By PAULINE W. CHEN
Published: September 11, 2008
Dr Chen describes patient-doctor lack of dialogue, or the bad quality of it, too quickly, using too much word without meaning for the health needs of patients facing a critical time in their lives. "But we have lost the ability to converse thoughtfully with one another. And because of that loss, we can no longer discuss the meaning of illness... " Dr Chen hopes "we can revive that conversation. Not in a clinic or hospital room, but here on the Web".
My 40 years of experience as pediatric nephrologists in a developing country - Uruguay - caring children and adolescents with renal diseases, even on chronic dialysis, have taught me the unique and irreplaceable value of face-to-face personal conversation with time and privacy as a way to give and receive support, to help and discuss topics bringing anxiety and sharing emotions, thus having an opportunity to express ideas, doubts, hypothesis, fears. Information technology and Web conversation is less time consuming than personal communication, but has a very limited power to efficiently face the growing doctor-patient divide. Real conversation with patients and their families or with colleagues and friends implies a complex milieu of words, attitudes (is the doctor checking his/her watch frequently?) silences, gestures, tone of voice, and all of its nuances. As a conversation component, silence is an important milestone in clinical practice, although unfortunately considered a loss of time.
My personal experience. Coming back to Uruguay following my training years in Paris at Pierre Royer's Service, the chairman asked me about the future of an adolescent, "Jose Pedemonte": severe blood hypertension and chronic renal insufficiency, in a time without dialysis and limited resources to treat hypertension. Jose, his mother, and the chairman were anxiously awaiting my answer. I had no other answer than silence and raising my right eyebrow. Few years later, Jose came back to my office with his fiancée, with quite an advanced renal insufficiency and severe uncontrolled hypertension. His comment: I've made lots of medical consultations, but I learned the truth about my future when you raised your left eyebrow. I understood the sad message in your silence and attitude; it was easy to know I had a short life ahead. Privacy and time to listen, to think and to speak are essential. Phone conversations are valuable complements to face-to-face conversation, since they a human voice with all it nuances.
The Web, mobile phones, e-mails, blackberries are strong and effective resources for communication, but are weak means to establish conversation with people looking for support in a critical time of their life. Personal communication is time consuming and implies high costs, just like sophisticated medical technology. But, it is essential to "cure" the doctors-patient divide. Web conversation poses a risk: to put an end to the still residual personal conversation habits.
Cure, care and love have close similarities: to give oneself to someone with whom we have confidence, looking for hopes, help and love. Personal contact is essential virtual connectiveness is a merely helpful and eventually evasive resource.