Surviving the Awkward

The doctor-patient relationship requires a lot of trust. From my side of the table, I listen to patient concerns trying to pull out pertinent information and build a story that leads me to a diagnosis. From the other side of the table, the patient needs a safe space to share their private concerns.

There is nothing off limits when it comes to patient encounters. Some information I have to coax out of the patient. Some information once shared, I can never block out (FYI – I never need to know how you refer to your own genitals). But regardless of what comes my way, I need to maintain a safe space with as little judgement as possible (we are human, not saints). For the young man who shows up with a huge neck mass, I stay calm. For the erectile dysfunction talks and sexually transmitted disease testing, I keep it professional and clinical pretending not to see the awkwardness and embarrassment that the patients are feeling. I accept the painful disclosures of previous abuse or current abuse with support and soothing words. I walk in ready to talk about a patient’s reported rash and they start crying for a completely unrelated recent loss of a parent, friend, or pet. After twenty years of working primary care, people have shared a lot with me.

Medical school and residency trained me for the medicine and science, but effectively communicating with the upset or uncomfortable patient is an art form a lot more difficult to learn. The subtleties of eye contact and body position, finding the right approach to breaking the touch barrier, controlling the volume and tone of my voice, even eyebrow control are all part of that communication. I have made mistakes, particularly early in my career. And I’m afraid I will probably make more in the future. I fully acknowledge that I’m not perfect, but I am trying. If I screw it up, please tell me so I don’t do it again. It won’t be fun for either of us in the moment, but not correcting me does a disservice to us both. I want to survive the awkward as much as you do.