange, which can, in turn, result in suboptimal medical care. Knowing how to guide and direct rambling historians is a delicate skill for physicians. The poor conversationalist, however, often errs on the side of demanding short, even yes or no answers only, to the questions he asks. He does not want all the details. As he sees it, like Officer Friday on Dragnet, he wants “just the facts, ma’am.”

Besides being annoying, the doctor who is a poor conversationalist of this sort will miss things, occasionally important things, because there are times when it is the details that really matter. A doctor like this often glances at the patient or the chart and makes an early, snap judgment about which way to go with the interview when it has barely begun. Already convinced about what is important, he may then interrupt patients who he perceives as wandering from the key points of the history.

Our innate personal conversational styles can also interfere with the process. These are things which, although causing little problem in other aspects of our lives, can interfere with our roles as physicians. Some of us mumble, others gaze at the ceiling when talking, and still others of us use convoluted ways of expressing ourselves. Some of us present ourselves as amiable conversationalists, others of us come across to patients as unduly grumpy.

Patients who find themselves opposite a physician who is a poor conversationalist for any of these or many other reasons often become frustrated, and sometimes angry. After all, they have been waiting to see this person, sometimes for hours, or they may have made this evaluation appointment weeks in advance. Now their concern is to get the most out of an interview that seems to them to be moving in an unsatisfactory direction — how can you change this?

I think the most crucial thing is to remind yourself that you and the patient are partners in the diagnostic and therapeutic enterprise. Most doctors, no matter how harried and frazzled at the moment, realize and understand this if given the chance.

Christopher Johnson, MD, is a pediatric intensive care physician and author of Keeping Your Kids Out of the Emergency Room: A Guide to Childhood Injuries and Illnesses; Your Critically Ill Child: Life and Death Choices Parents Must Face; How to Talk to Your Child’s Doctor: A Handbook for Parents; and How Your Child Heals: An Inside Look At Common Childhood Ailments. He blogs at his self-titled site, Christopher Johnson, MD.

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