All of my patients are smart 2

I did a porch call a bit over a year ago. It’s like a house call except on a porch.

A friend/patient asks me to see a long time friend of his. The friend has multiple chemical sensitivities. We meet, the three of us, on his porch.

My friend has had me as a physician but he has not seen me at work with someone else.

I ask a lot of questions and then launch into an explanation of the immune system and how antibodies work.

My friend states, “He can’t understand that.’

I smile at his friend. “Oh yes he can. And you followed what I said, didn’t you?”

His friend grins back and said, “Yes, I did. Most of it. Or enough.”

All of my patients are smart. One day in clinic I think how blessed I am, that ALL of my patients are smart and fascinating people. Then I think, how could that be? And, how lucky am I?

And then I think: everyone is smart.

They are not all educated in the same way I am. They may not be well read. They may not have my science background or my geeky fiction and poetry and song brain. But they ALL are smart.

Some are brilliant at mechanical things. I have a patient who is an expert in restoring church organs and is working 3000 miles away in New York City. “They are driving me crazy.” he says. “You have to have the approval signed off on over 20 groups, historic preservation, the fire fighters, etc, etc, to remove one board from the church. The organ was covered over by bad repairs over the years. We’re trying to get it back. After this I will put in new organs, but this is my last restoration.”

Veterans, teachers, attorneys, physicians, retired computer engineers, car mechanics, marine engineers, parents, grandparents. They are all smart, men and women.

We finish the porch visit with some options and the friend of my friend says he will think about what I said and try some things.

A few days later my friend calls. “I couldn’t believe he was following your science talk, but he was. He got it. He remembers it and understood it.”

“Of course he did,” I say.

“I am actually impressed,” says my friend. “It was really interesting watching you do that.”

That may be one of my weird skills. To be able to listen to the person thoroughly and then respond in language that they understand and a bit more. An assumption, always, that they can follow a complex and intricate idea.

I do not know if they always follow what I say. But they always respond to the assumption that they are smart and that they can understand and that they are an equal. I am explaining from my expertise, but I know they can understand when I explain it correctly.

And I have not seen this in the physicians that I have seen. Out of 22 physicians since 2012, four were excellent and met me and explained as an equal.

The rest did not. They dismiss me. They talk down or avoid me once they realize that they do not understand why I keep getting pneumonia. They are afraid to say “I don’t know.” Four are not afraid and recognize that it’s something weird and say, “We do not understand this and we don’t know how to fix it.”

Four out of 22 have my respect. And that is a sad number. Medical training needs to change and physicians need time to listen and need to learn how to listen.

Meanwhile, all of my patients are smart. And I am so blessed.

10 thoughts on “All of my patients are smart 2

  1. Mohd Shamshad khan says:

    U form

  2. This is exactly why so many people in places like this mistrust educated people and see them as “other.” I don’t like hearing people disparage people with degrees, but when they talk openly about it to me, I feel it is some kind of compliment because somehow, some time, somewhere I hadn’t acted like an asshole.

    It was an interesting challenge persuading my business communication students that all the “fancy” words they were taught to use by English teachers (and I am one) weren’t the thing in business communication where the goal is to be understood (and to understand). The most difficult thing to teach was that the customer had something to say, was a real person out there in a real world and that kindness was a very good tool for communicating.

    • drkottaway says:

      Bravo! I wish I would get to talk to some of YOUR students when I call a business.

      • It’s a thing I don’t get in our world. I’ve learned a lot about conversation since I retired and moved here. A lot of it has nothing to do at all with the content or the words.

        • drkottaway says:

          Body language, facial expression, tone of voice, all of that. That is why I would get the history from patients myself and enter it as we talked. You learn much more watching and listening than from a filled out form.

          • My doc’s PA is excellent at that and at getting my BP down since I have white coat syndrome. And why? There are bad doctors. I’ve had 2 1/2. One didn’t send me to a specialist when she should have she just yelled at me, “Why aren’t you better?” I took myself to a specialist. He was great. “Hmmm, I don’t totally understand this, but we can shrink those nasal polyps and clear up that sinus infection. I’m sending you to an allergist and to a dermatologist to take care of that pre-cancer on your cheek.” The allergist? Also excellent. After a LONG appointment and a major allergy test, “You don’t have allergies, that leaves one possibility and you have all the symptoms. It’s a thing called Samter’s Triad.” She conferred with the ENT doc and here I am today, mostly asthma free, not bothered by the polyps. I’m saying this because there are some really awesome docs out there who — like you — listen to their patients and attempt to deal with objective reality beyond their day-to-day experience and defer to someone who might know more. Listening. What a wonderful skill that is for anyone.

          • drkottaway says:


  3. One of my pet peeves – people who talk in order to make themselves feel smart or their listener feel dumb…like using jargon because you don’t really know what you’re talking about but want others to think you do.

    • drkottaway says:

      Absolutely. I have a set of fracture books so that I can describe a fracture more exactly to ortho, since I don’t do that terribly often. But it’s important to be able to say it in English too.

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