Much is written about patient-provider interactions and how they can be improved. As I learned this week, there is an elegant solution to what is doubtless a common concern among health care providers: is the patient telling the truth, no matter how inconvenient?
The truth: I snore. In fact, my snoring is loud and legendary—famed in song and story, as an old friend likes to say. I am also considerably overweight. Being a health-conscious (if not always health-practicing) person, I am aware that these two facts are not unrelated. More than that: I know that obesity is a risk factor for obstructive sleep apnea, and that serious snoring is a telltale symptom. I also know, perhaps in part because of what I do for a living, that sleep apnea is a risk factor for cardiovascular disease and that treatments include weight loss (duh), CPAP (ugh), and surgery (eww).
It’s all too easy to attribute poor clinical communication to low health literacy. In my case, however, it was all-too-well-informed self-interest that led me to significantly downplay my snoring when asked about it earlier this week by a perceptive and persistent cardiologist. I had been referred to him by my primary care provider (PCP), not for any particular issue, but simply because I was, in my PCP’s words, “over”: overweight and over 40. So, even though I’ve made the effort to schedule this preventive consultation, and I’m paying out of my own pocket for it (HDHP), here I am brushing off the diligent cardiologist’s inquiries because, well, I don’t want to go there.
Dr. Rosenberg has clearly seen this sort of thing before. He innocently asks about my marital status and my partner. Then: “Do you think we could give him a call?” “Right now?” I ask, surprised. “Sure. I’d just like to talk to him for a second.” “You’re going to ask him to characterize my snoring, aren’t you?” I probe, trying to steer. “Just hand me the phone,” he says.
You know where this is going: my partner gleefully confirms the good doctor’s worst suspicions, volunteering that he’s been badgering me about this for years, while I squirm under the cold light of Truth, looking like an unusually large five-year-old who’s been caught fibbing. I’d been reading just that morning about using mobile phones to help patients manage their health, but I didn’t expect to get such a first-hand (and comparatively low-tech) demonstration of the principle later that afternoon.
Kudos to Dr. Rosenberg for doing something that, in my experience, is rare. He took the time to get another perspective on the patient, seeking input that would confirm his hypothesis. I wish I’d been a more reliable narrator, but like many of us, I often paint myself in a flattering light. I’d love to hear whether something like this has ever happened to any of you.
In the meantime, the episode raises a few questions that I know I’ll keep in mind the next time I’m thinking through a health-education program: How can we encourage patients to tell themselves, and their providers, the truth? How can we reduce patient fear of the truth’s implications, so that they don’t have such a strong motivation to, you know, sort of sugar-coat it? And how do we empower/equip those who know us so well, those who sometimes see us more clearly than we can see ourselves, to become our partners in prevention?