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Systematic reviews and evidence-based medicine

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How patients and doctors talk to each other
Harold Lambert Physician
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There was another thing I wanted to mention about this terrible business about misunderstanding or how patients and doctors talk to each other and it's, it's got a real bit and a kind of bogus bit so, I mean, one of Richard Asher's examples is the patient comes in and says- I've got this terrible sore tongue and the doctor says- looks at it and says- you've got glossitis; and the patient says- oh thank you doctor, now I know. Now the real bit is the word. It really is deeply comforting to have a name for something. It's- sort of part of your uncertainty and doubt is resolved and, of course, the bogus thing is it's a tautology. You can read that sentence from right to left and it has no more meaning than if you read it from left to right. And we do tautologies in medicine all the time, absolutely all the time, most of them unrecognised by us and I- it's just another thing where a chap like Richard Asher, who wrote things like "Talking Sense". He did a kind of medical equivalent of George Orwell in a way of- penetrating look at the words we use and what they mean and in which ways the- we obfuscate or conceal what we don't know, which we do a great deal. And so, I mean, that's why I think there's a great deal of misunderstanding because there's all these elements we've been talking about which make it difficult but, on the other hand, you know, mostly you get along all right and the patient and the doctor more or less know what, what they're on about. And presumably the patients can also make the same obfuscation with their own words that- Oh indeed. Yes, that's true. Do, do you, do you feel, looking back, that when it came to those- that sort of obfuscation or that sort of unpeeling of things that actually you were able to change the way in which you talked about things or, or do you feel that you were very much the product of your education, if you see what I mean? Yes. I don't know. I suppose as you realise these things, often from a particular episode rather than from a book you, you kind of recognise it. I suppose actually part of the problem- part of the solution is recognising it. Once you recognise it as a problem it's- you don't exactly explicitly solve it but it makes it easier to deal with. And the reason I came back to this thing about intellectual barriers is that a lot of people think the intellectual barrier is doctors using long words. I think that's a totally superficial judgement. A: most doctors don't now use obscure words, and B: as I've been saying, it's much deeper than that, about how the patient and the doctor understand the process of what's going on. Do you think we're actually looking for those barriers? That they're in a sense- the, the patient's looking for them as well? I mean, looking for, looking for a barrier, something to heap up their anxiety against in some way? Oh I, I, I don't know about that. I hadn't thought of that really. Patients seem to want a, a name for things, don't they? Oh yeah. Yeah. Yeah. And even if the name doesn't mean very much it's, it's something, which you can- Yes. It is comforting, isn't it? Yeah. Yeah. To all of us. How did you find explaining research to patients? Did you find that that was something that you could explain? It's becoming much more formalised, hasn't it, in recent years, the explanatory sheets and all this kind of thing and- but I, I think it is difficult if the technique is a difficult technique but I think it is possible. I think the general thing is if you understand it yourself you can explain it to somebody else; if you don't know what you're on about you, you can't. But I think it's perfectly possible but, again, rather like medicine, sheets about medicine, there's a balance between too little and too much. And if there's a potential danger to the patient it's obviously extremely important to be absolutely fully informed, but if it's not in any way a hazardous thing, except maybe, you know, taking blood from a vein or something I don't think it's difficult at all really, on the whole. I mean, the pertussis one- and we did a lot of other work on pertussis- was really saying about the lung function tests, which as you know, are not invasive and saying what we were trying to find out and I think that was easy. But there are much more difficult ones. I think it can be a bit bogus, the explanation, if it's, if it's explaining- trying to explain something which is extremely technical and almost impossible to understand.

British doctor Harold Lambert (1926-2017) spent his career tackling infectious diseases, helping in the development of pyrazinamide as an effective treatment for tuberculosis. He also published work on the rational use of antibiotics and was a trustee and medical advisor for the Meningitis Research Foundation.

Listeners: Roger Higgs

Roger Higgs was an inner city GP for 30 years in south London, UK, and is Emeritus Professor of General Practice at Kings College London, where he set up the department.

He gained scholarships in classics at Cambridge but changed to medicine after a period of voluntary work in Kenya in 1962. He was Harold Lambert's registrar for 18 months in the early 1970s, the most influential and exciting episode in his hospital training. He set up his own practice in 1975. He helped to establish medical ethics as a practical and academic subject through teaching, writing and broadcasting, and jointly set up the 'Journal of Medical Ethics' in 1975.

His other work included studies in whole person assessment and narrative in general practice and development work in primary medical care: innovations here included intermediate care centres, primary care assessment in accident and emergency departments, teaching internal medicine in general practice and establishing counselling services in medicine.

He was made MBE in 1987 for this development work and now combines bioethics governance, teaching and writing with an arts based retirement.

Tags: intellectual barrier, long words, communicating with patients

Duration: 5 minutes

Date story recorded: October 2004

Date story went live: 24 January 2008