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We must realize, as physicians, that learning the "art of medicine" goes hand-in-hand with learning the art of communication.
As physicians-in-training, medical students focus a significant amount of energy on learning how to think and speak "like a doctor."
Many of us emerge from this maze of medical lexicon, however, only to discover that we lack the ability to translate the information we have spent so long learning into something patients will understand. As such, we must realize that learning the "art of medicine" goes hand-in-hand with learning the art of communication.
Learning the lesson
To my dismay, I did a terrible job, reverting to using complicated words and medical terminology. My assignment for that weekend was to come up with an appropriate description for the flu vaccine that anyone could comprehend.
Later that day, I found an interesting article that detailed the challenges of obtaining informed consent for a clinical trial of a vaccine against hookworm in an endemic area of Brazil (PLoS Negl Trop Dis. 2010;4:e749). The authors produced a video that compared the daily experiences of the local inhabitants (such as the cultivation of cassava) to manufacturing vaccines. I decided to base my description on something relatable to the diverse population here in Chicago. My attending and I felt that the end result of my assignment was worth sharing.
For this analogy, I ask the patient (or parent), "What is your favorite sports team?" I then describe the immune system as being like the patient's favorite team, with viruses and bacteria (germs) as an opposing team. If the immune system "wins" the game, the patient remains healthy; if the germs win, the patient gets sick.
I ask the patient how the immune system might best prepare for the competition. Perhaps a team needs to see its opponent play before a game in order to devise a "game plan." I liken the influenza vaccine to an opponent's game film the immune system team might watch to get ready.
The game film is not the real game, of course, so it cannot really "beat" our team: in other words, it cannot make the patient sick. In this sense, the vaccine gives the immune system the best possible chance to "win the game" if and when it really comes into contact with the virus, because the immune system is prepared for the "game strategy" of the real virus. This analogy not only explains the mechanism of the influenza vaccine in a simple way, but it also helps to explain away the common myth that the vaccine itself can cause illness.
Putting the analogy to the test
Shortly after finishing my assignment, I had the opportunity to test out my new analogy on rounds. A 6-month-old patient had been given the influenza vaccine during her hospital course, and her mother was confused about whether this was appropriate, given the child's acute illness. I talked through the vaccine with her and was delighted with the results: no blank stare washed over her face, and she clearly was engaged with me throughout the conversation.
After we finished, my attending asked her if she understood, to which she replied, "Yes, that makes a lot of sense." Like brush strokes on canvas, my words painted a picture with which she could connect. As my career progresses, I will be sure to leave room on my proverbial painter's palate not only for those skills that will allow me to examine and diagnose patients with confidence, but those that will allow me to better communicate and connect with them as well.
Special thanks to Dr Margot Bell, senior attending in the Division of Adolescent and Young Adult Medicine in the Department of Pediatrics at John H. Stroger Jr Hospital of Cook County, Chicago, Illinois.