I haven’t had too much experience in talking to patients as I’ve only completed my Preclinicals (first 2.5 years of Med course). During the entire Preclinicals, I’ve visited different hospitals and GP clinics around 30 times and there, I had the opportunity to interact with patients. I know that it’s very petty compared to the Clinical rotations that I’ll experience later on, but I felt that I learnt a noticeable amount of communication skills that would benefit me professionally and also socially in non-medical situations, so it can gradually reduce my innate social difficulties due to my Asperger Syndrome to an extent.
Along with such visits, we had many tute classes for a component in our Health Practices subject called ICM (Introduction to Clinical Medicine). ICM teaches you basics in how to conduct medical conversations with patients, how to say certain things, and what to say in reaction to certain comments by a patient. I need rules and details (step by step) on how to talk to patients and people in general, so I found the booklets quite useful because it was well written despite not being specifically intended for people with an ASD.
For starters, it gave extra enforcement of the concept that patients have FEELINGS, and how you say certain things will impact on their mood and subsequent interaction with you, for the remainder of the interview and in further visits. I always knew that practically everyone (including me) had feelings, but my AS caused me to have a reduced Theory of Mind which impairs my ability to intuitively understand the feelings of Neurotypicals (who comprise the vast majority of patients) based on their body language, facial expressions, and subtle social cues. The AS also causes me to innately communicate in a more objective/pragmatic/blunt manner as opposed to a style that’s primarily sentimental, hence causing me to appear “rude”, “weird” or “insensitive” to many NTs.
The ICM booklets were helpful in that they explained the types of feelings that get ignited in patients when you use certain communication styles, because what you say SHOWS something to them, and they often don’t take things literally or word-by-word like people with ASDs tend to do. For example, I learnt that after a patient tells me a load of information about their condition/illness, it really helps for me to paraphrase or repeat what they said, to confirm the info AND TO SHOW that I’m proactively listening to what they’re saying, and that I’m not ignoring them. They can also correct any mistakes that I make, while FEELING less offended.
Another thing I learnt is that when patients are feeling anxious or upset because of their pain or illness, it helps to acknowledge their anxiety/depression by saying a sentence like “I’m sorry to hear that you’ve been having [X condition] for [Y amount of time], it would certainly affect [Z aspects of patient’s life], so I can imagine that this would be very frustrating/upsetting for you.” By saying such a sentence, it SHOWS to the patient that their illness isn’t trivial and that they’re being taken seriously. However, my problem is that my AS causes me to have difficulty with reading body language and facial expressions as previously mentioned, so it’s hard for me to figure out when people are a bit anxious/depressed, so I have to compensate by using more verbal info such as asking “How are you feeling today?” (near the very start of interview), “How’s Uni/work going for you?” or “How’s your family?”, and seeking for certain cue words in the patient’s answer to indicate their mood such as “pisses”, “sucks”, “hard time”, “bitch”, “tired”, “shit”. ICM also taught me that if I see a patient crying, that I should offer them a box of tissues.
ICM taught me that it can be helpful to say certain things in a more indirect manner to avoid offending or upsetting the patient, to avoid appearing aggressive and to SHOW that the patient plays a role in directing their own healthcare and that it’s not being forced on them. For example, if I spoke to a person who’s a chronic smoker, I learnt that I shouldn’t say “You should quit smoking coz it’s bad for you.” , but you suggest it by giving other alternatives or asking questions such as “Have you considered quitting smoking?” , “How do you feel about stopping smoking?”, “Have you tried Nicotine Patches or Zyban?”.
But it also states that at certain times, it’s better to be direct for certain sensitive questions (which I’m very grateful for coz I’m naturally blunt), because if you were to ask it another way, it can appear judgmental and offend the patient even more. For example, the ICM booklet states that when asking people about “illicit” drug use, it’s best to ask directly like “Do you use Cannabis/Marijuana?” instead of “You don’t happen to use Cannabis, do you?” because by asking it in the indirect manner, it actually ignites the patient into feeling like they’re being stereotyped or judged negatively. I also appreciate that ICM taught me how to ask questions in a specific order and explains why. For example in the area of “illicit” drug use, you start off by asking the usage of the most popular drug, progressively to the less popular ones. If the patient asks why you ask in such an order, you then have the medical excuse of stating that you’re asking in terms of epidemiological relevance, and that you’re not being judgmental. There are many “illicit” drugs in existence (in fact the list of “illicit” drugs is astronomical in Australia due to the ridiculously insane Analogues Act), so you only ask the top 5 or so, ie Cannabis --> Methamphetamine --> Ecstasy (MDMA) --> Cocaine --> Heroin (if I recall this order correctly).
So for some situations, it’s best to be indirect, but in others direct is better, and this is quite confusing for me as my AS causes me to have a naturally more rigid mindset. Hopefully as time goes on, I’ll gain more decent Clinical experience and learn to be more rapidly flexible in figuring out how which questions are asked more appropriately and in the least offensive manner.
Then there’s the case where I learnt that you have to be direct, but delicate with the words that you use, as verbal differences are converted into social subtleties that are intuitively noticed by NTs, igniting further emotions.
For example, when I begin to conduct a breast examination on a woman, I’m extremely tempted to say:
“I want to see and touch your breasts to see if you have Breast Cancer.”
coz it’s the direct/blunt Aspie method. If I was to say this to a woman with an ASD, she most likely wouldn’t be offended at all. HOWEVER in the minds of many NT women, the segment “I want to see and touch your breasts” is automatically correlated with sexual harassment despite this being a medical examination, and the segment “to see if you have Breast Cancer” is also alarming due to mention of the potential pathology, igniting fear/anxiety. Therefore I was taught instead to say:
“I want to inspect and palpate your breasts to make sure that they are healthy.”
The words “inspect” and “palpate” (both are synonyms of “see” and “touch” respectively) are used because these words are used less frequently in informal conversations and therefore have a more professional/clinical tone to it, hence having less correlations with sexual harassment. The segment “to make sure that they are healthy” is used instead because it avoids mentioning any pathologies, but it still directly retains the intention of the examination, ie just said differently. “Healthy” is considered by many to be a positive word and hence the breast examination APPEARS to have more positive connotations with it by NT women, and so they’re more willing to proceed.
I’ve learnt that not only do the majority of NTs care about substance, but the vast majority of them also care about APPEARANCES and what you SHOW to them by the way you talk (social subtleties), sometimes even more so than substance!!!
It appears that if you cater to the patients’ emotions to an extent, the entire conversation is more likely to be cordial. Although very tiring and difficult for me, I treat the talking in an “emotionally sensitive/empathetic” manner as a price to pay for a smoother medical conversation and for a politer relationship.
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