Do healthcare providers need healing? You bet we do! Our bodies are no different than those of our patients. We have the same pains, same diseases and infirmities, the same psychological problems and the same social problems; these have the ability to render us impotent and impair our professions and our practice. Where am I going with this diatribe? This would not be an article from me without a quote, so here we go. “Healing begins with the open compassionate acknowledgement of those unpleasant aspects of our lives.” Sharon Salzberg, author and meditation teacher
I would like us to focus on one organ today: the tongue. The tongue is a muscular organ in the mouth. Its main function is to compliment digestion, and it is vital for taste, chewing and swallowing food (mastication), and for speaking. When we as clinicians request that our patient sticks out their tongue, we desire to see if it is midline or does it deviate to one side, indicating an impending stroke. While performing this aspect of physical diagnosis, what other diseases or findings are we looking for? We are ruling out thrush, cancers, inflammation, enlargement, canker sores, and bald or hairy tongue, among other diagnostic cues.
What else should we know about this little organ besides its anatomical and physical presentation? The tongue is inevitably connected to the brain. Because it is associated with speech, we need to understand its possible destructive power. Like a cigarette carelessly thrown in a dry forest, it has the ability to become destructive just like a wildfire. When and where we make comments becomes very important as regardless of the dry or wet soil indicated by my illustration, it can still be a destructive force. The tongue is one of the most dangerous organs in our body because our speech incriminates both us and our professions.
We all utilize speech every day; but sometimes we speak without thinking of who else may be listening or how our comments affect others. If you want to understand the implications of what I just mentioned, ask your significant other. I have just read a book called Trading Places by DRS. Les and Leslie Parrot. The focus is on learning to place ourselves in the other person’s shoes and to think about how they interpret our speech.
Today, many of your elder colleagues have observed that the last decade of physicians, residents, PAs and NPs do not touch their patients. We are somewhat apprehensive because we feel that they have placed their dependency on modalities such as ultrasound and radiological studies. We question how they would practice if these tests were not available, such as in a private office or in rural medicine. They have been placed in a position where they learned to examine patients more quickly and have developed a dependency on ordering diagnostic tests rather than following the concepts in Cope’s Diagnosis of the Acute Abdomen. The problem with us dinosaurs is that we may say this among ourselves or in the presence of eight people at a restaurant or our neighbors or friends. My SP once said to me, “Bobby, how does that comment help our practice?” Lose lips can sink ships was a quote familiar to the WWII generation and it affected national security. Practitioners who are in Telemedicine may disagree with me but I am not familiar with the tools in their toolbox; therefore, I make that possibly ignorant remark.
We can talk about a clinician who missed a pneumothorax or pulmonary embolism because they listened to the history and diagnosed it as an intercostal chondritis, which is also painful but has a different presentation and cause. How does that comment affect the reputation of our colleagues? This is not how to make friends, and the enemy that you make, because the comment reaches their ears, may become your next boss. Don’t make a demeaning remark to a knowledgeable patient because they were diligent enough to look at the possible differential diagnosis that they discovered at one of our wonderful internet medical sites. And for maintaining a positive relationship with your patient, don’t blow them off midway into your exam and say “I’ll be right back,” while you go into the next room to appease your front desk person.
In conclusion, another organ of the body is the ear. Who else may be listening? Who else will repeat what they heard to a dozen friends and then the comment continues to become the news of the day created by a clinician? Who else is on the hospital elevator? Is it another patient or an attorney or a Risk Management officer? When a subpoena is issued with your name on the front of the blue cover, do you have an insurance policy with your name on it to protect you? This message is how we, as your colleagues, can demonstrate our concern for you, having been in the same trenches and observing outcomes of the behaviors discussed here. Oprah Winfrey said, “There is no greater gift that you can give or receive than to honor your calling. It’s why you were born.” We need to honor our calling by reflecting on how we speak.
Written For CM&F By: Robert M. Blumm, PA, DFAAPA, PA-C Emeritus
CM&F Clinical Advisor